England Lucinda, Brenner Ruth, Bhaskar Brinda, Simons-Morton Bruce, Das Abhik, Revenis Mary, Mehta Nitin, Clemens John
Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, Department of Health and Human Services, Bethesda, MD 20895, USA.
BMC Public Health. 2003 Aug 20;3:28. doi: 10.1186/1471-2458-3-28.
Little is known about the role of breastfeeding contraindications in breastfeeding practices. Our objectives were to 1) identify predictors of breastfeeding initiation and duration among a cohort of predominantly low-income, inner-city women, and 2) evaluate the contribution of breastfeeding contraindications to breastfeeding practices.
Mother-infant dyads were systematically selected from 3 District of Columbia hospitals between 1995 and 1996. Breastfeeding contraindications and potential predictors of breastfeeding practices were identified through medical record reviews and interviews conducted after delivery (baseline). Interviews were conducted at 3-7 months postpartum and again at 7-12 months postpartum to determine breastfeeding initiation rates and duration. Multivariable logistic regression analysis was used to identify baseline factors associated with initiation of breastfeeding. Cox proportional hazards models were generated to identify baseline factors associated with duration of breastfeeding.
Of 393 study participants, 201 (51%) initiated breastfeeding. A total of 61 women (16%) had at lease one documented contraindication to breastfeeding; 94% of these had a history of HIV infection and/or cocaine use. Of the 332 women with no documented contraindications, 58% initiated breastfeeding, vs. 13% of women with a contraindication. In adjusted analysis, factors most strongly associated with breastfeeding initiation were presence of a contraindication (adjusted odds ratio [AOR], 0.19; 95% confidence interval [CI], 0.08-0.47), and mother foreign-born (AOR, 4.90; 95% CI, 2.38-10.10). Twenty-five percent of study participants who did not initiate breastfeeding cited concern about passing dangerous things to their infants through breast milk. Factors associated with discontinuation of breastfeeding (all protective) included mother foreign-born (hazard ratio [HR], 0.55; 95% CI 0.39-0.77) increasing maternal age (HR for 5-year increments, 0.80; 95% CI, 0.69-0.92), and infant birth weight > or = 2500 grams (HR, 0.45; 95% CI, 0.26-0.80).
Breastfeeding initiation rates and duration were suboptimal in this inner-city population. Many women who did not breastfeed had contraindications and/or were concerned about passing dangerous things to their infants through breast milk. It is important to consider the prevalence of contraindications to breastfeeding when evaluating breastfeeding practices in high-risk communities.
关于母乳喂养禁忌在母乳喂养实践中的作用，人们了解甚少。我们的目标是：1）在一群主要为低收入的市中心女性中确定母乳喂养开始和持续时间的预测因素；2）评估母乳喂养禁忌对母乳喂养实践的影响。
1995年至1996年间，从哥伦比亚特区的3家医院系统选取母婴对。通过病历审查和产后（基线）访谈确定母乳喂养禁忌和母乳喂养实践的潜在预测因素。在产后3至7个月以及产后7至12个月进行访谈，以确定母乳喂养开始率和持续时间。采用多变量逻辑回归分析确定与母乳喂养开始相关的基线因素。生成Cox比例风险模型以确定与母乳喂养持续时间相关的基线因素。
在393名研究参与者中，201人（51%）开始母乳喂养。共有61名女性（16%）至少有一项记录在案的母乳喂养禁忌；其中94%有艾滋病毒感染史和/或使用过可卡因。在332名无记录在案禁忌的女性中，58%开始母乳喂养，而有禁忌的女性中这一比例为13%。在调整分析中，与母乳喂养开始最密切相关的因素是存在禁忌（调整后的优势比[AOR]，0.19；95%置信区间[CI]，0.08 - 0.47）以及母亲为外国出生（AOR，4.90；95% CI，2.38 - 10.10）。25%未开始母乳喂养的研究参与者表示担心通过母乳将危险物质传给婴儿。与停止母乳喂养相关的因素（均具有保护作用）包括母亲为外国出生（风险比[HR]，0.55；95% CI 0.39 - 0.77）、母亲年龄增加（每增加5岁的HR，0.80；95% CI，0.69 - 0.92）以及婴儿出生体重≥2500克（HR，0.45；95% CI，0.26 - 0.80）。
在这个市中心人群中，母乳喂养开始率和持续时间不理想。许多未进行母乳喂养的女性有禁忌和/或担心通过母乳将危险物质传给婴儿。在评估高危社区的母乳喂养实践时，考虑母乳喂养禁忌的患病率很重要。
