Dewey Kathryn G, Nommsen-Rivers Laurie A, Heinig M Jane, Cohen Roberta J
Department of Nutrition, University of California, Davis 95616-8669, USA.
Pediatrics. 2003 Sep;112(3 Pt 1):607-19. doi: 10.1542/peds.112.3.607.
Some mothers have difficulty initiating lactation even when highly motivated to breastfeed. The purpose of this study was to determine the incidence of and risk factors for suboptimal infant breastfeeding behavior (SIBB), delayed onset of lactation, and excess neonatal weight loss among mother-infant pairs in a population with high educational levels and motivation to breastfeed.
All mothers residing in Davis, California, who gave birth to a healthy, single, term infant at 1 of 5 area hospitals during the 10-month recruitment period in 1999 were invited to participate if they were willing to attempt to breastfeed exclusively for at least 1 month. Lactation guidance was provided and data were collected in the hospital (day 0) and on days 3, 5, 7, and 14. Infant breastfeeding behavior was evaluated by trained lactation consultants using the Infant Breastfeeding Assessment Tool. Onset of lactation was defined based on maternal report of changes in breast fullness. Infant weight loss was considered excessive if it was >or=10% of birth weight by day 3.
Of the 328 eligible mothers, 280 (85%) participated in the study. The prevalence of SIBB was 49% on day 0, 22% on day 3, and 14% on day 7. SIBB was significantly associated with primiparity (days 0 and 3), cesarean section (in multiparas, day 0), flat or inverted nipples, infant status at birth (days 0 and 3), use of nonbreast milk fluids in the first 48 hours (days 3 and 7), pacifier use (day 3), stage II labor >1 hour (day 7), maternal body mass index >27 kg/m(2) (day 7) and birth weight <3600 g (day 7). Delayed onset of lactation (>72 hours) occurred in 22% of women and was associated with primiparity, cesarean section, stage II labor >1 hour, maternal body mass index >27 kg/m(2), flat or inverted nipples, and birth weight >3600 g (in primiparas). Excess weight loss occurred in 12% of infants and was associated with primiparity, long duration of labor, use of labor medications (in multiparas), and infant status at birth. The risk of excess infant weight loss was 7.1 times greater if the mother had delayed onset of lactation, and 2.6 times greater if the infant had SIBB on day 0.
Early lactation success is strongly influenced by parity, but may also be affected by potentially modifiable factors such as delivery mode, duration of labor, labor medications, use of nonbreast milk fluids and/or pacifiers, and maternal overweight. All breastfeeding mother-infant pairs should be evaluated at 72 to 96 hours' postpartum.
即使有强烈的母乳喂养意愿，一些母亲在开始泌乳时仍会遇到困难。本研究旨在确定在受教育程度高且有母乳喂养意愿的母婴群体中，婴儿非最佳母乳喂养行为（SIBB）、泌乳延迟和新生儿体重过度减轻的发生率及风险因素。
邀请了1999年为期10个月的招募期内在加利福尼亚州戴维斯市5家地区医院之一分娩出健康、单胎、足月儿的所有母亲参加研究，前提是她们愿意尝试纯母乳喂养至少1个月。提供了泌乳指导，并在医院（第0天）以及第3、5、7和14天收集数据。由训练有素的泌乳顾问使用婴儿母乳喂养评估工具对婴儿的母乳喂养行为进行评估。根据母亲报告的乳房充盈度变化来定义泌乳开始时间。如果婴儿在第3天时体重减轻≥出生体重的10%，则认为体重减轻过度。
328名符合条件的母亲中，280名（85%）参与了研究。SIBB的发生率在第0天为49%，第3天为22%，第7天为14%。SIBB与初产（第0天和第3天）、剖宫产（经产妇第0天）、乳头扁平或内陷、婴儿出生时状况（第0天和第3天）、出生后48小时内使用非母乳液体（第3天和第7天）、使用安抚奶嘴（第3天）、第二产程>1小时（第7天）、母亲体重指数>27kg/m²（第7天）以及出生体重<3600g（第7天）显著相关。22%的女性出现泌乳延迟（>72小时），这与初产、剖宫产、第二产程>1小时、母亲体重指数>27kg/m²、乳头扁平或内陷以及出生体重>3600g（初产妇）有关。12%的婴儿出现体重过度减轻，这与初产、产程长、使用产程用药（经产妇）以及婴儿出生时状况有关。如果母亲泌乳延迟，婴儿体重过度减轻的风险会增加7.1倍；如果婴儿在第0天出现SIBB，风险会增加2.6倍。
早期泌乳成功受产次影响较大，但也可能受到一些潜在可改变因素的影响，如分娩方式、产程、产程用药、非母乳液体和/或安抚奶嘴的使用以及母亲超重。所有母乳喂养的母婴对在产后72至96小时都应接受评估。
