Forster Della A, McLachlan Helen L, Lumley Judith
Mother and Child Health Research, La Trobe University, 251 Faraday St, Carlton 3053, Australia.
Int Breastfeed J. 2006 Oct 12;1:18. doi: 10.1186/1746-4358-1-18.
Despite high levels of breastfeeding initiation in Australia, only 47 percent of women are breastfeeding (exclusively or partially) six months later, with marked differences between social groups. It is important to identify women who are at increased risk of early cessation of breastfeeding.
Data from the three arms of a randomised controlled trial were pooled and analysed as a cohort using logistic regression to identify which factors predicted women continuing to feed any breast milk at six months postpartum. The original trial included 981 primiparous women attending a public, tertiary, women's hospital in Melbourne, Australia in 1999-2001. The trial evaluated the effect of two mid-pregnancy educational interventions on breastfeeding initiation and duration. In the 889 women with six month outcomes available, neither intervention increased breastfeeding initiation nor duration compared to standard care. Independent variables were included in the predictive model based on the literature and discussion with peers and were each tested individually against the dependent variable (any breastfeeding at six months).
Thirty-three independent variables of interest were identified, of which 25 qualified for inclusion in the preliminary regression model; 764 observations had complete data available. Factors remaining in the final model that were positively associated with breastfeeding any breast milk at six months were: a very strong desire to breastfeed; having been breastfed oneself as a baby; being born in an Asian country; and older maternal age. There was an increasing association with increasing age. Factors negatively associated with feeding any breast milk at six months were: a woman having no intention to breastfeed six months or more; smoking 20 or more cigarettes per day pre-pregnancy; not attending childbirth education; maternal obesity; having self-reported depression in the six months after birth; and the baby receiving infant formula while in hospital.
In addition to the factors commonly reported as being associated with breastfeeding in previous work, this study found a negative association between breastfeeding outcomes and giving babies infant formula in hospital, a high maternal body mass index, and self-reported maternal depression or anxiety in the six months after the baby was born. Interventions that seek to increase breastfeeding should consider focusing on women who wish to breastfeed but are at high risk of early discontinuation.
尽管澳大利亚母乳喂养的起始率很高，但六个月后只有47%的女性仍在进行母乳喂养（完全或部分母乳喂养），不同社会群体之间存在显著差异。识别出母乳喂养过早停止风险增加的女性很重要。
汇总一项随机对照试验三个组的数据，并作为队列进行分析，使用逻辑回归来确定哪些因素可预测女性在产后六个月仍继续母乳喂养任何母乳。最初的试验纳入了1999年至2001年在澳大利亚墨尔本一家公立三级妇产医院就诊的981名初产妇。该试验评估了两种孕中期教育干预措施对母乳喂养起始率和持续时间的影响。在有六个月结果数据的889名女性中，与标准护理相比，两种干预措施均未提高母乳喂养的起始率或持续时间。基于文献以及与同行的讨论，将自变量纳入预测模型，并分别针对因变量（六个月时进行任何母乳喂养）进行单独测试。
确定了33个感兴趣的自变量，其中25个符合纳入初步回归模型的条件；764条观察数据有完整可用信息。最终模型中与六个月时母乳喂养任何母乳呈正相关的因素有：非常强烈的母乳喂养意愿；自己婴儿时期接受过母乳喂养；出生在亚洲国家；以及产妇年龄较大。随着年龄增长，相关性增强。与六个月时进行任何母乳喂养呈负相关的因素有：女性六个月或更长时间内无意进行母乳喂养；孕前每天吸烟20支或更多；未参加分娩教育；产妇肥胖；产后六个月内自我报告有抑郁症；以及婴儿住院期间接受婴儿配方奶粉喂养。
除了先前研究中普遍报道的与母乳喂养相关的因素外，本研究发现母乳喂养结果与婴儿住院期间接受婴儿配方奶粉喂养、产妇高体重指数以及产后六个月内自我报告的产妇抑郁或焦虑之间存在负相关。旨在增加母乳喂养的干预措施应考虑关注那些希望进行母乳喂养但过早停止风险较高的女性。
