Weiser Thomas M, Lin Mei, Garikapaty Venkata, Feyerharm Robert W, Bensyl Diana M, Zhu Bao-Ping
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Pediatrics. 2009 Dec;124(6):1603-10. doi: 10.1542/peds.2008-2711. Epub 2009 Nov 16.
We sought to determine the association of smoking status as a risk factor for reduced initiation and duration of breastfeeding.
The Missouri Pregnancy Related Assessment and Monitoring System collected a stratified sample of new mothers in 2005. Surveys were mailed, with telephone follow-up, and completed within 2 to 12 months after delivery. Respondents were classified as nonsmokers, smokers who quit during pregnancy, light smokers (<or=10 cigarettes per day), or moderate/heavy smokers (>10 cigarettes per day). Multivariable binomial regression and Cox proportional hazards models were used to assess breastfeeding initiation and duration according to smoking status.
Overall, 1789 women participated (weighted response rate: 61%). Approximately 74% of the women ever breastfed; 31% of the women ever smoked while pregnant. Compared with nonsmokers, the moderate/heavy smokers and light smokers were less likely to initiate breastfeeding, after controlling for sociodemographic characteristics, the presence of other smokers in the household, alcohol use, mode of delivery, and infant hospitalization. Compared with nonsmokers, the moderate/heavy smokers, light smokers, and smokers who quit during pregnancy were more likely to wean over time, controlling for the same covariates. There were no significant differences between nonsmokers and smokers regarding reasons for not initiating or ceasing breastfeeding.
Mothers who smoked initiated breastfeeding less often and weaned earlier than nonsmoking mothers. Incorporating knowledge of the association between smoking and breastfeeding into existing smoking-cessation and breastfeeding programs could provide opportunities to reduce perinatal exposure to tobacco smoke, improve interest in breastfeeding, and address other barriers to breastfeeding that smoking mothers may face.
我们试图确定吸烟状况作为母乳喂养开始时间缩短和持续时间缩短的危险因素之间的关联。
密苏里州与妊娠相关的评估和监测系统在2005年收集了新妈妈的分层样本。通过邮寄调查问卷并进行电话随访，在分娩后2至12个月内完成。受访者被分为非吸烟者、孕期戒烟者、轻度吸烟者（每天吸≤10支烟）或中度/重度吸烟者（每天吸>10支烟）。使用多变量二项式回归和Cox比例风险模型根据吸烟状况评估母乳喂养的开始时间和持续时间。
总体而言，1789名女性参与了调查（加权回复率：61%）。约74%的女性曾进行母乳喂养；31%的女性在孕期吸烟。在控制了社会人口统计学特征、家庭中其他吸烟者的存在、饮酒情况、分娩方式和婴儿住院情况后，与非吸烟者相比，中度/重度吸烟者和轻度吸烟者开始母乳喂养的可能性较小。在控制相同协变量的情况下，与非吸烟者相比，中度/重度吸烟者、轻度吸烟者和孕期戒烟者随着时间推移更有可能断奶。在未开始或停止母乳喂养的原因方面，非吸烟者和吸烟者之间没有显著差异。
吸烟的母亲开始母乳喂养的频率低于不吸烟的母亲，且断奶更早。将吸烟与母乳喂养之间关联的知识纳入现有的戒烟和母乳喂养项目中，可能会提供减少围产期烟草烟雾暴露、提高对母乳喂养的兴趣以及解决吸烟母亲可能面临的其他母乳喂养障碍的机会。
