Institute of Human Nutrition and Department of Epidemiology, Columbia University, New York, NY, USA.
J Nutr. 2013 Jul;143(7):1168-75. doi: 10.3945/jn.112.171751. Epub 2013 May 22.
Maternal weight loss during exclusive breastfeeding may influence the growth of exclusively breast-fed infants through impaired quality or quantity of breast milk. This study evaluated how maternal weight loss from 2 to 24 wk postpartum was related to infant weight and length gain in 1309 lactating HIV-infected mothers and their exclusively breast-fed infants. Malawian mother-infant pairs in the Breastfeeding, Antiretrovirals, and Nutrition Study were randomized with a 2 × 3 factorial design to a 2-arm nutritional intervention with a lipid-based nutrient supplement (LNS), meeting nutritional needs of lactation, or no LNS and a 3-arm antiretroviral (ARV) intervention (maternal, infant, or no ARV regimen). Linear regression models were used to relate maternal weight loss (weight loss vs. no weight loss) to infant weight and length gain from birth to 24 mo, stratifying by gender and controlling for maternal BMI at 2 wk (mean ± SD: 23.2 ± 3.0 kg/m(2)) and interacting maternal BMI with weight loss. In adjusted models, compared with daughters of women who did not lose weight, length and weight gain were lower in daughters whose mothers had a lower BMI at 2 wk postpartum coupled with the weight loss. For example, among mothers with an initial BMI of 18 kg/m(2), daughters of those who lost weight gained less weight [β = -0.29 kg (95% CI: -0.53, -0.06)] and length [β = -0.88 cm (95% CI: -1.52, -0.23)] from birth to 24 wk than daughters of those who gained weight. Though effects were only observed in girls, suggesting possible gender differences in suckling and feeding behavior, these findings indicate that maternal weight loss with low energy reserves represents a risk factor for poor infant growth outcomes.
哺乳期妇女体重下降可能会通过降低母乳质量或数量影响纯母乳喂养婴儿的生长。本研究评估了产后 2 至 24 周期间，HIV 感染产妇体重下降与 1309 名纯母乳喂养婴儿的体重和身长增长的关系。在母乳喂养、抗逆转录病毒和营养研究中，马拉维母婴对按照 2×3 析因设计随机分配到 2 种营养干预组：含脂类营养素补充剂（LNS）的组，满足哺乳期营养需求；或不含 LNS 的组；以及 3 种抗逆转录病毒（ARV）干预组（母亲、婴儿、或不接受 ARV 治疗）。采用线性回归模型，按性别分层，并控制母亲产后 2 周 BMI（平均值±标准差：23.2±3.0kg/m(2)）和母亲 BMI 与体重下降的相互作用，将体重下降（体重下降与体重未下降）与婴儿出生至 24 个月的体重和身长增长相关联。在调整后的模型中，与产后 2 周时体重未下降的母亲的女儿相比，体重下降且产后 2 周时 BMI 较低的母亲的女儿的身长和体重增长较低。例如，在初始 BMI 为 18kg/m(2)的母亲中，体重下降的母亲的女儿体重增长较少[β=-0.29kg（95%CI：-0.53，-0.06）]，身长增长也较少[β=-0.88cm（95%CI：-1.52，-0.23）]，从出生到 24 周时。虽然仅在女孩中观察到这些效果，提示哺乳和喂养行为可能存在性别差异，但这些发现表明，低能量储备导致的母亲体重下降是婴儿生长不良的一个风险因素。
