Kozhimannil Katy B, Jou Judy, Attanasio Laura B, Joarnt Lauren K, McGovern Patricia
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America.
Harvard University, Cambridge, Massachusetts, United States of America.
PLoS One. 2014 Aug 13;9(8):e104820. doi: 10.1371/journal.pone.0104820. eCollection 2014.
Breastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor-related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices.
We performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status.
More than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52-0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with >30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47-0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81-8.94; and AOR = 2.68; 95% CI, 1.70-4.23, respectively).
Improving clinical and hospital support for women with complex pregnancies may increase breastfeeding rates and the benefits of breastfeeding for women and infants.
母乳喂养对女性和婴儿有益，且医学上的禁忌情况很少见。产前及与分娩相关的并发症可能会妨碍母乳喂养，但医院的支持性措施可能会鼓励有母乳喂养意愿的女性。我们测量了患有复杂妊娠（妊娠合并高血压、糖尿病或肥胖）与早期婴儿喂养之间的关系，并考虑了母乳喂养意愿和医院的支持性措施。
我们对2011 - 2012年在美国一家医院分娩的女性进行的全国代表性调查数据进行了回顾性分析（N = 2400）。我们使用逻辑回归来研究妊娠复杂性与母乳喂养之间的关系。自我报告的孕前糖尿病或高血压、妊娠期糖尿病或肥胖表明为复杂妊娠。结局指标是产后1周的喂养状况；在有母乳喂养意愿的女性中评估任何形式的母乳喂养情况（N = 1990），在打算纯母乳喂养的女性中评估纯母乳喂养情况（N = 1418）。我们还测试了母乳喂养意愿或医院的支持性措施是否介导了妊娠复杂性与婴儿喂养状况之间的关系。
超过33%的女性患有复杂妊娠；这些女性打算母乳喂养的几率降低了30%（调整后比值比[AOR] = 0.71；95%置信区间[CI]，0.52 - 0.98）。有和没有复杂妊娠的女性纯母乳喂养意愿率相似。有母乳喂养意愿的女性，无论妊娠复杂性如何，产后1周任何形式母乳喂养的比例相似，但对于打算纯母乳喂养的女性，妊娠复杂性与产后1周纯母乳喂养几率降低超过30%相关（AOR = 0.68；95% CI，0.47 - 0.98）。医院的支持性措施与产后1周任何形式或纯母乳喂养几率较高密切相关（分别为AOR = 4.03；95% CI，1.81 - 8.94；以及AOR = 2.68；95% CI，1.70 - 4.23）。
改善对患有复杂妊娠女性的临床和医院支持可能会提高母乳喂养率，并增加母乳喂养对女性和婴儿的益处。
