Zhu Yeyi, Hernandez Ladia M, Mueller Peter, Dong Yongquan, Hirschfeld Steven, Forman Michele R
Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, 78703, USA.
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
Matern Child Health J. 2016 Feb;20(2):398-407. doi: 10.1007/s10995-015-1838-3.
Maternal lactation performance varies across populations, yet the relative impact of maternal sociodemographics, perinatal factors, and birth outcomes on disparities in exclusive breastfeeding (XBR) outcomes is not well known. We aimed to develop predictive models and compare the relative contribution of predictors for XBR initiation and XBR ≥ 6 months.
Infant feeding data were obtained from women with children aged 0-6 years (n = 1471) in a multi-ethnic cross-sectional study in the US (2011-2012). We compared discriminant ability of predictors for ever XBR and XBR ≥ 6 months using discriminant function analysis, respectively. We also calculated adjusted ORs for factors associated with XBR outcomes and breast-bottle feeding (BrBot) subgroups.
Maternal sociodemographics (education level, marital status, nativity, and age at childbirth) had greater discriminating abilities in predicting ever XBR and XBR ≥ 6 months than birth outcomes and perinatal factors. Foreign-born women were two-fold more likely to initiate XBR but not necessarily continue to 6 months compared to their US-born counterparts. Factors associated with BrBot subgroups differed from those associated with XBR outcomes, whereas maternal age was the only predictor consistently associated with ever XBR, XBR ≥ 6 months, and BrBot subgroups. The areas under the receiver operating characteristic curves for models predicting ever XBR and XBR ≥ 6 months were 0.88 (95 % CI 0.85, 0.91) and 0.90 (95 % CI 0.88, 0.93), respectively.
Findings underscore the importance of educational, clinical, and social support to promote XBR in mothers with sociodemographic factors predictive of none or poor XBR outcomes.
不同人群的产妇泌乳表现存在差异，但产妇社会人口统计学因素、围产期因素和分娩结局对纯母乳喂养（XBR）结局差异的相对影响尚不清楚。我们旨在建立预测模型，并比较预测因素对XBR起始和XBR≥6个月的相对贡献。
在美国一项多民族横断面研究（2011 - 2012年）中，获取了有0 - 6岁子女的女性（n = 1471）的婴儿喂养数据。我们分别使用判别函数分析比较了预测因素对曾经进行过XBR和XBR≥6个月的判别能力。我们还计算了与XBR结局和奶瓶喂养（BrBot）亚组相关因素的调整后比值比。
产妇社会人口统计学因素（教育水平、婚姻状况、出生地和分娩年龄）在预测曾经进行过XBR和XBR≥6个月方面，比分娩结局和围产期因素具有更强的判别能力。与美国出生的女性相比，外国出生的女性开始进行XBR的可能性高出两倍，但不一定能持续到6个月。与BrBot亚组相关的因素与与XBR结局相关的因素不同，而产妇年龄是唯一一个始终与曾经进行过XBR、XBR≥6个月以及BrBot亚组相关的预测因素。预测曾经进行过XBR和XBR≥6个月的模型的受试者工作特征曲线下面积分别为0.88（95%可信区间0.85, 0.91）和0.90（95%可信区间0.88, 0.93）。
研究结果强调了教育、临床和社会支持对于在具有预测无XBR或XBR结局不佳的社会人口统计学因素的母亲中促进XBR的重要性。
