1 Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital , Nationwide Children's Hospital, Columbus, Ohio.
2 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital , Nationwide Children's Hospital, Columbus, Ohio.
Breastfeed Med. 2017 Jul/Aug;12(6):338-344. doi: 10.1089/bfm.2017.0019. Epub 2017 Jun 20.
Little is known about how in-hospital supplementation with water, infant formula, or sugar water affects the relationship between breastfeeding intentions and duration, and whether this differs by gestational diabetes mellitus (GDM) history. Our study objectives were to assess the associations between GDM and exclusive breastfeeding intentions, hospital supplementation, and breastfeeding duration, including whether hospital supplementation mediates the association between exclusive breastfeeding intentions and breastfeeding duration.
Using data from the Infant Feeding Practices Study II (2005-2007), we included women with GDM (n = 160) and women without GDM or prepregnancy diabetes (no diabetes mellitus [NDM]) (n = 2,139). We used multivariable logistic and linear regressions to determine the associations between GDM history and exclusive breastfeeding intentions, and between breastfeeding intentions, hospital supplementation, and breastfeeding duration, by GDM. We used mediation analysis to assess whether hospital supplementation mediated the association between exclusive breastfeeding intention and breastfeeding duration, also by GDM. All analyses were adjusted for prepregnancy body mass index.
GDM was associated with lower odds of intending to exclusively breastfeed (adjusted odds ratio [AOR] 0.71; 95% confidence interval [CI, 0.51-0.99]). GDM and NDM women who did not intend to exclusively breastfeed had similarly increased odds of hospital supplementation (GDM: AOR 3.52; 95% CI [1.44-8.57], NDM: AOR 3.66; 95% CI [2.93-4.56]). Breastfeeding duration was similar by exclusive breastfeeding intentions and by hospital supplementation, regardless of GDM. Hospital supplementation partially mediated the association between breastfeeding intentions and duration in NDM women, but it did not mediate the association in women with GDM.
Breastfeeding intentions, rather than hospital supplementation, are particularly important for women with GDM to optimize breastfeeding outcomes.
对于住院期间补充水分、婴儿配方奶或糖水如何影响母乳喂养意愿和持续时间的关系，以及这种关系是否因妊娠糖尿病（GDM）病史而异，我们知之甚少。我们的研究目的是评估 GDM 与纯母乳喂养意愿、医院补充喂养以及母乳喂养持续时间之间的关联，包括医院补充喂养是否在纯母乳喂养意愿和母乳喂养持续时间之间起中介作用。
使用来自婴儿喂养实践研究 II（2005-2007 年）的数据，我们纳入了患有 GDM（n=160）和没有 GDM 或孕前糖尿病（无糖尿病）（n=2139）的女性。我们使用多变量逻辑回归和线性回归来确定 GDM 史与纯母乳喂养意愿之间的关联，以及母乳喂养意愿、医院补充喂养和母乳喂养持续时间之间的关联，按 GDM 进行分层。我们使用中介分析来评估医院补充喂养是否在纯母乳喂养意愿和母乳喂养持续时间之间起中介作用，也按 GDM 进行分层。所有分析均按孕前体重指数进行调整。
GDM 与纯母乳喂养意愿较低相关（调整后的优势比 [AOR] 0.71；95%置信区间 [CI]，0.51-0.99）。不打算纯母乳喂养的 GDM 和 NDM 女性，接受医院补充喂养的可能性相似增加（GDM：AOR 3.52；95%CI [1.44-8.57]，NDM：AOR 3.66；95%CI [2.93-4.56]）。无论 GDM 与否，纯母乳喂养意愿和医院补充喂养对母乳喂养持续时间的影响相似。在 NDM 女性中，医院补充喂养部分中介了母乳喂养意愿和持续时间之间的关联，但在 GDM 女性中没有中介作用。
对于 GDM 女性来说，母乳喂养意愿而非医院补充喂养对于优化母乳喂养结局尤为重要。
