Moraes de Oliveira Mariana, Camelo José Simon
Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Faculdade de Medicina de Ribeirao Preto, Departamento de Puericultura e Pediatria, Universidade de São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirao Preto, São Paulo, SP 14048-900 Brazil.
Int Breastfeed J. 2017 Oct 3;12:42. doi: 10.1186/s13006-017-0132-y. eCollection 2017.
Despite evidences indicating the superiority of breastfeeding and recent advances in the indicators of breastfeeding in Brazil, exclusive breastfeeding (EBF) during the first six months after birth continues to be an infrequent practice in the country. The objective of the present study was to determine which gestational, perinatal, and postnatal factors of the mother-baby dyad might be associated with the cessation of EBF by six months after birth.
Data were collected at the rooming-in facility of the Reference Center of Women's Health of Ribeirão Preto-Mater (CRSM-Mater) during the postpartum period (24 to 72 h after birth) from December 2012 to April 2013 and by telephone contact between the researcher and participating mothers by six months after birth. Questionnaires were applied to collect data, such as the practice of EBF in the last 24 h in the sixth month after birth. The hierarchical theoretical model was proposed and data were analyzed statistically by log-binomial regression models using SAS 9.3.
The study involved 283 mother-baby dyads in which the mother evaluated did not present pregnancy-puerperal complications that could impede breastfeeding and confirmed the interest in breastfeeding her child. After the telephone contact in the exact sixth month after the birth of each participating baby, 84.8% of the participating mothers reported that they were no longer exclusively breastfeeding their babies. After statistical analysis, we found that there was a significant association between cessation of EBF and maternal report of previous experience with EBF for one month (0.91, 95% CI 0.81, 0.99) and six months (0.81; 95% CI 0.68, 0.94). These practices were associated with the maintenance of EBF and, even after adjustment for maternal socio-demographic variables, this association was maintained (0.85; 95% CI 0.73, 0.99). Thus, there is a greater chance of practicing and maintaining EBF by six months after birth when mother had previous experience with it.
The identification of the risk variables associated with cessation of EBF by six months postpartum, such as previous experience with exclusive breastfeeding, may contribute to the effectiveness of EBF intervention and support measures during the first six months after birth.
尽管有证据表明母乳喂养具有优越性，且巴西母乳喂养指标近期有所改善，但在该国，出生后前六个月纯母乳喂养（EBF）的情况仍然并不常见。本研究的目的是确定母婴二元组的哪些孕期、围产期和产后因素可能与出生后六个月内停止纯母乳喂养有关。
于2012年12月至2013年4月产后期间（出生后24至72小时），在里贝朗普雷图产妇健康参考中心（CRSM-Mater）的母婴同室设施收集数据，并在出生后六个月通过研究人员与参与研究的母亲进行电话联系。应用问卷收集数据，如出生后第六个月最近24小时内的纯母乳喂养情况。提出了分层理论模型，并使用SAS 9.3通过对数二项回归模型对数据进行统计分析。
该研究涉及283对母婴二元组，其中接受评估的母亲未出现可能妨碍母乳喂养的妊娠-产褥期并发症，并确认有母乳喂养孩子的意愿。在每个参与研究的婴儿出生后正好六个月进行电话联系后，84.8%的参与研究的母亲报告她们不再对婴儿进行纯母乳喂养。经过统计分析，我们发现纯母乳喂养的停止与母亲报告的之前纯母乳喂养一个月（0.91，95%置信区间0.81，0.99）和六个月（0.81；95%置信区间0. .68，0.94）的经历之间存在显著关联。这些做法与纯母乳喂养的维持有关，即使在对母亲的社会人口学变量进行调整后，这种关联仍然存在（0.85；95%置信区间0.73，0.99）。因此，母亲之前有过纯母乳喂养经历时，在出生后六个月进行并维持纯母乳喂养的可能性更大。
识别与产后六个月内停止纯母乳喂养相关的风险变量，如之前的纯母乳喂养经历，可能有助于提高出生后前六个月纯母乳喂养干预和支持措施的有效性。
