Gomes Marina, Trocado Vera, Carlos-Alves Mariana, Arteiro Diana, Pinheiro Paula
a Department of Obstetrics and Gynecology , Local Unit of Health in Alto Minho , Viana do Castelo , Portugal.
b School of Health Sciences , University of Minho, Life and Health Sciences Research Institute , Braga , Portugal.
J Obstet Gynaecol. 2018 Aug;38(6):745-749. doi: 10.1080/01443615.2017.1405924. Epub 2018 Mar 9.
Non-pulsatile oxytocin given during labour can negatively affect breastfeeding. The aim of this study was to assess whether intrapartum oxytocin administration has any effect on breastfeeding. Secondly, to assess whether some maternal or neonatal variables influence breastfeeding. A retrospective cohort study was done, comparing two groups: women exposed (n = 101) and not exposed to oxytocin (n = 100) during labour. Women with caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation, premature neonates and with an Apgar score <7 at 5 minutes were excluded. Duration of breastfeeding was evaluated by a phone call interview. A regression analysis was done, evaluating possible confounding factors. The use of oxytocin during labour was demonstrated to be a predictor of impaired first hour breastfeeding (OR =2.493, CI: 1.05-5.92; p = .038). At three months' postpartum, 26.7% women in the exposed group versus 14% in the non-exposed group were not breastfeeding (p = .035). This result was not statistically significant when adjusting for possible confounders. High pregestational body mass index was the best predictor of an impaired third month's postpartum breastfeeding (OR =0.901, CI: 0.835-0.972; p = .007). Intrapartum oxytocin administration could inhibit first hour breastfeeding. A novel association was detected, pregestational body mass index was a predictor of impaired breastfeeding at three months, possibly confounding the oxytocin effect. Additional prospective studies are needed to investigate potential associations between intrapartum oxytocin and breastfeeding. Impact statement What is already known on this subject? Oxytocin is a common medical intervention during labour. Some studies suggest a negative association between intrapartum oxytocin dose, newborn sucking and an increased risk of early breastfeeding discontinuation. However, some maternal variables were not considered in these studies and the impact synthetic oxytocin may have on breastfeeding has not been thoroughly researched. What do the results of this study add? In this study, intrapartum oxytocin administration seems to inhibit the first hour breastfeeding. However, a novel association was detected, high pregestational body mass index was a predictor of impaired breastfeeding at three months, possibly confounding oxytocin effects. What are the implications of these findings for clinical practice and/or further research? Additional prospective studies are needed to investigate potential associations between intrapartum oxytocin and breastfeeding. Therefore, health care professionals should help obese women, starting from conception, to maximise breastfeeding outcomes as much as possible.
分娩期间使用的非脉冲式缩宫素可能会对母乳喂养产生负面影响。本研究的目的是评估产时使用缩宫素是否会对母乳喂养产生任何影响。其次，评估一些母亲或新生儿变量是否会影响母乳喂养。我们进行了一项回顾性队列研究，比较了两组：分娩期间使用缩宫素的女性（n = 101）和未使用缩宫素的女性（n = 100）。剖宫产、真空吸引/产钳助产、双胎妊娠、臀位、早产儿以及5分钟时阿氏评分<7分的女性被排除在外。通过电话访谈评估母乳喂养的持续时间。进行了回归分析，评估可能的混杂因素。结果表明，产时使用缩宫素是产后第一小时母乳喂养受损的一个预测因素（OR = 2.493，CI：1.05 - 5.92；p = 0.038）。产后三个月时，使用缩宫素组26.7%的女性停止母乳喂养，而未使用缩宫素组为14%（p = 0.035）。在对可能的混杂因素进行校正后，这一结果无统计学意义。孕前体重指数高是产后第三个月母乳喂养受损的最佳预测因素（OR = 0.901，CI：0.835 - 0.972；p = 0.007）。产时使用缩宫素可能会抑制产后第一小时的母乳喂养。我们发现了一种新的关联，孕前体重指数是三个月时母乳喂养受损的一个预测因素，可能会混淆缩宫素的作用。需要进一步的前瞻性研究来调查产时缩宫素与母乳喂养之间的潜在关联。影响声明关于这个主题已经知道了什么？缩宫素是分娩期间常见的医疗干预措施。一些研究表明，产时缩宫素剂量、新生儿吸吮与早期停止母乳喂养风险增加之间存在负相关。然而，这些研究未考虑一些母亲变量，合成缩宫素对母乳喂养的影响尚未得到充分研究。这项研究的结果增加了什么？在本研究中，产时使用缩宫素似乎会抑制产后第一小时的母乳喂养。然而，我们发现了一种新的关联，孕前体重指数高是三个月时母乳喂养受损的一个预测因素，可能会混淆缩宫素的作用。这些发现对临床实践和/或进一步研究有什么意义？需要进一步的前瞻性研究来调查产时缩宫素与母乳喂养之间的潜在关联。因此，医护人员应从受孕开始就帮助肥胖女性尽可能最大化母乳喂养的效果。
