Tan Daryl Jian An, Lew John Paul, Jumhasan Maria Binte, Pang Cynthia, Sultana Rehena, Sng Ban Leong
1Duke-NUS Medical School, Singapore, Singapore.
2Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore.
Int Breastfeed J. 2018 Sep 5;13:42. doi: 10.1186/s13006-018-0184-7. eCollection 2018.
We investigated the possible risk factors that could influence the likelihood of breastfeeding at 5 to 9 weeks postpartum with our primary aim being to analyse the associations between psychological vulnerabilities, such as peripartum depression and anxiety, and continued breastfeeding. Our secondary aim was to investigate other non-psychological factors' influence on continued breastfeeding.
A prospective cohort study was conducted in KK Women's and Children's Hospital in Singapore. Healthy nulliparous parturients at ≥36 weeks gestation with a singleton fetus who received epidural analgesia were recruited. Demographic and anaesthetic data were obtained. Self-reported psychological and pain determinants such as anxiety (State-Trait Anxiety Inventory), depression (Edinburgh Postnatal Depression Scale), stress (Perceived Stress Scale), pain susceptibility (Pain Catastrophizing Scale) and pain perception (McGill Pain Questionnaire) were also recorded at baseline. A phone interview was then performed at 5 to 9 weeks postpartum to obtain information on breastfeeding status.
329 participants were included into this study, of which 263 (79.9%) of them were still breastfeeding at 5 weeks postpartum. Multivariate logistic regression analysis showed that a higher State-Trait Anxiety Inventory score (Adjusted Odds Ratio [AOR] 0.97; 95% Confidence Interval [CI] 0.94, 1.00) at baseline, higher intrapartum blood loss (AOR 0.76; 95% CI 0.61, 0.93), and occurrence of fetal anomalies (AOR 0.15; 95% CI 0.03, 0.72) were associated with reduced likelihood of breastfeeding at 5 to 9 weeks postpartum. Indians (AOR 0.56; 95% CI 0.20, 1.53), Malays (AOR 0.30; 95% CI 0.14, 0.62) and other ethnicities (AOR 0.36; 95% CI 0.16, 0.83) were less likely to continue breastfeeding compared to Chinese participants. On the other hand, receiving any support services on breastfeeding during the participants' hospital stay was 3.3 times more likely (AOR 3.30; 95% CI 1.21, 9.02) to increase the likelihood of breastfeeding at 5 to 9 weeks postpartum.
We identified 5 independent association factors that could have significant influences on breastfeeding at 5 to 9 weeks postpartum. Healthcare providers could utilize this risk stratification to identify parturients likely to have poorer breastfeeding outcomes and undertake interventions that may help safeguard optimization of breastfeeding outcomes and parturient care.
Clinicaltrials.gov NCT02278601. Registered 26 October 2014.
我们调查了可能影响产后5至9周母乳喂养可能性的潜在风险因素，主要目的是分析心理脆弱性（如围产期抑郁和焦虑）与持续母乳喂养之间的关联。次要目的是研究其他非心理因素对持续母乳喂养的影响。
在新加坡KK妇女儿童医院进行了一项前瞻性队列研究。招募了妊娠≥36周、单胎且接受硬膜外镇痛的健康未生育产妇。获取了人口统计学和麻醉数据。在基线时还记录了自我报告的心理和疼痛决定因素，如焦虑（状态-特质焦虑量表）、抑郁（爱丁堡产后抑郁量表）、压力（感知压力量表）、疼痛易感性（疼痛灾难化量表）和疼痛感知（麦吉尔疼痛问卷）。然后在产后5至9周进行电话访谈，以获取母乳喂养状况的信息。
329名参与者纳入本研究，其中263名（79.9%）在产后5周仍在进行母乳喂养。多因素逻辑回归分析显示，基线时较高的状态-特质焦虑量表评分（调整优势比[AOR]0.97；95%置信区间[CI]0.94，1.00）、较高的产时失血（AOR 0.76；95%CI 0.61，0.93）以及胎儿异常的发生（AOR 0.15；95%CI 0.03，0.72）与产后5至9周母乳喂养可能性降低相关。与中国参与者相比，印度人（AOR 0.56；95%CI 0.20，1.53）、马来人（AOR 0.30；95%CI 0.14，0.62）和其他种族（AOR 0.36；95%CI 0.16，0.83）继续母乳喂养的可能性较小。另一方面，参与者住院期间接受任何母乳喂养支持服务，产后5至9周母乳喂养的可能性增加3.3倍（AOR 3.30；95%CI 1.21，9.02）。
我们确定了5个独立的关联因素，它们可能对产后5至9周的母乳喂养有重大影响。医疗保健提供者可以利用这种风险分层来识别可能母乳喂养结果较差的产妇，并采取有助于保障母乳喂养结果优化和产妇护理的干预措施。
Clinicaltrials.gov NCT02278601。于2014年10月26日注册。
