Department of Pediatrics, University of California Davis, Sacramento, California, USA.
Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Matern Child Nutr. 2019 Jul;15(3):e12783. doi: 10.1111/mcn.12783. Epub 2019 Feb 27.
Overweight and obese mothers in the United States have disproportionately lower rates of exclusive breastfeeding than mothers of normal weight. The Ten Steps to Successful Breastfeeding (Ten Steps), a series of evidence-based practices designed to support breastfeeding initiation, duration, and exclusivity, demonstrate effectiveness at the population level. It is unknown, however, whether they are consistently provided to women across all maternal body mass index (BMI) categories. We sought to determine whether pre-pregnancy BMI is associated with the implementation and effectiveness of the Ten Steps. We used data from Listening to Mothers III, a cross-sectional survey administered to a sample of mothers who delivered in U.S. hospitals between July 2011 and June 2012. Measures of the Ten Steps were based on maternal self-report on Listening to Mothers III. Our analytic sample was limited to mothers of term infants intending to breastfeed (N = 1,506, weighted). We conducted chi-square testing and constructed weighted multivariable logistic regression models to account for potential confounders. Results suggest that two practices (i.e., holding their babies skin-to-skin for the first time and being encouraged to breastfeed on demand) were more strongly associated with exclusive breastfeeding among mothers with obesity than other mothers. Additionally, mothers with obesity reported holding babies skin-to-skin significantly less often than other mothers. Thus, interventions aimed at helping mothers with obesity to hold their babies skin-to-skin in the first hour and teaching them to breastfeed on demand have the potential to decrease the breastfeeding disparities in this population.
美国超重和肥胖的母亲与体重正常的母亲相比，纯母乳喂养的比例不成比例地低。“成功母乳喂养的 10 个步骤”（10 个步骤）是一系列基于证据的实践，旨在支持母乳喂养的开始、持续和排他性，在人群水平上证明了其有效性。然而，尚不清楚这些步骤是否在所有产妇体重指数（BMI）类别中都能一致地提供给妇女。我们试图确定孕前 BMI 是否与 10 个步骤的实施和有效性有关。我们使用了来自“倾听母亲 III”的横截面调查数据，该调查是对 2011 年 7 月至 2012 年 6 月期间在美国医院分娩的母亲样本进行的。10 个步骤的测量方法基于母亲在“倾听母亲 III”上的自我报告。我们的分析样本仅限于打算母乳喂养的足月婴儿的母亲（n=1506，加权）。我们进行了卡方检验，并构建了加权多变量逻辑回归模型来解释潜在的混杂因素。结果表明，在肥胖母亲中，有两个实践（即首次让婴儿与皮肤接触和按需鼓励母乳喂养）与纯母乳喂养的关系更为密切，而其他母亲则不然。此外，肥胖母亲报告的与婴儿皮肤接触的频率明显低于其他母亲。因此，旨在帮助肥胖母亲在头一个小时让婴儿与皮肤接触并教导她们按需母乳喂养的干预措施有可能减少这一人群中的母乳喂养差异。
