Veile Amanda, Faria Amy A, Rivera Sydney, Tuller Sydney M, Kramer Karen L
Department of Anthropology, Purdue University, West Lafayette, Indiana, USA.
Department of Consumer Science, Purdue University, West Lafayette, Indiana, USA.
Am J Hum Biol. 2019 Mar;31(2):e23218. doi: 10.1002/ajhb.23218. Epub 2019 Jan 31.
Cesarean delivery is linked to breastfeeding complications and child morbidity. These outcomes may disproportionately affect Latin American indigenous populations that are experiencing rising cesarean delivery rates, but often inhabit environments that exacerbate postnatal morbidity risks. We therefore assess relationships between birth mode, infant feeding practices, and childhood infectious morbidity in a modernizing Yucatec Maya community, where prolonged breastfeeding is the norm. We predicted that under these conditions, cesarean delivery would increase risk of childhood infectious morbidity, but prolonged breastfeeding postcesarean would mitigate morbidity risk.
Using a longitudinal child health dataset (n = 88 children aged 0-60 months, 24% cesarean-delivered, 2290 observations total), we compare gastrointestinal infectious (GI) and respiratory infectious (RI) morbidity rates by birth mode. We model associations between cesarean delivery and breastfeeding duration, formula feeding and child nutritional status, then model GI and RI as a function of birth mode, child age, and feeding practices.
Cesarean delivery was associated with longer breastfeeding durations and higher child weight-for-age, but not with formula feeding, GI, or RI. Adolescent motherhood and RI were risk factors for GI; formula feeding and GI were risk factors for RI. Regional housing materials protected against GI; breastfeeding protected against RI and mitigated the effect of formula feeding.
We find no direct link between birth mode and child infectious morbidity. Yucatec Maya mothers practice prolonged breastfeeding, especially postcesarean, and in conjunction with formula feeding. This practice protects against childhood RI, but not GI, perhaps because GI is more susceptible to maternal and household factors.
剖宫产与母乳喂养并发症及儿童发病率相关。这些结果可能对剖宫产率不断上升的拉丁美洲原住民产生不成比例的影响，而这些人群往往生活在会加剧产后发病风险的环境中。因此，我们在一个不断现代化的尤卡坦玛雅社区评估分娩方式、婴儿喂养方式与儿童感染性疾病发病率之间的关系，在该社区长期母乳喂养是常态。我们预测，在这些情况下，剖宫产会增加儿童感染性疾病的发病风险，但剖宫产后的长期母乳喂养会降低发病风险。
我们使用一个儿童健康纵向数据集（n = 88名0 - 60个月大的儿童，24%为剖宫产，共2290次观察），比较不同分娩方式的胃肠道感染（GI）和呼吸道感染（RI）发病率。我们建立剖宫产与母乳喂养持续时间、配方奶喂养及儿童营养状况之间的关联模型，然后将GI和RI作为分娩方式、儿童年龄及喂养方式的函数进行建模。
剖宫产与更长的母乳喂养持续时间及更高的儿童年龄别体重相关，但与配方奶喂养、GI或RI无关。青少年母亲身份和RI是GI的风险因素；配方奶喂养和GI是RI的风险因素。当地的住房材料可预防GI；母乳喂养可预防RI并减轻配方奶喂养的影响。
我们发现分娩方式与儿童感染性疾病发病率之间没有直接联系。尤卡坦玛雅母亲会进行长期母乳喂养，尤其是剖宫产后，并且会结合配方奶喂养。这种做法可预防儿童RI，但不能预防GI，这可能是因为GI更容易受到母亲和家庭因素的影响。
