Department of Public Health, Akita University Graduate School of Medicine, Akita, Japan.
Department of Obstetrics and Gynecology, Japanese Red Cross Medical Center, Tokyo, Japan.
Nutrition. 2019 Jun;62:93-99. doi: 10.1016/j.nut.2018.11.003. Epub 2018 Nov 22.
Breastfeeding rates in many countries fall short of the World Health Organization's recommendations. It has been reported that exclusive breastfeeding (EBF) is negatively associated with obesity; however, the association varies with ethnicity, and little information is available from Asia. We explored whether prepregnancy body mass index (BMI) and gestational weight gain (GWG) were associated with initiation of EBF.
We investigated 6125 Japanese women with full-term (37-42 wk of gestation) singleton babies between January 2010 and June 2013, in a hospital with the largest annual number of deliveries in Tokyo, Japan.
Successful EBF initiation was observed in 72% of women 1 mo after delivery. The average GWG was 10 kg in underweight (BMI < 18.5 kg/m) and normal weight (BMI 18.5-24.9 kg/m) women; 7 kg in overweight (BMI 25-29.9 kg/m) women, and 4 kg in obese (BMI ≥ 30 kg/m) women. After adjusting for covariates, stepwise modeling revealed that compared with women of normal weight, obesity (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.16-0.53), and a single-unit increase in the GWG (OR, 0.98; 95% CI, 0.96-1.00) were significantly associated with unsuccessful EBF initiation. No statistical interaction was evident between prepregnancy BMI and GWG. Other significant risk factors for unsuccessful EBF initiation included older maternal age (P < 0.001), nulliparity (P < 0.001), cesarean delivery (P < 0.001), an earlier gestational week (P < 0.001), a light-for-date infant (P < 0.05), and mother-child separation for clinical reasons (P < 0.001).
This study suggested that prepregnancy obesity is a risk factor for EBF initiation among Japanese women.
许多国家的母乳喂养率均未达到世界卫生组织的建议标准。有报道称，纯母乳喂养（EBF）与肥胖呈负相关；然而，这种关联因种族而异，亚洲的相关信息较少。我们探讨了孕前体重指数（BMI）和孕期体重增加（GWG）是否与 EBF 的开始有关。
我们调查了 2010 年 1 月至 2013 年 6 月期间在日本东京一家拥有最大年度分娩量的医院分娩的 6125 名足月（37-42 周妊娠）单胎婴儿的日本女性。
产后 1 个月，72%的女性成功开始 EBF。体重不足（BMI<18.5kg/m）和正常体重（BMI 18.5-24.9kg/m）的女性平均 GWG 为 10kg；超重（BMI 25-29.9kg/m）的女性为 7kg，肥胖（BMI≥30kg/m）的女性为 4kg。调整了混杂因素后，逐步模型显示，与正常体重的女性相比，肥胖（比值比 [OR]，0.29；95%置信区间 [CI]，0.16-0.53）和 GWG 增加一个单位（OR，0.98；95%CI，0.96-1.00）与 EBF 启动失败显著相关。孕前 BMI 和 GWG 之间没有明显的统计学相互作用。EBF 启动失败的其他显著危险因素包括母亲年龄较大（P<0.001）、初产（P<0.001）、剖宫产（P<0.001）、妊娠周数较早（P<0.001）、小于胎龄儿（P<0.05）和因临床原因母婴分离（P<0.001）。
本研究表明，孕前肥胖是日本女性 EBF 启动的危险因素。
