Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Dublin, Ohio.
School of Nursing, College of Health Sciences and Professions, Ohio University, Athens, Ohio.
Breastfeed Med. 2019 Oct;14(8):538-550. doi: 10.1089/bfm.2018.0204. Epub 2019 Jul 12.
Over half of pregnant women in the United States do not meet the recommended gestational weight gain (GWG). In addition, the prevalence of gestational diabetes mellitus (GDM) is increasing. We examined the combined influence of GDM and GWG on breastfeeding practices on exclusive breastfeeding during the neonatal period and at 3 months postpartum. A cross-sectional study was performed on 173,603 women from the pregnancy risk assessment monitoring system, 2009-2015. Descriptive statistics and multivariable logistic regression modeling were performed. The prevalence of GDM was 9.5%. Only 30.7% of women had weight gain within the Institute of Medicine (IOM) recommended guidelines. Approximately 21.7% and 10.3% of the participants exclusively breastfed their infants during the neonatal period and at 3 months postpartum, respectively. After adjusting for potential confounders, there was a significant multiplicative interaction between GWG and GDM on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Among women with normal and excessive GWG, the odds of exclusively breastfeeding during the neonatal period were lower for women with GDM compared with women without GDM (odds ratio, 95% confidence interval: 0.74, 0.64-0.85 and 0.75, 0.66-0.85, respectively). Similarly, among women with normal and excessive GWG, the odds of exclusively breastfeeding at 3 months postpartum were lower for women with GDM compared to women without GDM (0.67, 0.55-0.81 and 0.71, 0.60-0.85, respectively). With the increasing prevalence of GDM and weight gain outside the IOM guidelines, it is critical to identify populations at risk and to promote exclusive breastfeeding practices.
超过一半的美国孕妇不符合推荐的妊娠体重增加（GWG）。此外，妊娠糖尿病（GDM）的患病率也在增加。我们研究了 GDM 和 GWG 对新生儿期和产后 3 个月纯母乳喂养的综合影响。
对 2009 年至 2015 年妊娠风险评估监测系统中的 173603 名妇女进行了横断面研究。进行了描述性统计和多变量逻辑回归建模。GDM 的患病率为 9.5%。只有 30.7%的女性体重增加符合医学研究所（IOM）推荐的指南。约 21.7%和 10.3%的参与者在新生儿期和产后 3 个月分别纯母乳喂养婴儿。在调整了潜在的混杂因素后，GWG 和 GDM 对新生儿期和产后 3 个月纯母乳喂养的影响存在显著的乘法交互作用。在正常和超重 GWG 的女性中，与无 GDM 的女性相比，患有 GDM 的女性在新生儿期纯母乳喂养的可能性较低（比值比，95%置信区间：0.74，0.64-0.85 和 0.75，0.66-0.85）。同样，在正常和超重 GWG 的女性中，与无 GDM 的女性相比，患有 GDM 的女性在产后 3 个月纯母乳喂养的可能性较低（0.67，0.55-0.81 和 0.71，0.60-0.85）。
随着 GDM 和 IOM 指南外体重增加的患病率增加，确定高危人群并促进纯母乳喂养实践至关重要。
