Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
Breastfeed Med. 2019 Nov;14(9):630-639. doi: 10.1089/bfm.2019.0065. Epub 2019 Jul 31.
The health benefits of breastfeeding for both the mother and her offspring are well established, and breastfeeding may be especially important for mitigating negative health effects of pregnancy complicated by diabetes. This study sought to examine the association between race/ethnicity, maternal diabetes, and breastfeeding initiation in South Carolina (SC). Our study population is comprised of all live, singleton, full-term births in SC delivered January 2004 to December 2016 (292,468 non-Hispanic Whites, 173,158 non-Hispanic Blacks, and 52,174 Hispanics). Generalized estimating equations and an interaction term between race/ethnicity and maternal diabetes status were used to estimate the race/ethnic-specific odds ratio (OR) and 95% confidence intervals (CIs) that a mother with diabetes versus without diabetes initiated breastfeeding. Models were adjusted for maternal and infant sociodemographics (Model 1), additionally for clinical variables and birth outcomes (Model 2), and also for maternal prepregnancy body mass index (BMI) (Model 3). We found statistically significant differences in breastfeeding initiation by race/ethnicity and diabetes status in Model 1. These associations were attenuated and lost significance upon additional adjustment. Non-Hispanic Black mothers with gestational diabetes were significantly more likely to initiate breastfeeding than nondiabetic non-Hispanic Black mothers, even after adjustment for prepregnancy BMI (OR: 1.07 [95% CI 1.02-1.12]). This large, population-based study of all live, singleton, full-term births in SC improves our understanding of how race/ethnicity and maternal metabolic disorders impact breastfeeding initiation, and may inform future hospital-based breastfeeding interventions in populations with the most need.
母乳喂养对母婴的健康益处已得到充分证实，对于减轻妊娠合并糖尿病的负面健康影响，母乳喂养可能尤为重要。本研究旨在探讨南卡罗来纳州（SC）的种族/民族、母亲糖尿病与母乳喂养开始之间的关系。我们的研究人群包括 2004 年 1 月至 2016 年 12 月在 SC 分娩的所有活产、单胎、足月出生儿（292468 名非西班牙裔白人、173158 名非西班牙裔黑人、52174 名西班牙裔）。使用广义估计方程和种族/民族与母亲糖尿病状态之间的交互项来估计种族/民族特定的优势比（OR）和 95%置信区间（CI），即患有糖尿病的母亲与没有糖尿病的母亲开始母乳喂养的几率。模型调整了母亲和婴儿的社会人口统计学因素（模型 1），此外还调整了临床变量和出生结局（模型 2），以及母亲孕前体重指数（BMI）（模型 3）。我们在模型 1 中发现了母乳喂养开始的种族/民族和糖尿病状态的统计学显著差异。这些关联在进一步调整后减弱并失去了意义。患有妊娠期糖尿病的非西班牙裔黑人母亲比没有糖尿病的非西班牙裔黑人母亲更有可能开始母乳喂养，即使在调整了孕前 BMI 后也是如此（OR：1.07 [95%CI 1.02-1.12]）。这项对 SC 所有活产、单胎、足月出生儿的大型基于人群的研究提高了我们对种族/民族和母亲代谢紊乱如何影响母乳喂养开始的理解，并可能为最需要的人群中的基于医院的母乳喂养干预提供信息。
