Heesen Philip, Halpern Stephen H, Beilin Yaakov, Mauri Paola A, Eidelman Leonid A, Heesen Michael, Orbach-Zinger Sharon
Faculty of Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
Department of Anesthesia, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
J Clin Anesth. 2021 Feb;68:110105. doi: 10.1016/j.jclinane.2020.110105. Epub 2020 Oct 15.
There have been numerous reports studying the effect of neuraxial analgesia on breastfeeding success, but the results are inconsistent.
We performed a literature search in various databases for studies comparing neuraxial analgesia to non-neuraxial or no analgesia. Outcomes were the percentage of women breastfeeding fully or mixed with formula. Where possible, nulliparous parturients were analyzed separately. We conducted an analysis excluding studies of serious and critical risk of bias. Odds ratios and 95% confidence intervals were calculated.
We included 15 studies (13 observational studies, 1 secondary analysis of a randomized controlled trial, 1 case-control study) with 16,112 participants. Overall, there were 6 studies that found no difference between groups, 6 studies that showed a significantly lower incidence of breastfeeding in the neuraxial group and 3 studies finding mixed results (at some time-points statistically significant and at some time-point statistically non-significant results). In nulliparous only studies, 2 found no difference between study groups, 1 found a lower breastfeeding rate in the neuraxial group and 3 studies showed mixed results. Excluding studies with a serious and critical risk of bias, 1 study found no difference between study groups, 3 studies found a decrease of breastfeeding rates in the neuraxial group, and 1 study showed mixed results.
In our review we found a high disparity in results. One reason is probably the high potential of confounding (immediate skin to skin placement, maternity leave etc.). Education programs and breastfeeding support are likely more important in determining long term breastfeeding success.
已有大量研究探讨了椎管内镇痛对母乳喂养成功的影响，但结果并不一致。
我们在多个数据库中进行了文献检索，以查找比较椎管内镇痛与非椎管内镇痛或无镇痛的研究。结果指标为完全母乳喂养或混合喂养（添加配方奶）的女性比例。在可能的情况下，对初产妇进行单独分析。我们进行了一项分析，排除了存在严重和关键偏倚风险的研究。计算了优势比和95%置信区间。
我们纳入了15项研究（13项观察性研究、1项随机对照试验的二次分析、1项病例对照研究），共16112名参与者。总体而言，6项研究发现两组之间无差异，6项研究表明椎管内镇痛组的母乳喂养发生率显著较低，3项研究结果不一（在某些时间点有统计学意义，在某些时间点无统计学意义）。仅针对初产妇的研究中，2项发现研究组之间无差异，1项发现椎管内镇痛组的母乳喂养率较低，3项研究结果不一。排除存在严重和关键偏倚风险的研究后，1项研究发现研究组之间无差异，3项研究发现椎管内镇痛组的母乳喂养率下降，1项研究结果不一。
在我们的综述中，我们发现结果存在很大差异。一个原因可能是混杂因素的可能性很高（立即皮肤接触、产假等）。教育项目和母乳喂养支持可能对决定长期母乳喂养成功更为重要。
