产后哺乳应激反应和母乳喂养自我效能作为可改变的预测因素，预测产后 3 个月时的纯母乳喂养：一项前瞻性队列研究。
Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3 months postpartum: a prospective cohort study.
机构信息
Department of Children and Women's Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, 1-7, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Graduate Program of Midwifery, Dokkyo Medical University, Tochigi, Japan.
出版信息
BMC Pregnancy Childbirth. 2020 Nov 25;20(1):730. doi: 10.1186/s12884-020-03431-8.
BACKGROUND
The rate of exclusive breastfeeding at 3 months postpartum is only 50% in Japan. In order to increase this rate, we aimed to examine modifiable factors related to exclusive breastfeeding at 3 months postpartum by focusing on breastfeeding-related and psychosocial variables at 1 month postpartum.
METHODS
This prospective cohort study was conducted at a secondary medical care center in Osaka, Japan from February 2017 to October 2018. Demographic variables, infant feeding modality, breastfeeding-related variables, and psychosocial variables were obtained using questionnaires at 1 month postpartum. Daytime salivary cortisol levels before and after breastfeeding at 1 month postpartum were measured as a biological marker for stress responses associated with breastfeeding. Each infant's feeding modality was re-assessed at 3 months postpartum. Multiple logistic regression analyses were performed to examine factors affecting exclusive breastfeeding at 3 months postpartum.
RESULTS
Of the 104 participants, 61 reported exclusive breastfeeding at 3 months postpartum. The following factors were significantly associated with exclusive breastfeeding at 3 months postpartum: multiparity (adjusted odds ratio, 95% confidence interval: 11.13, 2.08-59.59), having a university degree (5.25, 1.04-26.53), no plan to return to work by 6 months postpartum (0.02, 0.00-0.46), and exclusive breastfeeding (42.84, 6.05-303.52), lower cortisol level after breastfeeding (0.00, 0.00-0.02), and higher breastfeeding self-efficacy scale score (1.07, 1.00-1.14) at 1 month postpartum. In parity-specific analyses, exclusive breastfeeding (25.33, 4.75-134.98) and lower cortisol level after breastfeeding (0.00, 0.00-0.21) at 1 month postpartum in primiparous women, and lower cortisol level after breastfeeding (0.00, 0.00-0.94), higher breastfeeding self-efficacy score (1.18, 1.05-1.32), and absence of breast complications (0.09, 0.01-0.82) at 1 month postpartum in multiparous women were associated with exclusive breastfeeding at 3 months postpartum.
CONCLUSIONS
Stress levels after breastfeeding, breastfeeding self-efficacy, and the presence of breast complications could be modifiable factors associated with subsequent exclusive breastfeeding. Further research is needed to examine whether approaches to reducing breastfeeding-related stress, improving breastfeeding self-efficacy, and preventing breast complications during lactation are effective to increase exclusive breastfeeding practices.
背景
日本产后 3 个月纯母乳喂养率仅为 50%。为了提高这一比例，我们旨在通过关注产后 1 个月与母乳喂养相关的和心理社会变量，来研究与产后 3 个月纯母乳喂养相关的可改变因素。
方法
本前瞻性队列研究于 2017 年 2 月至 2018 年 10 月在日本大阪的一家二级医疗机构进行。在产后 1 个月时使用问卷收集人口统计学变量、婴儿喂养方式、与母乳喂养相关的变量和心理社会变量。在产后 1 个月时测量了两次母乳喂养前后的日间唾液皮质醇水平，作为与母乳喂养相关的应激反应的生物学标志物。在产后 3 个月时重新评估每个婴儿的喂养方式。采用多因素逻辑回归分析来研究与产后 3 个月纯母乳喂养相关的因素。
结果
在 104 名参与者中，61 名报告在产后 3 个月时进行纯母乳喂养。以下因素与产后 3 个月纯母乳喂养显著相关：多胎妊娠（调整后的优势比，95%置信区间：11.13，2.08-59.59）、大学学历（5.25，1.04-26.53）、6 个月内无重返工作的计划（0.02，0.00-0.46）和纯母乳喂养（42.84，6.05-303.52），产后 1 个月时母乳喂养后皮质醇水平较低（0.00，0.00-0.02）和母乳喂养自我效能评分较高（1.07，1.00-1.14）。在特定产次的分析中，产后 1 个月时纯母乳喂养（25.33，4.75-134.98）和母乳喂养后皮质醇水平较低（0.00，0.00-0.21）与初产妇有关，而母乳喂养后皮质醇水平较低（0.00，0.00-0.94）、母乳喂养自我效能评分较高（1.18，1.05-1.32）和无乳房并发症（0.09，0.01-0.82）与多产妇有关。
结论
母乳喂养后应激水平、母乳喂养自我效能和乳房并发症的发生可能是与随后纯母乳喂养相关的可改变因素。需要进一步研究，以检验减轻母乳喂养相关压力、提高母乳喂养自我效能和预防哺乳期乳房并发症的方法是否能有效增加纯母乳喂养的做法。
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