School of Nursing, Fudan University, Shanghai, PR China.
Obstetrics and Gynecology Hospital of Fudan University, Shanghai, PR China.
J Clin Nurs. 2021 May;30(9-10):1347-1359. doi: 10.1111/jocn.15684. Epub 2021 Feb 15.
To determine the effects of an individualised mixed management combined lactation education and psychoeducation intervention on breastfeeding outcomes and postpartum depression (PPD) at 3 and 42 days postpartum.
Pregnant women with antenatal depression are prone to postpartum depression and failure in breastfeeding.
Eligible women participated in a randomised single-blind controlled trial. Results are reported as per the CONSORT 2010 statement.
Participants were recruited from December 2017-August 2018 at a major teaching hospital located in Shanghai. Primiparous women (n = 182) with an Edinburgh Postnatal Depression Scale score ≥9 were randomly enrolled in the intervention group (n = 91) or the control group (n = 91). The intervention group participated in a 4-session face-to-face mixed management intervention targeting perinatal depression and breastfeeding. The control group received usual care. Breastfeeding and psychological outcomes were measured during the third trimester (≥28 weeks and <35 weeks), and at 3 and 42 days postpartum.
There were statistically significant differences in rates of overall and exclusive breastfeeding, initial breastfeeding experience, breastfeeding behaviour and self-efficacy between the two groups at 3 and 42 days postpartum (p < .05). Intention-to-treat linear mixed model analysis showed that EPDS scores were statistically significantly different between groups over time (F = 20.42, p < .001). Intervention group were more satisfied with their husbands' care and care received during the first month postpartum (p < .05).
The results demonstrate the effectiveness and feasibility of delivering an individualised mixed management intervention combining lactation guidance with psychological support during pregnancy.
This study supports the need to identify pregnant women at risk of perinatal depression and indicates that the prenatal individualised mixed management intervention has the potential to reduce PPD and help achieve better breastfeeding outcomes.
确定个体化混合管理联合哺乳教育和心理教育干预对母乳喂养结果和产后抑郁（PPD）的影响，分别在产后 3 天和 42 天。
产前抑郁的孕妇易发生产后抑郁和母乳喂养失败。
符合条件的女性参加了一项随机单盲对照试验。结果按照 CONSORT 2010 声明报告。
参与者于 2017 年 12 月至 2018 年 8 月在上海一家主要教学医院招募。将 Edinburgh Postnatal Depression Scale 评分≥9 的初产妇（n=182）随机纳入干预组（n=91）或对照组（n=91）。干预组参加了 4 次面对面的个体化混合管理干预，针对围产期抑郁和母乳喂养。对照组接受常规护理。在妊娠晚期（≥28 周且<35 周）、产后 3 天和 42 天测量母乳喂养和心理结果。
两组产后 3 天和 42 天的总母乳喂养率、纯母乳喂养率、初始母乳喂养体验、母乳喂养行为和自我效能均有统计学差异（p<0.05）。意向治疗线性混合模型分析显示，两组 EPDS 评分随时间变化有统计学差异（F=20.42，p<0.001）。干预组对其丈夫在产后第一个月的照顾和护理更满意（p<0.05）。
结果表明，在孕期提供个体化混合管理干预，结合哺乳指导和心理支持是有效且可行的。
本研究支持识别有围产期抑郁风险的孕妇的必要性，并表明产前个体化混合管理干预有可能降低 PPD 并帮助实现更好的母乳喂养结果。
