Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital (EK Chung).
Department of Health Services, University of Washington (I Painter and VD Souter), Seattle, Wash; The Foundation for Health Care Quality (I Painter, K Sitcov, and VD Souter), Seattle, Wash.
Acad Pediatr. 2022 Aug;22(6):918-926. doi: 10.1016/j.acap.2021.09.016. Epub 2021 Sep 30.
Mothers who are Black, Indigenous, and people of color (BIPOC) are disproportionately impacted by substance use in pregnancy and less likely to breastfeed. Our objectives were to assess relationships between substance use in pregnancy and exclusive breastfeeding at discharge (EBF) and race/ethnicity and EBF, and determine the extent to which substance use influences the relationship between race/ethnicity and EBF.
This is a retrospective cohort study of term mother-infant dyads using 2016 to 2019 data from a Northwest quality improvement collaborative, Obstetrical Care Outcomes Assessment Program. Stepwise and stratified multivariable logistic regression analyses were conducted to determine associations between independent variables consisting of characteristics, including maternal race/ethnicity and substance use, and the dependent variable, EBF.
Our sample consisted of 84,742 dyads, 69.5% of whom had EBF. The adjusted odds of EBF for non-Hispanic Black and Hispanic mothers were half, and for American Indian/Alaska Native mothers two-thirds, that of White mothers (aOR [95% CI]: 0.52 [0.48, 0.57], 0.51 [0.48, 0.54], 0.64 [0.55, 0.76], respectively). Substance use did not mediate the association between race/ethnicity and EBF, but it modified the association. Among those reporting nicotine or marijuana use, Hispanic mothers were half as likely as White mothers were to exclusively breastfeed. Other factors associated with a lower likelihood of EBF included public or no insurance, rural setting, C-section, NICU admission, and LBW.
Disparities in EBF related to race/ethnicity and substance use were pronounced in this study, particularly among Hispanic mothers with nicotine or marijuana use.
非裔、印第安裔和有色人种（BIPOC）的母亲在怀孕期间物质滥用的比例不成比例，并且更不可能进行母乳喂养。我们的目标是评估怀孕期间物质使用与出院时的纯母乳喂养（EBF）以及种族/民族与 EBF 之间的关系，并确定物质使用在多大程度上影响了种族/民族与 EBF 之间的关系。
这是一项回顾性队列研究，使用了 2016 年至 2019 年西北质量改进合作组织的 Obstetrical Care Outcomes Assessment Program 的数据，研究对象为足月母婴对子。采用逐步和分层多变量逻辑回归分析，确定由特征组成的自变量（包括母亲的种族/民族和物质使用）与因变量 EBF 之间的关系。
我们的样本包括 84742 对母婴，其中 69.5%的婴儿进行了 EBF。与白人母亲相比，非西班牙裔黑人母亲和西班牙裔母亲进行 EBF 的调整后优势比（aOR [95%CI]）分别为 0.52（0.48，0.57）和 0.51（0.48，0.54），而美洲印第安人/阿拉斯加原住民母亲的调整后优势比则为 0.64（0.55，0.76）。物质使用并没有介导种族/民族与 EBF 之间的关联，但它改变了这种关联。在报告尼古丁或大麻使用的母亲中，西班牙裔母亲与白人母亲相比，进行 EBF 的可能性是其一半。其他与 EBF 可能性较低相关的因素包括公共或无保险、农村环境、剖腹产、新生儿重症监护病房入院和低出生体重儿。
在这项研究中，与种族/民族和物质使用相关的 EBF 差异显著，尤其是在使用尼古丁或大麻的西班牙裔母亲中。
