Baker Natasha, Potts Laura, Jennings Stacey, Trevillion Kylee, Howard Louise M
Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom.
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom.
Front Glob Womens Health. 2021 Apr 9;2:624485. doi: 10.3389/fgwh.2021.624485. eCollection 2021.
The health benefits of breastfeeding are well-established but for mothers with severe mental illness (SMI), the decision to breastfeed can be complex. Very few prior studies have investigated the infant feeding choices of women with SMI, or the factors associated with this. Our aims were to examine antenatal infant feeding intentions and infant feeding outcomes in a cohort of women admitted for acute psychiatric care in the first postpartum year. We also aimed to examine whether demographic and clinical characteristics associated with breastfeeding were similar to those found in previous studies in the general population, including age, employment, education, BMI, mode of delivery, smoking status, and social support. This study was a mixed-methods secondary analysis of a national cohort study, ESMI-MBU (Examining the effectiveness and cost-effectiveness of perinatal mental health services). Participants had been admitted to acute care with SMI in the first postpartum year. Infant feeding outcomes were retrospectively self-reported by women during a 1-month post-discharge interview. Free-text responses to questions relating to infant feeding and experience of psychiatric services were also explored using thematic analysis. 144 (66.1%) of 218 women reported breastfeeding (mix feeding and exclusive breastfeeding). Eighty five percentage of the cohort had intended to breastfeed and of these, 76.5% did so. Factors associated with breastfeeding included infant feeding intentions, employment and non-Caucasian ethnicity. Although very few women were taking psychotropic medication contraindicated for breastfeeding, over a quarter ( = 57, 26.15%) reported being advised against breastfeeding because of their medication. Women were given this advice by psychiatry practitioners (40% = 22), maternity practitioners (32.73% = 18) and postnatal primary care (27.27% = 15). Most women stopped breastfeeding earlier than they had planned to as a result (81.1% = 43). Twenty five women provided free text responses, most felt unsupported with infant feeding due to inconsistent information about medication when breastfeeding and that breastfeeding intentions were de-prioritized for mental health care. Women with SMI intend to breastfeed and for the majority, this intention is fulfilled. Contradictory and insufficient advice relating to breastfeeding and psychotropic medication indicates that further training is required for professionals caring for women at risk of perinatal SMI about how to manage infant feeding in this population. Further research is required to develop a more in-depth understanding of the unique infant feeding support needs of women with perinatal SMI.
母乳喂养对健康有益，这一点已得到充分证实，但对于患有严重精神疾病（SMI）的母亲来说，是否进行母乳喂养的决定可能很复杂。此前很少有研究调查过患有SMI的女性的婴儿喂养选择，以及与之相关的因素。我们的目标是在产后第一年因急性精神病护理入院的一组女性中，研究产前婴儿喂养意向和婴儿喂养结果。我们还旨在研究与母乳喂养相关的人口统计学和临床特征，是否与之前普通人群研究中发现的特征相似，包括年龄、就业情况、教育程度、体重指数、分娩方式、吸烟状况和社会支持。本研究是对一项全国队列研究ESMI-MBU（研究围产期心理健康服务的有效性和成本效益）的混合方法二次分析。参与者在产后第一年因SMI接受了急性护理。婴儿喂养结果是女性在出院后1个月的访谈中通过回顾性自我报告得出的。还使用主题分析方法探讨了对与婴儿喂养及精神科服务经历相关问题的自由文本回复。218名女性中有144名（66.1%）报告进行了母乳喂养（混合喂养和纯母乳喂养）。该队列中85%的女性原本打算母乳喂养，其中76.5%的人实现了这一打算。与母乳喂养相关的因素包括婴儿喂养意向、就业情况和非白人种族。尽管很少有女性正在服用禁止母乳喂养的精神药物，但超过四分之一（n = 57，26.15%）的女性报告因药物原因被建议不要母乳喂养。给出此建议的有精神科医生（40%，n = 22）、产科医生（32.73%，n = 18）和产后初级护理人员（27.27%，n = 15）。结果，大多数女性比计划的更早停止了母乳喂养（81.1%，n = 43）。25名女性提供了自由文本回复，大多数人觉得在婴儿喂养方面缺乏支持，原因是母乳喂养时关于药物的信息不一致，而且母乳喂养意向在心理健康护理中未被优先考虑。患有SMI的女性打算进行母乳喂养，而且对大多数人来说，这一打算得以实现。关于母乳喂养和精神药物的相互矛盾且不充分的建议表明，对于照顾有围产期SMI风险女性的专业人员，需要就如何处理该人群的婴儿喂养问题进行进一步培训。需要进行进一步研究，以更深入地了解围产期SMI女性独特的婴儿喂养支持需求。
