Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, M.B. 8318, New Orleans, LA 70112, USA.
Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada.
Nutrients. 2022 Feb 19;14(4):876. doi: 10.3390/nu14040876.
Lactogenesis II is the onset of copious milk production following parturition. Delayed onset of lactogenesis II (DLII) often contributes to poorer lactation performance, which may adversely affect maternal and child health. The present study aims to identify the metabolic and obstetric risk factors for DLII in a secondary analysis of a prospective cohort study following pregnant women through postpartum. We defined the onset of lactogenesis II as delayed if it occurred ≥72 h postpartum. Multiple logistic regression analyses were conducted to evaluate the associations of metabolic and obstetric variables with DLII. Median onset of lactogenesis II was 72.4 h (IQR 60.4-91.6) postpartum, and 55.4% (98 of 177) of women experienced DLII. Time to first breast contact ≥ 2 h postpartum compared to ≤1 h postpartum was associated with DLII (OR 2.71 95% CI 1.12-6.53) with adjustment for age, race, pregravid BMI, primiparity, and mode of delivery, while metabolic variables were not significantly associated with DLII. In this comprehensive examination of potential metabolic and obstetric parameters, earlier timing of putting the infant to the breast remained significantly associated with earlier onset of milk coming in after consideration of the other potential risk factors. Obstetrical practices, including putting the baby to the breast later, may have an important impact on the timing of lactation, and interventions are needed to address this concern.
二期泌乳是分娩后大量产奶的开始。二期泌乳延迟（DLII）常常导致较差的哺乳表现，这可能对母婴健康产生不利影响。本研究旨在通过对产后孕妇进行前瞻性队列研究的二次分析，确定 DLII 的代谢和产科危险因素。我们将二期泌乳的开始定义为如果发生在产后≥72 小时。采用多因素逻辑回归分析评估代谢和产科变量与 DLII 的关系。二期泌乳的中位发生时间为产后 72.4 小时（IQR 60.4-91.6），55.4%（98/177）的妇女发生 DLII。与产后≤1 小时首次乳房接触相比，≥2 小时与 DLII 相关（OR 2.71，95%CI 1.12-6.53），调整年龄、种族、妊娠前 BMI、初产和分娩方式后仍有统计学意义，而代谢变量与 DLII 无显著相关性。在对潜在代谢和产科参数的全面检查中，考虑到其他潜在危险因素后，婴儿更早接触乳房的时间与更早开始产奶仍然显著相关。包括让婴儿晚接触乳房在内的产科做法可能对泌乳时间有重要影响，需要采取干预措施来解决这一问题。
