Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
BMC Pregnancy Childbirth. 2022 Mar 19;22(1):225. doi: 10.1186/s12884-022-04570-w.
Exclusive breastmilk feeding during the delivery hospitalization, a Joint Commission indicator of perinatal care quality, is associated with longer-term breastfeeding success. Marked racial and ethnic disparities in breastfeeding exclusivity and duration existed prior to COVID-19. The pandemic, accompanied by uncertainty regarding intrapartum and postpartum safety practices, may have influenced disparities in infant feeding practices. Our objective was to examine whether the first wave of the COVID-19 pandemic in New York City was associated with a change in racial and ethnic disparities in exclusive breastmilk feeding during the delivery stay.
We conducted a cross-sectional study of electronic medical records from 14,964 births in two New York City hospitals. We conducted a difference-in-differences (DID) analysis to compare Black-white, Latina-white, and Asian-white disparities in exclusive breastmilk feeding in a pandemic cohort (April 1-July 31, 2020, n=3122 deliveries) to disparities in a pre-pandemic cohort (January 1, 2019-February 28, 2020, n=11,842). We defined exclusive breastmilk feeding as receipt of only breastmilk during delivery hospitalization, regardless of route of administration. We ascertained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection status from reverse transcription-polymerase chain reaction tests from nasopharyngeal swab at admission. For each DID model (e.g. Black-white disparity), we used covariate-adjusted log binomial regression models to estimate racial and ethnic risk differences, pandemic versus pre-pandemic cohort risk differences, and an interaction term representing the DID estimator.
Exclusive breastmilk feeding increased from pre-pandemic to pandemic among white (40.8% to 46.6%, p<0.001) and Asian (27.9% to 35.8%, p=0.004) women, but not Black (22.6% to 25.3%, p=0.275) or Latina (20.1% to 21.4%, p=0.515) women overall. There was an increase in the Latina-white exclusive breastmilk feeding disparity associated with the pandemic (DID estimator=6.3 fewer cases per 100 births (95% CI=-10.8, -1.9)). We found decreased breastmilk feeding specifically among SARS-CoV-2 positive Latina women (20.1% pre-pandemic vs. 9.1% pandemic p=0.013), and no change in Black-white or Asian-white disparities.
We observed a pandemic-related increase in the Latina-white disparity in exclusive breastmilk feeding, urging hospital policies and programs to increase equity in breastmilk feeding and perinatal care quality during and beyond this health emergency.
分娩住院期间纯母乳喂养是围产期护理质量的联合委员会指标，与长期母乳喂养的成功相关。在 COVID-19 之前，母乳喂养的排他性和持续时间存在明显的种族和民族差异。大流行伴随着关于分娩和产后安全实践的不确定性，可能影响了婴儿喂养实践的差异。我们的目的是研究纽约市 COVID-19 第一波疫情是否与分娩期间纯母乳喂养的种族和民族差异的变化有关。
我们对两家纽约市医院的 14964 例分娩的电子病历进行了横断面研究。我们进行了差异中的差异（DID）分析，以比较 2020 年 4 月 1 日至 7 月 31 日大流行队列（3122 例分娩）中黑人-白人、拉丁裔-白人、亚裔-白人间纯母乳喂养的差异与 2019 年 1 月 1 日至 2 月 28 日大流行前队列（11842 例）的差异。我们将纯母乳喂养定义为分娩期间仅接受母乳喂养，无论给药途径如何。我们从入院时鼻咽拭子的逆转录-聚合酶链反应（RT-PCR）检测中确定严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染状态。对于每个 DID 模型（例如黑人-白人差异），我们使用调整后的协变量对数二项式回归模型来估计种族和民族风险差异、大流行与大流行前队列风险差异以及代表 DID 估计值的交互项。
白人（40.8%至 46.6%，p<0.001）和亚裔（27.9%至 35.8%，p=0.004）女性的纯母乳喂养率从大流行前到大流行期间有所增加，但黑人（22.6%至 25.3%，p=0.275）或拉丁裔（20.1%至 21.4%，p=0.515）女性总体上没有增加。与大流行相关的拉丁裔-白人纯母乳喂养差异增加（DID 估计值=每 100 例出生减少 6.3 例（95%CI=-10.8，-1.9））。我们发现 SARS-CoV-2 阳性拉丁裔女性的母乳喂养率具体下降（大流行前为 20.1%，大流行时为 9.1%，p=0.013），而黑人-白人或亚裔-白人差异没有变化。
我们观察到与大流行相关的拉丁裔-白人纯母乳喂养差异增加，敦促医院政策和计划在这一卫生紧急情况期间和之后增加母乳喂养和围产期护理质量的公平性。
