Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Breastfeed Med. 2022 Sep;17(9):758-763. doi: 10.1089/bfm.2021.0355. Epub 2022 Jul 29.
The rates of severe maternal morbidity (SMM) including blood transfusions after delivery are rising, yet little is known about the impact of these experiences on breastfeeding. This is a single-institution retrospective cohort study examining breastfeeding rates at three time points for 1,857 first-time parents delivered at term between July 1, 2016 and June 30, 2019. Our exposure of interest was SMM, which was subdivided into SMM where transfusion was the only indicator (transfusion-only SMM) and SMM where another indicator (diagnostic or procedural) was met, which may also include transfusion (all-cause SMM). Association between transfusion-only SMM and all-cause SMM with feeding method was determined using multinomial regression modeling and adjusting for relevant sociodemographic characteristics. The majority of those with uncomplicated deliveries were exclusively breastfeeding at the 2- to 4-week and 2- to 3-month time points (59.6% and 53.6%, respectively), in contrast to 46.3% and 42.0% of those who had experienced transfusion-only SMM, and 40.9% and 30% of those who had experienced all-cause SMM. In adjusted models, receipt of a blood transfusion was found to be associated with greater risk of exclusive formula feeding at all time points. Experience of all-cause SMM was significantly associated with increased likelihood of exclusive formula feeding at hospital discharge and the 2- to 3-month time point. We identified that experience of all-cause SMM and transfusion-only SMM are independently associated with a lower likelihood of exclusive breastfeeding after adjusting for sociodemographic factors. Perinatal clinicians should be aware of these risks and offer increased support to these couplets.
严重产妇发病率（SMM）的发生率（包括产后输血）正在上升，但人们对这些经历对母乳喂养的影响知之甚少。这是一项单机构回顾性队列研究，调查了 2016 年 7 月 1 日至 2019 年 6 月 30 日期间足月分娩的 1857 对初次父母在三个时间点的母乳喂养率。我们感兴趣的暴露因素是 SMM，它分为仅输血作为指标的 SMM（仅输血 SMM）和另一个指标（诊断或手术）符合的 SMM，其中也可能包括输血（所有原因 SMM）。使用多项回归建模确定仅输血 SMM 和所有原因 SMM 与喂养方式之间的关联，并调整相关社会人口统计学特征。与未经历输血的 SMM 相比，经历仅输血 SMM 和所有原因 SMM 的母亲在 2 至 4 周和 2 至 3 个月时，纯母乳喂养的比例分别为 59.6%和 53.6%，而经历仅输血 SMM 的母亲分别为 46.3%和 42.0%，经历所有原因 SMM 的母亲分别为 40.9%和 30%。在调整后的模型中，输血与所有时间点纯配方奶喂养的风险增加有关。所有原因 SMM 的经历与产后和 2 至 3 个月时纯配方奶喂养的可能性增加显著相关。我们发现，在调整了社会人口学因素后，所有原因 SMM 和仅输血 SMM 的经历与纯母乳喂养的可能性降低独立相关。围产期临床医生应意识到这些风险，并为这些夫妇提供更多支持。
