Department of Nursing, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus, Shanghai, China.
Matern Child Nutr. 2023 Apr;19(2):e13470. doi: 10.1111/mcn.13470. Epub 2022 Dec 25.
Breastfeeding plays an important role in the growth and development of preterm infants, and exclusive breastfeeding (EBF) in the first 6 weeks post-partum is the key to continuous breastfeeding. This study was designed to explore the influencing factors that contribute to breastfeeding attrition among mothers of preterm infants at Week 6 post-partum based on the theory of planned behaviour (TPB). We herein adopted a prospective observational study design in which 97 mothers who exclusively breastfed at Week 6 post-partum at a tertiary specialised hospital in Shanghai from June 2021 to February 2022 were taken as the EBF group, and 179 mothers without EBF were assigned to the EBF attrition group. Through an extensive literature review and expert consultation, we determined the possible factors influencing EBF attrition, analysed those factors that showed statistical significance in our univariate analysis by applying binary logistic regression, and constructed a nomogram model for predicting EBF attrition. The results revealed that negative breastfeeding sentiment (odds ratio [OR] = 1.006; 95% confidence interval [CI], 1.000-1.011) generated a greater risk of breastfeeding attrition. However, positive breastfeeding sentiment (OR = 0.991; 95% CI, 0.983-0.999), social and professional support (OR = 0.993; 95% CI, 0.987-0.999), breastfeeding control (OR = 0.945; 95% CI, 0.896-0.996), knowledge (OR = 0.893; 95% CI, 0.799-0.998), and intention to EBF at Week 6 post-partum (OR = 0.522; 95% CI, 0.276-0.988) were the protective factors and facilitated the development of our nomogram model. The Hosmer-Lemeshow goodness-of-fit test generated a χ value of 11.344 (p = 0.183) and an area under the curve of 0.822 (95% CI, 0.771-0.873). The C-index was 0.800 in the internal bootstrap validation, indicating that the nomogram model possessed favourable predictive accuracy and discrimination.
母乳喂养在早产儿的生长和发育中起着重要作用，产后 6 周内的纯母乳喂养（EBF）是持续母乳喂养的关键。本研究基于计划行为理论（TPB），旨在探讨影响产后 6 周内早产儿母亲母乳喂养中断的因素。本研究采用前瞻性观察研究设计，纳入 2021 年 6 月至 2022 年 2 月在上海一家三级专科医院产后 6 周内纯母乳喂养的 97 例母亲为 EBF 组，无 EBF 的 179 例母亲为 EBF 中断组。通过广泛的文献回顾和专家咨询，确定了可能影响 EBF 中断的因素，通过单因素分析应用二元逻辑回归分析具有统计学意义的因素，并构建了预测 EBF 中断的列线图模型。结果表明，负性母乳喂养情绪（比值比[OR] = 1.006；95%置信区间[CI]，1.000-1.011）增加了母乳喂养中断的风险。然而，正性母乳喂养情绪（OR = 0.991；95%CI，0.983-0.999）、社会和专业支持（OR = 0.993；95%CI，0.987-0.999）、母乳喂养控制（OR = 0.945；95%CI，0.896-0.996）、知识（OR = 0.893；95%CI，0.799-0.998）和产后 6 周的 EBF 意愿（OR = 0.522；95%CI，0.276-0.988）是保护因素，并促进了我们的列线图模型的发展。Hosmer-Lemeshow 拟合优度检验产生 χ 值为 11.344（p = 0.183），曲线下面积为 0.822（95%CI，0.771-0.873）。内部自举验证的 C 指数为 0.800，表明列线图模型具有良好的预测准确性和区分度。
