Neonatal Intensive Care Unit. Hospital Professor Doutor Fernando Fonseca. Amadora. Portugal.
Neonatology Unit. Hospital de Cascais Doutor José Almeida. Cascais. Portugal.
Acta Med Port. 2023 Jun 1;36(6):416-423. doi: 10.20344/amp.18692. Epub 2023 Mar 22.
Exclusive breastfeeding (EBF) is currently recommended until six months of age. The Baby-friendly Hospital (BFH) initiative an international program to promote breastfeeding, was launched in Portugal in 1994. The aim of this study was to identify the prevalence and factors influencing breastfeeding in the first six months of life and to compare the results with a study carried out in 1999 including population from the same geographic area.
A prospective, longitudinal and observational study was carried out in two hospitals in the Lisbon metropolitan area, one BFH and another non-BFH. It consisted of different questionnaires answered by mothers at three distinct moments (zero, three and six months). The first questionnaire was applied between February and June 2019.
A total of 423 infants were included, 324 from the BFH and 99 from the non-BFH. The breastfeeding rate was 94.3% at discharge, 78.2% at three months and 64.4% at six months, whereas EBF rate was 74.2%, 51.8% and 25.6% respectively. All women on EBF at six months, except one, were breastfeeding on demand. The discontinuation of EBF was associated with delayed skin-to-skin contact, Neonatal Intensive Care Unit admission, pacifier and artificial teats use, mother's return to work earlier and lower education levels. Conversely, factors that promote EBF were older gestational age, adequate birthweight, breastfeeding initiation in the first hour of life, rooming-in practice, shorter hospital stay and absence of infant's illnesses. Compared with 1999, although there was a significant improvement of breastfeeding rates at three and six months, the EBF rate was similar at six months (23%). Both studies identified the mother's lower education level and mother's return to work as contributing factors to breastfeeding discontinuation.
Our results are in agreement with previously reported causes of breastfeeding discontinuation and emphasize the importance of sociocultural factors. Compared with 1999, the breastfeeding rates in this Portuguese population increased significantly at three and six months. However, it is still necessary to improve in order to achieve the World Health Organization global target.
目前建议纯母乳喂养至六个月大。婴儿友好医院倡议（Baby-friendly Hospital Initiative，BFHI）是一个促进母乳喂养的国际项目，于 1994 年在葡萄牙推出。本研究旨在确定生命最初六个月内母乳喂养的流行率和影响因素，并将结果与 1999 年在同一地理区域进行的一项研究进行比较。
在里斯本大都市区的两家医院（一家 BFHI 和另一家非 BFHI）进行了一项前瞻性、纵向和观察性研究。该研究由母亲在三个不同时间点（零、三、六个月）回答的不同问卷组成。第一个问卷于 2019 年 2 月至 6 月期间进行。
共纳入 423 名婴儿，其中 324 名来自 BFHI，99 名来自非 BFHI。出院时母乳喂养率为 94.3%，三个月时为 78.2%，六个月时为 64.4%，而纯母乳喂养率分别为 74.2%、51.8%和 25.6%。六个月时仍进行纯母乳喂养的所有女性（除一名女性外）均按需进行母乳喂养。纯母乳喂养的终止与延迟皮肤接触、新生儿重症监护病房入院、使用安抚奶嘴和人工奶嘴、母亲较早返回工作岗位以及较低的教育水平有关。相反，促进纯母乳喂养的因素是胎龄较大、出生体重适当、生命最初一小时开始母乳喂养、母婴同室、住院时间较短以及婴儿无疾病。与 1999 年相比，尽管三个月和六个月时母乳喂养率显著提高，但六个月时的纯母乳喂养率相似（23%）。这两项研究都发现，母亲较低的教育水平和母亲返回工作是导致母乳喂养中断的因素。
我们的结果与先前报道的母乳喂养中断原因一致，并强调了社会文化因素的重要性。与 1999 年相比，葡萄牙人口中母乳喂养率在三个月和六个月时显著增加。然而，为了实现世界卫生组织的全球目标，仍有必要进一步提高。
