School of Nursing, Fudan University, 305 Fenglin Road, Xuhui District, 200032, Shanghai, China.
Department of Nursing, The Women's Hospital of Nanjing Medical University, 123 Tianfei Lane, Mochou Road, Qinhuai District, 210004, Nanjing, China.
Appetite. 2023 Sep 1;188:106631. doi: 10.1016/j.appet.2023.106631. Epub 2023 Jun 9.
The mechanisms underlying the negative associations between pre-pregnancy body mass index (BMI) and exclusive breastfeeding remain poorly understood. Thus, the study aimed to determine whether the negative associations between high pre-pregnancy BMI and exclusive breastfeeding at six weeks postpartum are mediated by components of the capability, opportunity, and motivation behaviour (COM-B) model. In this prospective observational study, we assigned 360 primiparous women to a pre-pregnancy overweight/obese group (n = 180) and a normal-BMI group (n = 180). A structural equation model was designed to study how capabilities (onset of lactogenesis II, perceived milk supply, breastfeeding knowledge, and postpartum depression), opportunities (pro-breastfeeding hospital practices, social influence, social support), and motivations (breastfeeding intention, breastfeeding self-efficacy, and attitudes towards breastfeeding) affected exclusive breastfeeding at six weeks postpartum in groups of women with different pre-pregnancy BMIs. In all, 342 participants (95.0%) possessed complete data. Women with high pre-pregnancy BMI were less likely to exclusively breastfeed at six weeks postpartum than women with a normal BMI were. We observed a significant negative direct effect of high pre-pregnancy BMI on exclusive breastfeeding at six weeks postpartum and a significantly negative indirect effect of high pre-pregnancy BMI via the explanatory mediating variables of capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy) on exclusive breastfeeding at six weeks postpartum. Our findings support certain capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy), partially explaining the negative association between high pre-pregnancy BMI and exclusive breastfeeding outcome. We suggest that interventions aimed at promoting exclusive breastfeeding among women with high pre-pregnancy BMI should address the capacity and motivation factors specific to this population.
孕前体重指数（BMI）与纯母乳喂养之间呈负相关，但相关机制仍不清楚。因此，本研究旨在确定孕前高 BMI 与产后 6 周纯母乳喂养之间的负相关是否由能力、机会和动机行为（COM-B）模型的组成部分介导。在这项前瞻性观察性研究中，我们将 360 名初产妇分为孕前超重/肥胖组（n=180）和正常 BMI 组（n=180）。设计了一个结构方程模型来研究能力（泌乳二期开始、感知奶量、母乳喂养知识和产后抑郁）、机会（促进母乳喂养的医院实践、社会影响、社会支持）和动机（母乳喂养意愿、母乳喂养自我效能和对母乳喂养的态度）如何影响不同孕前 BMI 组的妇女产后 6 周的纯母乳喂养。共有 342 名参与者（95.0%）拥有完整的数据。与正常 BMI 的女性相比，孕前 BMI 较高的女性在产后 6 周时更不可能进行纯母乳喂养。我们观察到孕前 BMI 较高对产后 6 周纯母乳喂养有显著的负向直接影响，以及孕前 BMI 通过能力（泌乳二期开始、感知奶量和母乳喂养知识）和动机（母乳喂养自我效能）对产后 6 周纯母乳喂养的解释性中介变量对产后 6 周纯母乳喂养有显著的负向间接影响。我们的研究结果支持某些能力（泌乳二期开始、感知奶量和母乳喂养知识）和动机（母乳喂养自我效能），部分解释了孕前高 BMI 与纯母乳喂养结果之间的负相关。我们建议，针对孕前 BMI 较高的妇女促进纯母乳喂养的干预措施应针对该人群的能力和动机因素。
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