Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA.
College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA.
Breastfeed Med. 2024 Apr;19(4):262-274. doi: 10.1089/bfm.2023.0180. Epub 2024 Mar 27.
Despite known benefits of breastfeeding, including prevention against infections for infants, in the presence of numerous barriers, less than half of infants in high-income countries breastfeed for 6 months. One potential barrier to breastfeeding is birth by cesarean section (C-Section), which can invoke long-term difficulties. However, our structured literature review found that existing empirical research does not fully elucidate this relationship due to differences in operationalization of C-section and breastfeeding, omission of important confounders, and failure to exclude those who did not initiate breastfeeding (or use time-to-event analyses). In this article, we attempt to overcome these limitations. We analyzed data from 14,414 mother-infant dyads enrolled in the United Kingdom-based prospective Millennium Cohort Study, beginning in 2001. Using multivariable logistic regression, we examined the association between mode of birth (vaginal, emergency C-section, and elective C-section) and likelihood of breastfeeding initiation. We then applied adjusted Accelerated Failure Time survival models to examine the associations between mode of birth and duration of any and exclusive breastfeeding. Those with planned (but not emergency) C-section were less likely to initiate breastfeeding (odds ratio: 0.84, 95% confidence interval [CI]: 0.71-0.99) relative to vaginal births. However, those with either planned or unplanned C-section discontinued both any and exclusive breastfeeding sooner than vaginal births. This effect was more pronounced for those with planned C-section (time ratio [TR]: 0.75, 95% CI: 0.64-0.89) than unplanned C-section (TR: 0.85, 95% CI: 0.74, 0.97) compared with vaginal births. Through application of rigorous methods, this study provides compelling evidence that breastfeeding duration may be impeded by C-section birth. The findings suggest that additional support for mothers who intend to breastfeed and have a C-section birth may be warranted.
尽管母乳喂养有诸多益处，包括预防婴儿感染，但在存在众多障碍的情况下，高收入国家中只有不到一半的婴儿母乳喂养 6 个月。母乳喂养的一个潜在障碍是剖腹产（C -section），这可能会带来长期的困难。然而，我们的系统文献综述发现，由于 C -section 和母乳喂养的操作化方式不同、重要混杂因素的遗漏以及未能排除那些未开始母乳喂养（或使用时间事件分析）的人，现有实证研究并未充分阐明这种关系。在本文中，我们试图克服这些限制。我们分析了来自 14414 对母婴对的英国前瞻性千年队列研究的数据，该研究于 2001 年开始。我们使用多变量逻辑回归，检查了分娩方式（阴道分娩、紧急 C -section 和选择性 C-section）与母乳喂养开始的可能性之间的关联。然后，我们应用调整后的加速失效时间生存模型，检查分娩方式与任何和纯母乳喂养持续时间之间的关联。与阴道分娩相比，有计划性（但非紧急）C-section 的产妇开始母乳喂养的可能性较低（比值比：0.84，95%置信区间[CI]：0.71-0.99）。然而，无论是计划性还是非计划性 C-section 的产妇，停止任何和纯母乳喂养的时间都早于阴道分娩。与非计划性 C-section（TR：0.85，95%CI：0.74，0.97）相比，计划性 C-section 的产妇这种影响更为明显（TR：0.75，95%CI：0.64-0.89）。通过应用严格的方法，本研究提供了令人信服的证据，表明 C-section 分娩可能会阻碍母乳喂养的持续时间。研究结果表明，可能需要为那些打算母乳喂养且有 C-section 分娩的母亲提供额外的支持。
