Translational Medicine, The Hospital for Sick Children, Toronto ON, Canada; Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada.
Department of Nutritional Sciences, University of Toronto, Toronto ON, Canada.
Adv Nutr. 2024 Jun;15(6):100228. doi: 10.1016/j.advnut.2024.100228. Epub 2024 Apr 11.
Maternal adiposity impacts lactation performance, but the pathways are unclear. We conducted a systematic review to understand whether maternal adiposity (body mass index [BMI] or percentage fat mass) is associated with onset of lactogenesis II (copious milk; hours), human milk production (expressed volume/24 h), and infant consumption of mother's own milk (volume/24 h). We used random-effects standard meta-analyses to compare the relative risk (RR) of delayed lactogenesis II (>72 h) between mothers classified as underweight (BMI <18.5 kg/m), healthy weight (BMI, 18.5-24.9 kg/m), and overweight/obese (BMI ≥25 kg/m) and random-effects meta-regressions to examine associations with hours to lactogenesis II and infant milk consumption. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. We included 122 articles. Mothers with underweight (RR: 0.64; 95% CI: 0.49, 0.83; I = 39.48%; 8 articles/data points) or healthy weight status (RR: 0.67; 95% CI: 0.57, 0.79; I = 70.91%; 15 articles/data points) were less likely to experience delayed lactogenesis II than mothers with overweight/obesity. We found no association between maternal BMI and time to onset of lactogenesis II (β: 1.45 h; 95% CI: -3.19, 6.09 h; P = 0.52, I = 0.00%; 8 articles, 17 data points). Due to limited data, we narratively reviewed articles examining BMI or percentage fat mass and milk production (n = 6); half reported an inverse association and half no association. We found no association between maternal BMI (β: 6.23 mL; 95% CI: -11.26, 23.72 mL; P = 0.48, I = 47.23%; 58 articles, 75 data points) or percentage fat mass (β: 7.82 mL; 95% CI: -1.66, 17.29 mL; P = 0.10, I = 28.55%; 30 articles, 41 data points) and infant milk consumption. The certainty of evidence for all outcomes was very low. In conclusion, mothers with overweight/obesity may be at risk of delayed lactogenesis II. The available data do not support an association with infant milk consumption, but the included studies do not adequately represent mothers with obesity. This study was registered in PROSPERO as 285344.
母体肥胖会影响哺乳表现，但具体机制尚不清楚。我们进行了一项系统评价，旨在了解母体肥胖（体重指数[BMI]或体脂百分比）是否与泌乳二期的开始（大量乳汁；时间）、人乳产量（24 小时表达量）和婴儿对母亲自身乳汁的摄入（24 小时量）有关。我们使用随机效应标准荟萃分析比较了超重/肥胖（BMI≥25kg/m2）、健康体重（BMI，18.5-24.9kg/m2）和体重不足（BMI＜18.5kg/m2）母亲中泌乳二期延迟（＞72 小时）的相对风险（RR），并使用随机效应荟萃回归来检查与泌乳二期开始时间和婴儿乳汁摄入量的关联。使用推荐评估、制定和评估方法（Grading of Recommendations, Assessment, Development and Evaluation approach）评估证据的确定性。我们纳入了 122 篇文章。体重不足（RR：0.64；95%置信区间：0.49，0.83；I = 39.48%；8 篇文章/数据点）或健康体重状态（RR：0.67；95%置信区间：0.57，0.79；I = 70.91%；15 篇文章/数据点）的母亲比超重/肥胖的母亲更不容易出现泌乳二期延迟。我们未发现母体 BMI 与泌乳二期开始时间之间存在关联（β：1.45 小时；95%置信区间：-3.19，6.09 小时；P = 0.52，I = 0.00%；8 篇文章，17 个数据点）。由于数据有限，我们对研究 BMI 或体脂百分比和乳汁产量的文章进行了叙述性综述（n=6）；一半报告了反比关系，一半没有关联。我们未发现母体 BMI（β：6.23mL；95%置信区间：-11.26，23.72mL；P = 0.48，I = 47.23%；58 篇文章，75 个数据点）或体脂百分比（β：7.82mL；95%置信区间：-1.66，17.29mL；P = 0.10，I = 28.55%；30 篇文章，41 个数据点）与婴儿乳汁摄入量之间存在关联。所有结局的证据确定性都非常低。总之，超重/肥胖的母亲可能存在泌乳二期延迟的风险。现有数据不支持与婴儿乳汁摄入量有关，但纳入的研究并不能充分代表肥胖母亲。本研究已在 PROSPERO 中注册为 285344。
