Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
BMJ Glob Health. 2024 Jun 10;9(6):e014223. doi: 10.1136/bmjgh-2023-014223.
Prelacteal feeding (PLF) is anything other than breastmilk given to newborns in the first few days of birth and/or before breastfeeding is established. PLF comes in many forms and is known as a challenge to optimal breastfeeding. Interestingly, both breastfeeding and PLF are common in Indonesia. This study investigated the association between PLF (any PLF, formula, honey, water and other milk) and breastfeeding duration.
This study used Indonesia Demographic and Health Surveys data from 2002, 2007 and 2017. Sample sizes were 5558 (2007), 6268 (2007) and 6227 (2017) mothers whose last child was aged 0-23 months. We used Cox regression survival analysis to assess the association between PLF and breastfeeding duration, estimating hazard ratios (HR) for stopping earlier.
Overall PLF was prevalent (59%, 67% and 45% in 2002, 2007 and 2017, respectively), with formula being the most common (38%, 50% and 25%). No association between any PLF and breastfeeding duration in 2002 (HR 0.90 (95% CI 0.70 to 1.16)), but in 2007 and 2017, mothers who gave any PLF were more likely to stop breastfeeding earlier than those who did not (HR 1.33 (95% CI 1.11 to 1.61) and 1.47 (95% CI 1.28 to 1.69), respectively), especially in the first 6 months (HR 2.13 (95% CI 1.55 to 2.92) and 2.07 (95% CI 1.74 to 2.47), respectively). This association was more consistent for milk-based PLF. For example, HR in 2017 was 2.13 (95% CI 1.78 to 2.53) for prelacteal formula and 1.73 (95% CI 1.39 to 2.15) for other milk. The associations were inconsistent for the other PLF types. Prelacteal water showed no association while prelacteal honey showed some association with a longer breastfeeding duration in 2002 and 2007.
The impact of PLF on breastfeeding duration varied by type. While this study supports current recommendations to avoid PLF unless medically indicated, the potential consequences of different PLF types on breastfeeding outcomes should be clearly communicated to healthcare providers and mothers. Further research should explore the reasons for the high PLF prevalence in this setting.
早于开奶期进食（PLF）是指在新生儿出生后的头几天内除母乳以外的任何食物或液体，以及在母乳喂养建立之前的任何食物或液体。PLF 有多种形式，是母乳喂养的主要障碍之一。有趣的是，印度尼西亚母乳喂养和 PLF 都很常见。本研究旨在探讨 PLF（任何 PLF、配方奶、蜂蜜、水和其他奶）与母乳喂养持续时间之间的关联。
本研究使用了 2002 年、2007 年和 2017 年印度尼西亚人口与健康调查的数据。样本量分别为 5558 名（2007 年）、6268 名（2007 年）和 6227 名（2017 年）最后一个孩子年龄在 0-23 个月的母亲。我们使用 Cox 回归生存分析来评估 PLF 与母乳喂养持续时间之间的关联，估计提前停止母乳喂养的风险比（HR）。
总体而言，PLF 很常见（2002 年、2007 年和 2017 年分别为 59%、67%和 45%），其中配方奶最常见（38%、50%和 25%）。2002 年，任何 PLF 与母乳喂养持续时间之间均无关联（HR 0.90（95%CI 0.70-1.16）），但在 2007 年和 2017 年，给予任何 PLF 的母亲比未给予任何 PLF 的母亲更有可能提前停止母乳喂养（HR 1.33（95%CI 1.11-1.61）和 1.47（95%CI 1.28-1.69）），尤其是在前 6 个月（HR 2.13（95%CI 1.55-2.92）和 2.07（95%CI 1.74-2.47））。这种关联在基于奶类的 PLF 中更为一致。例如，2017 年，PLF 配方奶的 HR 为 2.13（95%CI 1.78-2.53），其他奶类的 HR 为 1.73（95%CI 1.39-2.15）。对于其他 PLF 类型，关联不一致。PLF 水与母乳喂养持续时间无关联，而 PLF 蜂蜜在 2002 年和 2007 年与母乳喂养持续时间呈正相关。
PLF 对母乳喂养持续时间的影响因类型而异。虽然本研究支持目前避免 PLF 除非医学需要的建议，但应向医疗保健提供者和母亲明确传达不同 PLF 类型对母乳喂养结果的潜在影响。进一步的研究应探讨在这种情况下 PLF 高流行率的原因。
