Salama Eman S, Hussein Mostafa, Fetih Ahmed N, Abul-Fadl Azza M A, Elghazally Shimaa A
Obstetrics & Gynecology Department, Faculty of Medicine, Merit University, Sohag Al Gadida City, Egypt.
Obstetrics & Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
J Egypt Public Health Assoc. 2024 Oct 14;99(1):27. doi: 10.1186/s42506-024-00172-w.
There is growing evidence that supports the role of breastfeeding in reducing the burden of non-communicable diseases (NCDs). There are considerable gaps in breastfeeding outcomes in mothers with chronic diseases due to a lack of knowledge and support in the postpartum period. Mothers who have NCDs and pregnancy complications are at risk of breastfeeding failure.
To compare breastfeeding outcomes in mothers with NCDs with healthy mothers and determine the underlying challenges that lead to poor outcomes.
A prospective cohort study was conducted among 150 women (50 with high-risk pregnancies (HRP) and 100 with normal pregnancies (NP)). They were recruited from those attending the immunization and outpatient clinics at Sohag General Hospital. Mothers were recruited at 34 weeks gestation and were followed up at 2 weeks, 6 weeks, and 6 months after delivery. A pretested and validated questionnaire was used to collect detailed epidemiological, personal, health-related status, medications, hospitalizations, reproductive history, current delivery, and previous breastfeeding experiences. On follow-up they were assessed for breastfeeding practices, their health and health and growth of their children, and social support.
Delivery by cesarean section and postpartum bleeding were commoner among HRP patients. Initiation of breastfeeding in the 1st hour of delivery was significantly lower among women with HRP than those with normal pregnancies (48.0% versus 71.0%, p = 0.006). The most common reason for not initiating breastfeeding among the NP group was insufficient milk (34.5%), while in the HRP group, it was the mother's illness (80.8%). Skin-to-skin contact with the baby after birth was significantly less practiced in the HRP than in the NP group (38.0% vs 64.0% at p = 0.003). Herbs (such as cumin, caraway, cinnamon, aniseed, and chamomile) were the most common pre-lacteal feeds offered (63.0% in NP vs 42.0% in HRP). Artificial milk was more used in HRP than NP (24.0% vs 4.0%). Breast engorgement was 3 times more common in the HRP compared to the NP group (61.5% vs19.6%). Stopping breastfeeding due to breast problems was 2.5 times higher in the HRP than in the NP group (38.5% vs. 15.2%, p = 0.003). Nipple fissures were twice as common among the NP than among the HRP group ((73.0%) vs. (38.5%), p = 0.026). Exclusive breastfeeding during the period of follow-up was lower in the HRP than in the NP group (40.0% vs 61.0%, p < 0.05) and formula feeding was twice as common in the HRP as in the NP group (34.0% vs. 18.0%, p = 0.015). Child illness was significantly higher among women with HRP than those with NP (66.0% vs 48.0%, p = 0.037).
Women with HRP are at a high risk of poor breastfeeding outcomes with increased lactation problems and formula feeding rates. Encouraging women especially those with HRP to achieve optimal breastfeeding practices is a simple intervention that can be included in daily practice and may have a positive impact on mothers' health.
越来越多的证据支持母乳喂养在减轻非传染性疾病（NCDs）负担方面的作用。由于产后缺乏知识和支持，慢性病母亲的母乳喂养结果存在相当大的差距。患有非传染性疾病和妊娠并发症的母亲有母乳喂养失败的风险。
比较患有非传染性疾病的母亲与健康母亲的母乳喂养结果，并确定导致不良结果的潜在挑战。
对150名女性进行了一项前瞻性队列研究（50名高危妊娠（HRP）女性和100名正常妊娠（NP）女性）。她们是从索哈格综合医院的免疫和门诊诊所就诊的人群中招募的。母亲们在妊娠34周时被招募，并在产后2周、6周和6个月进行随访。使用经过预测试和验证的问卷收集详细的流行病学、个人、健康相关状况、药物治疗、住院情况、生殖史、当前分娩情况和以前的母乳喂养经历。在随访中，评估她们的母乳喂养情况、自身健康状况以及孩子的健康和成长情况，以及社会支持情况。
剖宫产和产后出血在HRP患者中更为常见。HRP女性在分娩后第1小时开始母乳喂养的比例显著低于正常妊娠女性（48.0%对71.0%，p = 0.006）。NP组中不开始母乳喂养的最常见原因是乳汁不足（34.5%），而在HRP组中，是母亲的疾病（80.8%）。HRP组产后与婴儿皮肤接触的比例明显低于NP组（38.0%对64.0%，p = 0.003）。草药（如孜然、香菜、肉桂、茴芹和洋甘菊）是最常见的产前喂养食物（NP组为63.0%，HRP组为42.0%）。HRP组比NP组更多地使用人工奶粉（24.0%对4.0%）。HRP组乳房胀痛的发生率是NP组的3倍（61.5%对19.6%）。因乳房问题停止母乳喂养的比例HRP组比NP组高2.5倍（38.5%对15.2%，p = 0.003）。乳头皲裂在NP组中的发生率是HRP组的两倍（（73.0%）对（38.5%），p = 0.026）。随访期间纯母乳喂养的比例HRP组低于NP组（40.0%对61.0%，p < 0.05），配方奶喂养在HRP组中的发生率是NP组的两倍（34.0%对18.0%，p = 0.015）。HRP女性的孩子患病比例显著高于NP女性（66.0%对48.0%，p = 0.037）。
HRP女性母乳喂养结果不佳的风险较高，泌乳问题和配方奶喂养率增加。鼓励女性尤其是HRP女性实现最佳母乳喂养做法是一种简单的干预措施，可以纳入日常实践，可能对母亲的健康产生积极影响。
