Kalluri Nikita S, Cordova-Ramos Erika G, Hwang Sunah S, Standish Katherine R, Parker Margaret G
Division of Neonatology, Department of Pediatrics, UMass Chan Medical School, Worcester, Massachusetts.
Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts.
JAMA Netw Open. 2025 May 1;8(5):e2510781. doi: 10.1001/jamanetworkopen.2025.10781.
The extent of mother's milk provision by race and ethnicity and its change over time is poorly understood in the US preterm population.
To examine US prevalence and trends over time of mother's milk initiation and continuation at 12 weeks after birth (2009-2019) by maternal race and ethnicity and to examine associations of maternal race and ethnicity and mother's milk initiation and continuation among mothers of preterm infants.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the nationally representative Pregnancy Risk Assessment Monitoring System database. Participants included mothers of preterm infants identifying as non-Hispanic Asian, non-Hispanic Black, Hispanic any race, or non-Hispanic White, with survey completion 12 or more weeks post partum from 2009 to 2019. Data were analyzed from February 2022 to June 2024.
Maternal race and ethnicity obtained from birth certificate data.
Mother's milk initiation and continuation at 12 weeks were assessed using survey questions. The overall prevalence and trends over time by maternal race and ethnicity were determined. Multivariable regression was used to analyze independent associations between maternal race and ethnicity and mother's milk initiation and continuation.
Among 1 523 131 (weighted) mother-preterm infant dyads, mother's milk initiation increased significantly from 2009 to 2019 for White and Black mothers but not for Asian or Hispanic mothers. Mother's milk provision at 12 weeks increased significantly among all groups. There were significant differences in mother's milk outcomes between groups. Initiation was highest for Asian mothers (92.8%; 95% CI, 91.1%-94.4%), followed by Hispanic (88.1%; 95% CI, 86.5%-89.8%), White (84.1%; 95% CI, 83.3%-84.9%), and Black (75.3%; 95% CI, 73.4%-76.6%) mothers. After adjusting for covariates of interest, compared with White mothers, initiation remained higher for Asian (adjusted relative risk [aRR], 1.09; 95% CI, 1.06-1.12) and Hispanic (aRR, 1.10; 95% CI, 1.08-1.12) mothers. Continuation at 12 weeks was highest for Asian mothers (65.4%; 95% CI, 62.7%-68.0%), followed by Hispanic (48.2%; 95% CI, 46.1%-50.3%), White (47.7%; 95% CI, 46.7%-48.7%), and Black (34.3%; 95% CI, 32.9%-35.7%) mothers. After adjustment, continuation was higher for Asian (aRR, 1.37; 95% CI, 1.24-1.47) and Hispanic (aRR, 1.33; 95% CI, 1.27-1.41) mothers compared with White mothers.
In this cross-sectional study, mother's milk provision among preterm infants increased from 2009 to 2019, but notable racial and ethnic disparities persist. Future work should address barriers to continued provision of mother's milk for preterm infants.
在美国早产人群中，按种族和族裔划分的母乳供应情况及其随时间的变化尚不清楚。
研究2009 - 2019年按母亲种族和族裔划分的美国早产婴儿出生后12周开始母乳喂养及持续母乳喂养的患病率和时间趋势，并研究早产婴儿母亲的种族和族裔与开始母乳喂养及持续母乳喂养之间的关联。
设计、背景和参与者：这项横断面研究使用了具有全国代表性的妊娠风险评估监测系统数据库中的数据。参与者包括早产婴儿的母亲，她们分别为非西班牙裔亚洲人、非西班牙裔黑人、任何种族的西班牙裔或非西班牙裔白人，调查在产后12周或更长时间完成，时间跨度为2009年至2019年。数据于2022年2月至2024年6月进行分析。
从出生证明数据中获取的母亲种族和族裔。
使用调查问题评估出生后12周开始母乳喂养及持续母乳喂养的情况。确定了按母亲种族和族裔划分的总体患病率和时间趋势。使用多变量回归分析母亲种族和族裔与开始母乳喂养及持续母乳喂养之间的独立关联。
在1523131对（加权）母亲 - 早产婴儿二元组中，2009年至2019年，白人母亲和黑人母亲开始母乳喂养的比例显著增加，而亚洲或西班牙裔母亲则没有。所有组在12周时的母乳喂养率均显著增加。各群体之间的母乳喂养结果存在显著差异。亚洲母亲开始母乳喂养的比例最高（92.8%；95%置信区间，91.1% - 94.4%），其次是西班牙裔（88.1%；95%置信区间，86.5% - 89.8%）、白人（84.1%；95%置信区间，83.3% - 84.9%）和黑人（75.3%；95%置信区间，73.4% - 76.6%）母亲。在调整了相关协变量后，与白人母亲相比，亚洲（调整后相对风险[aRR]，1.09；95%置信区间，1.06 - 1.12）和西班牙裔（aRR，1.10；95%置信区间，1.08 - 1.12）母亲开始母乳喂养的比例仍然较高。12周时持续母乳喂养的比例亚洲母亲最高（65.4%；95%置信区间，62.7% - 68.0%），其次是西班牙裔（48.2%；95%置信区间，46.1% - 50.3%）、白人（47.7%；95%置信区间，46.7% - 48.7%）和黑人（34.3%；95%置信区间，32.9% - 35.7%）母亲。调整后，与白人母亲相比，亚洲（aRR，1.37；95%置信区间，1.24 - 1.47）和西班牙裔（aRR，1.33；95%置信区间，1.27 - 1.41）母亲持续母乳喂养的比例更高。
在这项横断面研究中，2009年至2019年早产婴儿的母乳喂养率有所增加，但显著的种族和族裔差异仍然存在。未来的工作应解决持续为早产婴儿提供母乳的障碍。
