Kalhor Mehri, Yazdkhasti Mansoureh, Simbar Masoumeh, Hajian Sepideh, Kiani Zahra, Khorsandi Behjat, Sattari Mahtab, Ezadi Zainab, Nazem Haniyeh, Jafari Massoma
Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical sciences, Tehran, Iran.
Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Karaj, Iran.
Int Breastfeed J. 2025 Jul 2;20(1):52. doi: 10.1186/s13006-025-00744-2.
Breast milk is the ideal and complete food for infants. Demographic, social, economic and clinical factors affect exclusive breastfeeding (EBF). Identifying and understanding these factors can improve breastfeeding success. This study systematically reviews and analyzes the predictors of EBF.
This study is a systematic review and meta-analysis. we searched electronic databases including PubMed/MEDLINE, Web of Science, PsycINFO, Cochrane, Scopus, EMBASE, Google Scholar, SID, and Magiran. we examined articles published between 2000 to 2023 using keywords like "risk factors", "related factors", "predictive factors", "exclusive breastfeeding ", and "women". The review included observational studies. Two reviewers independently selected the studies extracted data. Quality assessment was based on the Newcastle-Ottawa Scale. The association between predictive factors and breastfeeding was combined in a meta-analysis using a restricted maximum likelihood method (REML). Heterogeneity was quantified using I and investigated through meta-regression, subgroup, and sensitivity analyses, while publication bias was assessed via a funnel plot.
Thirty eight articles were included in this review. Predictive factors in EBF were categorized into seven groups: mother's awareness of breastfeeding benefits, support received in breastfeeding and child-rearing, early breastfeeding after birth, mother's education level, annual income, mother's age, and prenatal care. Nineteen articles with a sample size of 70,183 were included in the meta-analysis. Results showed that a mother's awareness of breastfeeding benefits increases the odds of EBF by 2.70 times, support in child-rearing by 2.57 times, early breastfeeding (< 24 h) by 1.853 times, higher education level by 1.44 times, self-efficacy by 1.067, multiparity ≥ 2 by 1.50 times, having upper-middle annual income was associated with 28.3% higher than odds of EBF (95% CI 1.68, 1.54), female sex of infant by 1.07 times, and one to three antenatal visits by 0.108 times, (95% CI 1.27, 4.18). In normal vaginal delivery (NVD), the odds increased 2.22 fold, all statistically significant (95% CI 0.91, 5.43).
The maternal awareness of the benefits of breastfeeding, maternal support, early breastfeeding, high education level, and improved family economic conditions are associated with EBF. Therefore, improving the educational, social, and economic levels of mothers improves EBF.
PROSPERO CRD42023483049.
母乳是婴儿理想的全营养食物。人口统计学、社会、经济和临床因素会影响纯母乳喂养（EBF）。识别并理解这些因素有助于提高母乳喂养的成功率。本研究系统回顾并分析了纯母乳喂养的预测因素。
本研究为系统回顾和荟萃分析。我们检索了包括PubMed/MEDLINE、Web of Science、PsycINFO、Cochrane、Scopus、EMBASE、Google Scholar、SID和Magiran在内的电子数据库。我们使用“风险因素”“相关因素”“预测因素”“纯母乳喂养”和“女性”等关键词，检索了2000年至2023年发表的文章。该综述纳入了观察性研究。两名评审员独立选择研究、提取数据。质量评估基于纽卡斯尔-渥太华量表。使用限制最大似然法（REML）对预测因素与母乳喂养之间的关联进行荟萃分析。使用I²对异质性进行量化，并通过荟萃回归、亚组分析和敏感性分析进行研究，同时通过漏斗图评估发表偏倚。
本综述纳入了38篇文章。纯母乳喂养的预测因素分为七组：母亲对母乳喂养益处的认知、母乳喂养和育儿过程中获得的支持、产后早期母乳喂养、母亲的教育水平、年收入、母亲年龄和产前护理。荟萃分析纳入了19篇样本量为70183的文章。结果显示，母亲对母乳喂养益处的认知使纯母乳喂养的几率增加2.70倍，育儿支持增加2.57倍，早期母乳喂养（<24小时）增加1.853倍，高等教育水平增加1.44倍，自我效能增加1.067倍，多胎妊娠≥2次增加1.50倍，中高年收入与纯母乳喂养几率高28.3%相关（95%CI 1.68，1.54），婴儿为女性增加1.07倍，产前检查1至3次增加0.108倍（95%CI 1.27，4.18）。在正常阴道分娩（NVD）中，几率增加2.22倍，均具有统计学意义（95%CI 0.91，5.43）。
母亲对母乳喂养益处的认知、母亲的支持、早期母乳喂养、高教育水平以及家庭经济状况的改善与纯母乳喂养相关。因此，提高母亲的教育、社会和经济水平可改善纯母乳喂养情况。
PROSPERO CRD42023483049。
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