Early Term Delivery and Breastfeeding Outcomes
Early Term Delivery and Breastfeeding Outcomes
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DOI：
10.1007/s10995-019-02787-4
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发表时间：
2019-10-01
影响因子：
2.3
通讯作者：
Borders, Ann E. B.
中科院分区：
文献类型：
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作者：
Keenan-Devlin, Lauren S.;Awosemusi, Yetunde F.;Borders, Ann E. B.
目的早产儿（37.0 ~ 38.6周）母乳喂养不良结局发生率高于足月儿（≥ 39.0周），但母乳喂养不良结局的差异尚未得到系统评价。本研究在美国大样本中调查了早期和足月婴儿的母乳喂养开始和排他性。该二次分析包括来自母亲压力测量研究队列的743名地理和种族多样化的妇女，以及来自伊利诺伊州埃文斯顿医院诊所质量评估的295名妇女。仅包括分娩>= 37周的受试者。出院后通过电子病历审查评估开始母乳喂养（IBF）和纯母乳喂养（EBF）。通过单因素和多因素Logistic回归分析评估IBF和EBF与早期和足月分娩的关系。结果在872名符合入选条件的女性中，IBF占85.7%，EBF占44.0%。早产与IBF发生率的任何差异无关（p = 0.43），但与EBF发生率显著降低相关（未校正OR 0.61，95%CI 0.466，0.803，p < 0.001）。在校正了母亲糖尿病、妊娠期高血压疾病、剖宫产、母亲年龄、种族/民族、产次、医疗补助状况、NICU入院、当前吸烟和分娩医院后，这种关联仍然显著（校正OR 0.694，95% CI 0.515，0.935，p = 0.016）。尽管母乳喂养的起始频率相当，但与足月儿相比，早产儿完全母乳喂养的可能性明显降低。这些数据表明，有早产儿的妇女可能会受益于有关母乳喂养困难的潜在咨询以及分娩后额外的母乳喂养支持。
Objective Higher rates of adverse outcomes have been reported for early term (37 0 to 38 6 weeks) versus full term (>= 39 0 weeks) infants, but differences in breastfeeding outcomes have not been systematically evaluated. This study examined breastfeeding initiation and exclusivity in early and full term infants in a large US based sample. Methods This secondary analysis included 743 geographically- and racially-diverse women from the Measurement of Maternal Stress Study cohort, and 295 women from a quality assessment at a hospital-based clinic in Evanston, IL. Only subjects delivering >= 37 weeks were included. Initiation of breastfeeding (IBF) and exclusive breastfeeding (EBF) were assessed via electronic medical record review after discharge. Associations of IBF and EBF with early and full term delivery were assessed via univariate and multivariate logistic regression. Results Among 872 women eligible for inclusion, 85.7% IBF and 44.0% EBF. Early term delivery was not associated with any difference in frequency of IBF (p = 0.43), but was associated with significantly lower odds of EBF (unadjusted OR 0.61, 95% CI 0.466, 0.803, p < 0.001). This association remained significant (adjusted OR 0.694, 95% CI 0.515, 0.935, p = 0.016) after adjusting for maternal diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal age, race/ethnicity, parity, Medicaid status, NICU admission, current smoking, and delivery hospital. Conclusions for Practice Despite comparable breastfeeding initiation frequencies, early term infants were significantly less likely to be exclusively breastfed compared to full term infants. These data suggest that women with early term infants may benefit from counseling regarding the potential for breastfeeding difficulties as well as additional breastfeeding support after delivery.