In-Hospital Formula Use Increases Early Breastfeeding Cessation Among First-Time Mothers Intending to Exclusively Breastfeed
In-Hospital Formula Use Increases Early Breastfeeding Cessation Among First-Time Mothers Intending to Exclusively Breastfeed
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DOI：
10.1016/j.jpeds.2013.12.035
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发表时间：
2014-06-01
影响因子：
5.1
通讯作者：
Nommsen-Rivers, Laurie A.
中科院分区：
文献类型：
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作者：
Chantry, Caroline J.;Dewey, Kathryn G.;Nommsen-Rivers, Laurie A.
目的评估在医院配方奶粉补充首次打算纯母乳喂养的母亲，并确定是否在医院配方奶粉补充缩短母乳喂养时间调整后，母乳喂养intention.Study设计我们评估的力量母乳喂养的意图产前在一个不同的队列的预期产妇和婴儿喂养的做法，通过第60天。在计划纯母乳喂养健康足月儿>= 1周的母亲中，我们确定了院内配方奶粉补充的预测因素、原因和特征，并计算393例住院婴儿在30-60天未完全母乳喂养和60天停止母乳喂养的意向调整相对风险（ARR）。在产妇住院期间，婴儿完全接受母乳喂养，183名（47%）婴儿在医院接受配方奶粉补充。母亲在医院补充配方奶粉的最常见原因是：认为牛奶供应不足（18%），摄入量不足的迹象（16%）和不良的闩锁或母乳喂养（14%）。第30-60天未完全母乳喂养的患病率分别为67.8%和36.7%，ARR 1.8（95% CI，1.4-2.3），住院配方奶粉补充组与纯母乳喂养组，第60天停止母乳喂养的患病率分别为32.8%和10.5%，ARR 2.7（95% CI，1.7-4.5）。两种不良结局的几率随着更多的住院配方补充饲料而增加（未完全母乳喂养30-60天，P = 0.003和母乳喂养停止，P = 0.011）。在医院补充配方奶粉与30-60天未完全母乳喂养的风险增加近2倍，与30-60天未完全母乳喂养的风险增加近3倍。到第60天停止母乳喂养的风险增加一倍，即使在调整母乳喂养意图的强度之后。应设法避免不必要的住院配方奶粉补充，并在住院配方奶粉补充不可避免时支持母乳喂养。
Objective To evaluate in-hospital formula supplementation among first-time mothers who intended to exclusively breastfeed and determined if in-hospital formula supplementation shortens breastfeeding duration after adjusting for breastfeeding intention.Study design We assessed strength of breastfeeding intentions prenatally in a diverse cohort of expectant primiparae and followed infant feeding practices through day 60. Among mothers planning to exclusively breastfeed their healthy term infants for >= 1 week, we determined predictors, reasons, and characteristics of in-hospital formula supplementation, and calculated the intention-adjusted relative risk (ARR) of not fully breastfeeding days 30-60 and breastfeeding cessation by day 60 with in-hospital formula supplementation (n = 393).Results Two hundred ten (53%) infants were exclusively breastfed during the maternity stay and 183 (47%) received in-hospital formula supplementation. The most prevalent reasons mothers cited for in-hospital formula supplementation were: perceived insufficient milk supply (18%), signs of inadequate intake (16%), and poor latch or breastfeeding (14%). Prevalence of not fully breastfeeding days 30-60 was 67.8% vs 36.7%, ARR 1.8 (95% CI, 1.4-2.3), in-hospital formula supplementation vs exclusively breastfed groups, respectively, and breastfeeding cessation by day 60 was 32.8% vs 10.5%, ARR 2.7 (95% CI, 1.7-4.5). Odds of both adverse outcomes increased with more in-hospital formula supplementation feeds (not fully breastfeeding days 30-60, P = .003 and breastfeeding cessation, P = .011).Conclusions Among women intending to exclusively breastfeed, in-hospital formula supplementation was associated with a nearly 2-fold greater risk of not fully breastfeeding days 30-60 and a nearly 3-fold risk of breastfeeding cessation by day 60, even after adjusting for strength of breastfeeding intentions. Strategies should be sought to avoid unnecessary in-hospital formula supplementation and to support breastfeeding when in-hospital formula supplementation is unavoidable.