Attitude towards breast feeding and its influencing factors among postpartum women 3 days after delivery in Shanghai
LI Wen-xian and LI Bing-ying contributed equally to this article
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摘要:
目的 调查上海市产后3 d内的妇女的母乳喂养态度和新生儿喂养方式，分析产妇生理、心理健康因素和卫生保健服务对产妇喂养意愿的影响。 方法 2020年6月-7月在全市43家助产医疗机构连续纳入分娩后3 d以内的产妇，在其出院前，采用结构性调查表、爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale, EPDS)、广泛性焦虑障碍量表(Generalized Anxiety Disorder 7 Scale, GAD-7)和中文版Iowa婴儿喂养态度量表(Iowa Infant Feeding Attitude Scale, IIFAS)，调查产妇的喂养态度和行为。采用t检验、单因素方差分析以及多元线性回归模型、Logistic回归分析模型进行统计学分析。 结果 研究共纳入991名产后3 d内的妇女，喂养态度IIFAS平均得分为(59.85±7.22)分。持有积极母乳喂养态度的产妇进行纯母乳喂养的可能性是持有积极的奶粉喂养态度的产妇的1.645倍(95% CI: 1.148~2.357)。单因素分析显示，文化程度、分娩医院类别、有无广泛性焦虑障碍症状(GAD-7≥10分)、有无产后抑郁症状(EPDS≥10分)和住院分娩期间是否接受医务人员母乳喂养指导这5个因素组间IIFAS得分差异均有统计学意义(均有P < 0.05);多元线性回归分析显示，IIFAS得分与分娩医院类别和有无产后抑郁症状有关(均有P < 0.05)。 结论 上海市产后3 d内母乳喂养态度积极的妇女进行纯母乳喂养的可能性较高。对抑郁倾向孕产妇早识别早干预可改善婴儿喂养态度。此外，应提升三级综合医院和二级妇产科专科医院母乳喂养支持服务能力，加强母乳喂养知识科普宣传，提供个性化咨询与指导，以引导孕产妇积极的母乳喂养态度，将保护、促进和支持母乳喂养作为妇幼全生命周期营养与健康的重要起点。 Abstract:Objective To investigate the newborn feeding attitude among postpartum women three days after delivery in Shanghai, and to analyze the effect of physiological and psychological factors and health care services on breastfeeding intention. Methods From June to July 2020, a cross sectional study involving 43 hospitals throughout Shanghai was performed. Postpartum women within three days hospitalization stay were asked to complete the self-designed scale including demographics, health information, Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7-item Scale (GAD-7) and simplified Chinese version of the Iowa Infant Feeding Attitude Scale (IIFAS). One-way analysis of variance, t test, multiple linear regression and multiple Logistic regression were used as statistical methods. Results In total, 991 postpartum women within 3 days hospitalization stay were investigated. The average score of IIFAS was (59.85±7.22) points. Mothers with IIFAS score >61 points were 1.645 times more likely to breastfeed exclusively than those with IIFAS score < 55 points (95% CI: 1.148-2.357). In the univariate analysis, the following variables were related to IIFAS scores: education degree, type of hospital, anxiety, depression and postpartum breastfeeding guide (all P < 0.05). The multiple linear regressions showed that IIFAS scores were associated with EPDS and hospital category. Conclusions The hospitalized postpartum women with positive attitudes towards breastfeeding are more likely to be breastfeeding exclusively. Early recognition and intervention for pregnant and postpartum women with symptoms of depression could improve infant feeding attitude. It is necessary to promote breastfeeding support service in third-grade general hospitals and second-grade women and children's specialized hospitals, including health education about breastfeeding knowledge, individualized counseling and guiding, to cultivate positive attitude of breastfeeding. -
Key words:
- Infant feeding attitude /
- Breastfeeding /
- Influencing factors
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表 1 不同分组产后3 d内的妇女IIFAS得分情况及组间IIFAS得分的比较
Table 1. Comparison of IIFAS scores of women within 3 d postpartum and IIFAS scores between different groups
分组 例数[n (%)] IIFAS得分(x±s) t/F值 P值 年龄(岁) 1.082 a 0.339 < 30 472(47.63) 59.65±6.96 30~ < 35 362(36.53) 59.81±7.06 ≥35 134(13.52) 60.68±8.16 不详b 23(2.32) 59.83±9.18 宝宝性别 1.614 a 0.107 男 510(51.46) 59.53±7.04 女 481(48.54) 60.26±7.20 户籍 0.955 a 0.340 上海市户籍 388(39.15) 60.12±7.39 非上海市户籍 603(60.85) 59.67±7.13 文化程度 3.796 c 0.023 高中及以下 246(24.90) 59.96±7.20 大专/本科 622(62.65) 59.49±7.32 硕士及以上 123(12.45) 61.44±6.60 生育史 0.515 a 0.606 经产妇 361(36.43) 60.01±6.82 初产妇 611(61.65) 59.76±7.48 不详b 19(1.92) 60.00±6.49 分娩方式 0.154 a 0.878 阴道分娩/助产 560(56.51) 59.83±7.20 剖宫产 431(43.49) 59.90±7.27 分娩医院类别 7.049 c < 0.001 三级综合 255(25.73) 58.67±6.84 三级妇产科专科 198(19.98) 61.25±6.85 二级综合 148(14.93) 61.19±8.01 二级妇产科专科 390(39.36) 59.41±7.18 广泛性焦虑障碍(GAD-7≥10分) 2.866 a 0.004 无 942(95.06) 60.00±7.17 有 49(4.94) 56.98±7.66 产后抑郁症状(EPDS≥10分) 5.310 a < 0.001 无 728(73.46) 60.58±7.24 有 263(26.54) 57.85±6.81 住院分娩期间医务人员母乳喂养指导 2.444 a 0.017 有 927(93.54) 60.06±7.27 无 64(6.46) 58.17±5.86 是否早产 0.281 a 0.779 是 26(2.62) 60.27±10.97 否 953(96.17) 59.87±7.07 不详b 12(1.21) 57.83±9.26 婴儿出生体重 0.843 c 0.431 低出生体重儿 24(2.42) 60.96±11.29 正常出生体重儿 888(89.61) 59.93±7.10 巨大儿 67(6.76) 58.96±6.76 不详d 12 (1.21) 55.82±8.33 注：a表示t检验; b表示未纳入t检验; c表示F检验; d表示未纳入单因素方差分析。 
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表 2 上海市产后3 d内的妇女新生儿喂养态度影响因素的多元线性回归分析自变量赋值
Table 2. Multiple Linear regression analysis for independent variable assignment of factors influencing the feeding attitude of women within 3 days postpartum in Shanghai
分类变量 赋值 文化程度 高中及以下=(1，0，0)，大专/本科=(0，1，0)，硕士及以上=(0，0，1) 分娩医院类别 三级妇产科专科=(1，0，0，0)，三级综合=(0，1，0，0)，二级综合=(0，0，1，0)，二级妇产科专科=(0，0，0，1) 广泛性焦虑障碍(GAD-7≥10分) 无=0，有=1 产后抑郁(EPDS≥10分) 无=0，有=1 住院分娩期间医务人员母乳喂养指导 无=0，有=1
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表 3 上海市产后3 d内的妇女新生儿喂养态度影响因素的多元线性回归分析
Table 3. Multiple Linear regression analysis of influencing factors of newborn feeding attitudes in women within 3 days postpartum in Shanghai
变量 B ${s_{\bar x}}$值 β值 t值 P值 文化程度 高中及以下 1.000 大专/本科 -0.571 0.545 -0.038 -1.048 0.295 硕士及以上 1.074 0.820 0.049 1.310 0.190 分娩医院类别 三级妇产科专科 1.000 三级综合 -2.059 0.693 -0.124 -2.972 0.003 二级综合 0.443 0.807 0.022 0.549 0.583 二级妇产科专科 -1.328 0.637 -0.090 -2.085 0.037 广泛性焦虑障碍(GAD-7≥10分) -2.000 1.059 -0.060 -1.888 0.059 产后抑郁(EPDS≥10分) -2.368 0.525 -0.145 -4.512 < 0.001 住院分娩期间医务人员母乳喂养指导 -0.028 0.766 -0.001 -0.036 0.971
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表 4 上海市产后3 d内的妇女新生儿喂养态度与喂养行为的Logistic回归分析模型自变量赋值
Table 4. Logistic regression analysis for neonatal feeding attitudes and feeding behaviors in women within 3 days postpartum in Shanghai
变量 赋值 年龄 原值纳入 母乳喂养态度 积极的奶粉喂养态度=(0，0)，中等母乳喂养态度=(1，0)，积极的母乳喂养态度=(0，1) 户籍 上海市户籍=0，非上海市户籍=1 文化程度 高中及以下=(0，0)，大专/本科=(1，0)，硕士及以上=(0，1) 分娩方式 阴道分娩/助产=0，剖宫产=1
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表 5 上海市产后3 d内的妇女新生儿喂养态度与喂养行为的Logistic回归分析模型分析
Table 5. Logistic regression analysis of neonatal feeding attitudes and feeding behaviors of women in Shanghai within 3 days postpartum
变量 β值 ${s_{\bar x}}$值 Wald值 P值 OR(95%CI)值 母乳喂养态度 积极的奶粉喂养态度(IIFAS < 55) 1.000 中等母乳喂养态度(55≤IIFAS≤61) -0.053 0.191 0.077 0.782 0.948(0.652~1.379) 积极的母乳喂养态度(IIFAS > 61) 0.498 0.183 7.368 0.007 1.645(1.148~2.357) 年龄 0.028 0.017 2.829 0.093 1.028(0.995~1.062) 户籍 -0.178 0.150 1.414 0.234 0.837(0.624~1.122) 文化程度 高中及以下 1.000 大专/本科 0.145 0.179 0.658 0.417 1.156(0.814~1.641) 硕士及以上 0.467 0.253 3.400 0.065 1.595(0.971~2.620) 分娩方式 -0.191 0.144 1.755 0.185 0.827(0.623~1.096)
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