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Objective:To investigate the incidence of delayed onset of lactogenesis Ⅱ (DOL Ⅱ) in mothers of preterm infants and its influencing factors.Methods:This retrospective cohort study involved women who delivered prematurely at the Department of Obstetrics of the First Affiliated Hospital of Zhengzhou University from September 2021 to March 2022. Demographic and perinatal data of the subjects were collected. According to lactation outcome on the third day after delivery, these women were divided into DOL Ⅱ and non-DOL Ⅱ groups. The two groups' differences in general conditions were compared, and the potential factors influencing DOL Ⅱ were also analyzed. Chi-square test, two independent samples t-test, Mann-Whitney U test, and logistic regression analysis were used for statistical analysis. Results:There were 286 mothers of premature infants enrolled in this study, and 73 (25.5%) of them experienced DOL Ⅱ. The other 213 cases without DOL Ⅱwere included as the non-DOL Ⅱ group. Univariate analysis showed significant differences between the DOL Ⅱ and non-DOL Ⅱ groups in the following aspects: the proportion of women with adverse pregnancy history [28.8% (21/73) vs 41.8% (89/213), χ2=3.89], the proportion of primiparas [60.3% (44/73) vs 38.0% (81/213), χ2=10.93], the incidence of hypertensive disorders of pregnancy [35.6% (26/73) vs 16.4% (35/213), χ2=11.92], the time to initiate breastfeeding after birth[5.0 h (3.0-7.0 h) vs 4.0 h (2.0-5.0 h), Z=－4.27], and the frequency of breastfeeding or pumping within 48 h after delivery [7.0 times (6.0-9.0 times) vs 9.0 times (7.0-11.0 times), Z=－3.62] (all P<0.05). Multivariate logistic regression showed that primipara ( OR=2.720, 95% CI: 1.485-4.982), hypertensive disorders of pregnancy ( OR=3.178, 95% CI: 1.609-6.274), the time to initiate breastfeeding ( OR=1.394, 95% CI: 1.211-1.604) and the frequency of breastfeeding/pumping within 48 h after delivery ( OR=0.861, 95% CI: 0.772-0.962) were independent influencing factors for DOL Ⅱ (all P<0.05). Conclusions:?The factors that influence the occurrence of DOL Ⅱ in preterm mothers are primipara hypertensive disorders of pregnancy, breastfeeding initiation time after delivery, and the frequency of breastfeeding or pumping within 48 h postpartum.
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Objective:To systematically review the association between delivery mode and exclusive breastfeeding rate during hospitalization and within the first six months of life.Methods:Observational studies on the association between delivery mode and feeding pattern were searched from PubMed, Web of Science, Cochrane Library, EBSCO, China Biomedical Literature Database, CNKI, Wanfang Database, and VIP Database from inception to October 2022. Two independent reviewers screened the literature, extracted data, and assessed the quality of included studies using Critical Appraisal Tools published by Joanna Briggs Institute or Newcastle-Ottawa Quality Scale (NOS). This meta-analysis was performed using R 4.1.0 software. Fixed-effect or random-effect models were used to pool data. Egger test and funnel plot were used to assess publication bias.Results:A total of 34 studies involving 597 203 subjects were included, including 22 cross-sectional studies and 12 cohort studies. All of the 22 cross-sectional studies were B-level quality, and eleven out of the 12 included cohort studies scored 7 points or above on the NOS scale with high quality. The results of meta-analysis showed that the likelihood of exclusive breastfeeding during hospitalization of women who had cesarean section was lower than those who delivered vaginally ( OR=0.33, 95% CI: 0.22-0.50, P<0.001); and so was the likelihood of exclusive breastfeeding at six months postpartum ( OR=0.61, 95% CI: 0.47-0.79, P<0.001). Conclusion:Current evidence suggests that cesarean section is a disadvantage to exclusive breastfeeding during hospitalization and within six months after delivery.
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Objective:To explore the risk factors of delayed onset of lactogenesis stage Ⅱ(DOL Ⅱ) after cesarean section, and to establish a risk prediction model.Methods:This study involved 330 women who underwent cesarean section in the First Affiliated Hospital of Zhengzhou University from September 2021 to January 2022 and were further divided into DOL Ⅱ group ( n=104) or non-DOL Ⅱ group ( n=226). All clinical data were compared. Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors of DOL Ⅱ after cesarean section to establish the risk prediction model and draw nomogram. The predictive validity of the model was evaluated by the area under the receiver operating curve (AUC) and the goodness of fit was verified by Hosmer-Lemeshow test. Another 129 women who underwent cesarean section in our hospital from February to March 2022 were recruited for external validation. Results:The incidence of DOL Ⅱ in the model development and validation cohort were 31.5%(104/330) and 31.0%(40/129), respectively . In the model developing cohort, significant differences were shown in the constituent ratio of different groups of pre-pregnant body mass index {lean:[9.7%(22/226) vs 3.8%(4/104)]; fit: [66.8%(151/226) vs 62.5%(65/104)]; overweight or obsess:[23.5%(53/226) vs 33.7%(35/104)]}, the proportion of primiparas [50.4%(114/226) vs 61.5%(64/104)], breastfeeding education during pregnancy [64.2%(145/226) vs 40.4%(42/104)] and maternal separation [36.3%(82/226) vs 50.0%(52/104)], and the gestational age at delivery[38.0(36.0-39.0) vs 37.0(35.0-38.5) weeks] and frequency of breastfeeding within 48 h post-delivery [6.0(3.0-9.0) vs 2.0(0.5-5.0)] between the DOL Ⅱ and non-DOI Ⅱ group (all P<0.05). The predictors included in the model were pre-pregnancy overweight or obese ( OR=4.040, 95% CI:1.196-13.651), primipara ( OR=1.866, 95% CI:1.079-3.227), breastfeeding education during pregnancy ( OR=0.582, 95% CI:0.339-1.000), and frequency of breastfeeding within 48 h after delivery ( OR=0.791, 95% CI:0.720-0.857). The Hosmer-Lemeshow test showed that P=0.814 and the AUC was 0.784(95% CI:0.731-0.837). The Youden index was 1.504 with a sensitivity of 0.769 and a specificity of 0.735. While for the external validation, Hosmer-Lemeshow test showed that P=0.260 and the AUC was 0.751(95% CI:0.661-0.840). The Youden index was 1.460 with a sensitivity of 0.775 and a specificity of 0.685. Conclusion:The risk prediction model for DOL Ⅱ developed in this study has a good consistency and predictive performance, which can provide a reference for clinical screening of mothers at high risk of DOL Ⅱ following cesarean section.
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Objective:To analyze the factors influencing breast milk volume in mothers of preterm infants during the period of maternal separation.Methods:This study retrospectively analyzed the data from lactation diaries of mothers of preterm infants ( n=371) in neonatal intensive care unit from the first Affiliated Hospital of Zhengzhou University from January 2017 to August 2021. According to whether the milk production reached 800 ml/d or not within two weeks after delivery, these women were divided into the reached group ( n=289) or unreached group ( n=82). Two independent sample t-test and Chi-square test were used for univariate analysis, and logistic regression was used to analyze the influencing factors. Results:Mothers who achieved the target milk volume accounted for 77.9% (289/371). There were no statistically significant differences in the ratio of milk production ≥50 ml between breasts or between two adjacent breastfeeding sessions (both P>0.05), while there were statistically significant differences in the maternal education background[high school education or below:16.3% (47/289) vs 41.5% (34/82); junior college or above:83.7% (242/289) vs 58.5% (48/82); χ2=23.77], type of breast pump [diaphragm breast pump:34.9% (101/289) vs 51.2% (42/82); piston pump: 65.1% (188/289) vs 48.8% (40/82); χ2=7.14], pre-pregnancy body mass index [<18.5 kg/m 2: 3.5% (10/289) vs 4.9% (4/82);≥18.5～<24.0 kg/m 2: 90.7% (262/289) vs 61.0% (50/82); ≥24.0 kg/m 2: 5.9% (17/289) vs 34.1% (28/82); χ2=40.89], and the initiation of lactation instruction [within 7 d after delivery: 77.2% (223/289) vs 45.1% (37/82);at 7-14 d after delivery: 22.8%(66/289) vs 54.9%(45/82); χ2=31.28] between the reached and unreached group (all P<0.05). Logistic regression analysis showed that high school education or below ( OR=4.279, 95% CI: 2.253-8.126, P<0.001), diaphragm breast pump ( OR=2.352, 95% CI: 1.309-4.226, P=0.004), pre-pregnancy body mass index ≥24.0 kg/m 2 ( OR=9.352, 95% CI: 4.389-19.928, P<0.001), and seeking lactation consultation at 7-14 d after delivery ( OR=3.654, 95% CI: 2.043-6.535, P<0.001) were risk factors for not achieving the target milk volume. Conclusions:Instruction on breastfeeding for less-educated mothers of preterm infants should be strengthened. Using piston breast pump, maintaining pre-pregnancy body mass index within the normal range, and receiving lactation instruction as early as possible will contribute to achieving the target milk volume.