爱婴医院院内外影响母乳喂养的多因素分析

目的 分析影响母乳喂养的因素,以提高母乳喂养率。方法 设计调查表对广州市1320例4个月婴儿的母乳喂养情况进行调查,并对影响纯母喂养率的因素进行回归分析。结果 4个月内纯母乳喂养率为56.5%,人工喂养率为7.3%,混合喂养率为36.2%。爱婴医院院内影响母乳喂养的主要因素有：母亲的年龄、职业、分娩方式、母婴同室、家庭经济水平、母乳喂养知识水平及母乳喂养态度等。采用多元回归分析的方法,筛选出影响纯母乳喂养持续行为的5个因素,其强度依次为：母乳量,母乳喂养咨询门诊,母亲患病,家庭经济收入,母乳喂养信念。结论 产妇出院后纯母乳喂养率逐月下降。提示我们应将妇幼保健服务从院内扩大到院外,采取有效的健康教育和干预措施,提高纯母乳喂养率。     

2003～2004年乌鲁木齐市维吾尔族婴儿母乳喂养状况调查

目的了解乌鲁木齐市维吾尔族婴儿母乳喂养状况。方法采用队列研究的方法,对362例新生儿的母亲进行了为期6个月的随访调查。结果产妇出院时婴儿的纯母乳喂养率为15.5%。几乎纯母乳喂养率为70.4%,80%母乳喂养率为6.1%,50%母乳喂养率为1.4%,20%母乳喂养率为1.7%,人工喂养率为5.0%。在随访的母乳喂养婴儿中,0.5个月、1.5个月、2.5个月、3.5个月、4.5个月和6个月的纯母乳喂养率分别为9.9%、17.8%、1.5%、0.4%、0%、0%;几乎纯母乳喂养率分别为81%、72.2%、76.7%、47.1%、1.7%、3.3%;80%母乳喂养率分别为6.7%、4.8%、9.1%、23.8%、41.3%、1.4%;50%母乳喂养率分别为0%、0.9%、7.3%、11.2%、17.0%、5.1%;20%母乳喂养率分别为1.5%、1.5%、1.8%、13.9%、35.2%、59.1%;人工喂养率分别为0.9%、2.7%、3.6%、3.6%、4.8%、31.2%:考虑到产妇出院时的人工喂养率,上述各月份的人工喂养率分别为5.9%、7.7%、8.6%、8.6%、9.8%、36.2%。结论纯母乳喂养率较低,应该加强母乳喂养重要性的宣传,尽可能使婴儿母乳喂养时间延长到6个月。     

Being born and growing up in the Ribeirão Preto and São Luís cohorts

This thematic issue consists of 14 articles derived from studies of the BRISA birth cohort (Ribeirão Preto, State of São Paulo and São Luís, State of Maranhão, northeastern Brazil, a socially and economically less developed region). In these more than 40 years of existence, these cohorts have been able to document the increase in women''s education, the improvement of health conditions, the creation of a public Unified Health System (SUS) that provides universal and free access to health care, eradication of hunger, and transition of the nutritional status characterized by a decrease in malnutrition rates and an increase in obesity in Brazil. Particularly in reproductive health, the country experienced a significant drop in fertility, a decrease in maternal and child mortality, and an increase in breastfeeding rates. Universal access to prenatal care and hospital delivery was accompanied by an excessive number of cesareans without clinical indication and early-term births and premature births, largely due to scheduled cesareans. Articles with a longitudinal and transversal methodological approach are presented, using structural equation analysis and propensity score, together with multivariate regressions, which gave a robust analytical treatment to articles in this thematic issue.     

Pregnancy related issues in inflammatory bowel disease: evidence base and patients' perspective

Inflammatory bowel disease (IBD) affects women of childbearing age and can influence fertility, pregnancy and decisions regarding breastfeeding. Women with IBD need to consider the possible course of disease during pregnancy, the benefits and risks associated with medications required for disease management during pregnancy and breastfeeding and the effects of mode of delivery on their disease. When indicated, aminosalicylates and thiopurines can be safely used during pregnancy. Infliximab and Adalimumab are considered probably safe during the first two trimesters. During the third trimester the placenta can be crossed and caution should be applied. Methotrexate is associated with severe teratogenicity due to its folate antagonism and is strictly contraindicated. Women with IBD tend to deliver earlier than healthy women, but can have a vaginal delivery in most cases. Caesarean sections are generally recommended for women with active perianal disease or after ileo-anal pouch surgery.While the impact of disease activity and medication has been addressed in several studies, there are minimal studies evaluating patients' perspective on these issues. Women's attitudes may influence their decision to have children and can positively or negatively influence the chance of conceiving, and their beliefs regarding therapies may impact on the course of their disease during pregnancy and/or breastfeeding. This review article outlines the impact of IBD and its treatment on pregnancy, and examines the available data on patients' views on this subject.     

First-time parents' experiences of home-based postnatal care in Sweden

Abstract

Aim. To gain a deeper understanding of first-time parents' experiences of early discharge from hospital after delivery and home-based postnatal care.

Material and methods. The study was comprised of focus group interviews, interviews with couples and with fathers. Twenty-one parents participated. Inclusion criteria: healthy women who have given birth to their first child after a normal pregnancy and delivery, the women's partners, healthy and full term babies, Swedish-speaking, discharge from the delivery ward within 24 hours, resident in the Uppsala community, the parents cohabited at the time of the delivery. The material was analysed by qualitative content analysis.

Results. Three themes emerged: The family's strategy, which describes the family's expectations of postnatal care and their experiences of the real situation. Some are flexible concerning going home early, and others have decided in advance. Self-reliance and strength, which explores the parents' feelings of security and uncertainty, freedom and independence, and shared responsibility. Breast-feeding is described as the ‘main thing’, an interactive learning process. Professional support in the home summarizes the parents' experience of the midwife's support at home. While conflicting feelings may be revealed during the first days, the midwife confirms their new roles as parents. The midwife is seen as a support and adviser to the parents.

Conclusion. This study shows that parents welcome home-based postnatal care with professional support from midwives. We conclude that this care suits healthy families. We think it will be more important in the future to discriminate between healthy families and those in need of hospital care, than to focus on the moment when they leave the hospital, early or late.     

Maternal Health, Breast-Feeding and Infant Nutrition in Australian Aborigines

Undernutrition is widespread in Australian Aboriginal infants and children and is associated with high rates of infections, particularly of the respiratory and gastrointestinal systems. Maternal ill health and under nutrition seem to be neglected factors which contribute to the high incidence of low birth weight in Aboriginal babies and to their poor growth in the first five years of life. More effective preventive programmes are needed to help overcome these problems.     

Breast-feeding and Social Factors

ABSTRACT. Information about every tenth child aged 14 to 38 months was collected by means of a questionnaire in Turku, Finland in March, 1983. This paper reports on duration of breastfeeding and its relation to social factors. The average duration of breast-feeding was 5.7 months. Length of breast-feeding was unaffected by sex, number of siblings, and birth order among siblings. The socioeconomic status of the father was associated with duration of breastfeeding: children in high status families were breast-fed longer than children in low status families. Mothers with occupations in the health service, education, and the social sector breast-fed longer than mothers in other occupations. Mothers who were working at the time of the study had breast-fed longer than housewives. For further promotion of breast-feeding, information must be made more effective in the lower social groups and among fathers.     

Prelacteal feeds and breast-feeding problems

A recent WHO sponsored study observed that health establishments in some developing countries tend to discourage breast-feeding. In order to determine the factors responsible for it, perinatal infant feeding-related experiences of 210 mother child pairs delivered in five different locales in Benin City, Nigeria, were investigated. It was found that while the participants were similar in relevant backgrounds and had generally similar experiences in the five delivery locales, those of two of the hospitals started bottle-feeding significantly earlier. They had more problems with breast-feeding and breast-fed their babies for shorter durations. These observations were found to be related to the practice of the so-called “pre-lacteal feeds” in the two hospital maternities.