孕妇妊娠期糖尿病和孕期体重增长对0~6个月纯母乳喂养影响的交互作用研究

目的探讨苏州地区0~6个月母乳喂养情况和相关影响因素,分析孕妇妊娠期糖尿病和孕期体重增长对母乳喂养的交互作用。方法选取2016年6月-2020年3月在苏州某医院就诊及分娩的4 256例符合入选标准的孕产妇作为研究对象。收集孕产妇基本情况、孕前体重、分娩前体重、分娩情况以及孕期妊娠糖尿病患病情况,并计算孕期体重变化。通过电话结合产后访视调查产后0~6个月母乳喂养情况。采用多因素logistic回归模型探索母乳喂养的影响因素,并通过Bootstrap方法分析孕妇妊娠期糖尿病和孕期体重增长对母乳喂养的交互作用。结果纳入研究的孕产妇平均年龄为(29.52±8.74)岁。15.20%的孕产妇患有妊娠糖尿病;14.80%的孕产妇孕期体重增长不足,而42.55%增长过度;57.38%的研究对象产后6个月内采取母乳喂养。多因素logistic回归分析结果显示,年龄在25岁以上(OR=1.68~3.82)、高中以上学历(OR=1.83~2.23)、足月生产孕产妇(OR=1.84)更倾向于母乳喂养,而孕前超重及肥胖(超重OR=0.82;肥胖OR=0.82)、有再次分娩意愿(OR=0.67)、妊娠期糖尿病(OR=0.61)及妊娠期体重增长过高(OR=0.61)或者过低者(OR=0.63)母乳喂养率更低。交互作用分析显示,并发妊娠糖尿病及孕期体重增长过低或过高者母乳喂养水平显著低于未患妊娠糖尿病且孕期体重增长正常者,交互作用指数为1.67(1.01,4.97)(P=0.02)。结论并发妊娠糖尿病及妊娠期体重增长过低或过高均为影响母乳喂养的重要因素,且二者存在相加交互作用。

Interaction of gestational diabetes mellitus and gestational weight gain of pregnant women on exclusive breastfeeding at 0-6 months postpartum

Objective To explore the status of breastfeeding at 0-6 months postpartum and its related influencing factors in Suzhou, and to analyze the interaction of gestational diabetes mellitus and gestational weight gain of pregnant women onbreastfeeding. Methods We selected 4,256 pregnant women who were hospitalized and delivered in a hospital in Suzhou from June 2016 to March 2020 and met the inclusion criteria to serve as the research subjects. Data about general information of the pregnant women, pre-pregnancy weight, pre-delivery weight, delivery status, and incidence of gestational diabetes mellitus during pregnancy were collected, and their weight change during pregnancy was calculated. The status of breastfeeding at 0-6 months postpartum was investigated by telephone follow-up combined with postpartum visits. Results The average age of the pregnant women included in the study was (29.52±8.74) years. 15.20% of the pregnant women suffered from gestational diabetes mellitus. 14.80% of the pregnant women had insufficient weight gain during pregnancy, while 42.55% had excessive weight gain. 57.38% of the research subjects adopted breastfeeding within 6 months after delivery. The results of multivariate logistic regression analysis showed that women aged above 25 years(OR=1.68-3.82), with high school education or above(OR=1.83-2.23), and with full-term delivery (OR=1.84) were more likely to breastfeed, but the breastfeeding rate was lower in those with overweight (OR=0.82) and obesity (OR=0.82) before pregnancy, willingness to give birth again (OR=0.67), gestational diabetes mellitus (OR=0.61) and excessive(OR=0.61) or lower (OR=0.63) weight gain during pregnancy. Interaction analysis displayed that the breastfeeding level was significantly lower in women with gestational diabetes mellitus and lower or excessive weight gain during pregnancy than in those without gestational diabetes mellitus and with normal weight gain during pregnancy, and the interaction index was 1.67 (1.01, 4.97) (P=0.02). Conclusions Complications like gestational diabetes mellitus and lower or excessive weight gain during pregnancy are important factors affecting breastfeeding, and there is an additive interaction between these two complications.