早产儿母亲泌乳Ⅱ期启动延迟现状及其影响因素

Status and influencing factors of delayed onset of lactogenesis Ⅱ in mothers of preterm infants

目的:探讨早产儿母亲泌乳Ⅱ期启动延迟(delayed onset of lactogenesisⅡ,DOLⅡ)的现状及其影响因素。方法:回顾性纳入2021年9月至2022年3月在郑州大学第一附属医院产科住院分娩的早产产妇。收集产妇人口学及围产期相关资料。根据产妇产后第3天的泌乳情况,将其分为DOLⅡ组和非DOLⅡ组。比较2组的临床资料,探讨早产儿母亲DOLⅡ的影响因素。采用χ^(2)检验、两独立样本t检验、Mann-Whitney U检验及logistic回归分析进行统计学分析。结果:共纳入286例早产产妇,其中73例(25.5%)发生DOLⅡ。单因素分析显示,DOLⅡ组和非DOLⅡ组(213例)不良孕产史[28.8%(21/73)与41.8%(89/213),χ^(2)=3.89]、初产[60.3%(44/73)与38.0%(81/213),χ^(2)=10.93]、合并妊娠期高血压疾病[35.6%(26/73)与16.4%(35/213),χ^(2)=11.92]的比例、开奶时间[产后5.0 h(3.0~7.0 h)与4.0 h(2.0~5.0 h),Z=-4.27],以及产后48 h母乳喂养/泵奶次数[7.0次(6.0~9.0次)与9.0次(7.0~11.0次),Z=-3.62]的差异均有统计学意义(P值均<0.05)。多因素logistic回归分析结果显示,初产(OR=2.720,95%CI:1.485~4.982)、妊娠期高血压疾病(OR=3.178,95%CI:1.609~6.274)、开奶时间(OR=1.394,95%CI:1.211~1.604)和产后48 h母乳喂养/泵奶次数(OR=0.861,95%CI:0.772~0.962)是早产儿母亲DOLⅡ的独立影响因素(P值均<0.05)。结论:初产、合并妊娠期高血压疾病、产后开奶时间、产后48 h内母乳喂养/泵奶次数是早产儿母亲发生DOLⅡ的高危因素。

Objective To investigate the incidence of delayed onset of lactogenesisⅡ(DOLⅡ)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 DOLⅡand non-DOLⅡgroups.The two groups'differences in general conditions were compared,and the potential factors influencing DOLⅡwere 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 DOLⅡ.The other 213 cases without DOLⅡwere included as the non-DOLⅡgroup.Univariate analysis showed significant differences between the DOLⅡand non-DOLⅡgroups in the following aspects:the proportion of women with adverse pregnancy history[28.8%(21/73)vs 41.8%(89/213),χ^(2)=3.89],the proportion of primiparas[60.3%(44/73)vs 38.0%(81/213),χ^(2)=10.93],the incidence of hypertensive disorders of pregnancy[35.6%(26/73)vs 16.4%(35/213),χ^(2)=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 DOLⅡ(all P<0.05).Conclusions The factors that influence the occurrence of DOLⅡin preterm mothers are primipara hypertensive disorders of pregnancy,breastfeeding initiation time after delivery,and the frequency of breastfeeding or pumping within 48 h postpartum.