产后延续健康管理对中国产妇纯母乳喂养和产后抑郁影响的meta分析

Continuousmaternal health management in the puerperium period for breastfeeding and postpartum depression：ameta-analysis

目的系统评价产后延续健康管理对中国产妇纯母乳喂养和产后抑郁的影响。方法系统检索PubMed、中国知网、万方电子期刊数据库、维普中文科技期刊数据库，检索日期截止2016年1月，起始时间未限定。纳入探讨产后延续健康管理影响母乳喂养和（或）产后抑郁发生的随机对照试验（RCT）研究，其中干预措施为产后健康管理和护理干预，包含出院后2次及以上产后访视；对照组为无产后访视或仅电话随访。分析影响纯母乳喂养、产后抑郁发生的随机对照研究（RCT），采用Revman5．3和适宜的模型进行效应值合并。结果最终纳入14个RCT研究。Meta分析结果显示，与无产后访视或电话随访对照组相比，产后延续健康管理干预组产妇纯母乳喂养率较高，产后抑郁发生率较低，合并效应值OR分别为5．48（95％CI：4．24-7．08；n=7；共970名产妇；I2=0）和0．16（95％CI：0．10-0．27；n=9；共1370名产妇；I2=0）。当根据初产妇、不同的对照组措施进行亚组分析时，结果并没有实质性改变。结论对产褥期产妇进行延续健康管理有可能减少产褥期产后抑郁的发生风险及增加纯母乳喂养率。

Objective To evaluate the effect of continuous maternal health management on the likelihood of exclusive breastfeeding and postpartum depression. Methods Studies published in the PubMed, CNKI, WanFang Med Online, and VIP database were searched up to January 2016. Randomized controlled trials （RCTs） that investigated continuous maternal health management in the puerperium period for breastfeeding and postpartum depression were included. Revman 5.3 software and fixed-effects models were used to summarize the risk estimates. Results 14 eligible RCTs were included in the meta-analysis, of which 7 studies reporting breastfeeding （970 women ） and 9 reporting postpartum depression （1370 women）. Women who received continuous maternal health management in the puerperium period, including at least two home visits, were significantly more likely to breastfeed their babies and less likely to develop postpartum depression at 6 weeks postpartum compared with those receiving no care or telephone based care （ average OR = 5.48, 95% confidence interval （CI） ：4.24 -7.08, and OR -0.16, 95% CI： 0. 10 -0. 27, respectively）. No material difference in pooled estimates was observed in stratified analyses based on parity and different care in the control group. Conclusion Continuous maternal health management in the puerperium period, including at least two home visits, may increase the rate of exclusive breastfeeding and decreased the risk of postpartum depression.