基于移动医疗的母乳喂养延续性干预方案的应用及评价

Application and evaluation of mobile device-based continuous breastfeeding intervention program

目的探讨基于移动医疗的孕产妇母乳喂养延续性干预方案的效果。方法本研究为类试验性研究。纳入2017年4月1日至5月31日同济大学附属第一妇婴保健院的孕妇,将东院符合纳入标准的孕妇作为干预组(n=100),南院符合纳入标准的孕妇作为对照组(n=100)。对照组按照"爱婴医院"要求进行常规母乳喂养支持,干预组在常规支持的基础上接受基于移动医疗的母乳喂养延续性干预(通过微信公众号平台对孕产妇进行问卷调查,孕产妇同时可获取母乳喂养支持内容,比如早孕期:母乳喂养的好处;中孕期:母乳与免疫等;晚孕期:孕期乳房护理等;分娩期:溢奶/吐奶的处理等;产褥期:补充铁剂和维生素等)。比较2组孕产妇的基本资料,早、中、晚孕期和分娩期、产褥期母乳喂养知识问卷得分,分娩期和产褥期母乳喂养自我效能量表得分,以及出院时和产后42 d时母乳喂养情况。采用两独立样本t检验和χ^2检验进行统计学分析。结果最终干预组83例、对照组80例纳入分析。母乳喂养知识问卷得分在早孕期时干预组与对照组差异无统计学意义[(13.4±1.9)与(13.3±1.9)分,t=0.133,P=0.895],但中孕期、晚孕期、分娩期和产褥期干预组得分[分别为(14.1±1.3)、(14.7±1.1)、(15.3±1.7)和(15.7±1.5)分]均高于对照组对应阶段[分别为(13.5±2.0)、(14.2±1.3)、(14.4±1.2)和(14.9±1.0)分](t值分别为2.160、2.435、4.104和3.946,P值均<0.05)。干预组分娩期和产褥期母乳喂养自我效能量表得分分别为(123.5±4.7)和(128.4±4.2)分,均高于对照组[(118.5±5.7)和(119.0±6.5)分](t值分别为6.170和10.959,P值均<0.01)。干预组出院时和产后42 d时的纯母乳喂养率均高于对照组[78.3%(65/83)与61.2%(49/80),χ^2=5.641;57.8%(48/83)与38.8%(31/80),χ^2=5.938;P值均<0.05]。结论基于移动医疗的孕产妇母乳喂养延续性干预方案可有效改善母乳喂养结局。

Objective To investigate the effects of a mobile application-based continuous breastfeeding intervention program for gravidas.Methods Pregnant women who received prenatal care and delivered at First Maternity and Infant Hospital Affiliated to Tongji University were enrolled in this quasi-experiment from April 1 to May 31,2017.Those women who met the inclusion criteria in the Eastern and Southern campuses of the hospital were recruited as intervention group (n=100) and control (n=100) group,respectively.In addition to the routine breastfeeding support which the control group was offered only,the intervention group also received mobile application-based continuous breastfeeding intervention,namely a questionnaire was sent through WeChat official account where the pregnant women had free access to continuous breastfeeding support based on their survey results,such as understanding the benefits of breastfeeding at the first trimester,relationships between breastfeeding and immunity at the second trimester,breast care at the third trimester,treatment of milk spillage/spit during labor,and iron and vitamin supplementation at puerperium.Basic information about the participants,results of Breastfeeding Knowledge Questionnaires administered at the first,second and third trimesters and during labor and the puerperium,responses to Self-efficacy of Breastfeeding Questionnaires during labor and the puerperium,and exclusive breastfeeding rates at discharge and 42 d postpartum were compared between the two groups using two independent sample t-test and Chi-square test.Results There were 83 and 80 pregnant women in the intervention group and control group finally analyzed,respectively.No statistical difference in the scores of the Breastfeeding Knowledge Questionnaire at the first trimester was observed between the intervention group and control group (13.4±1.9 vs 13.3±1.9,t=0.133,P=0.895).However,the scores at the second and third trimesters and during labor and the puerperium in the intervention group were higher than those in the control group (14.1±1.3 vs 13.5±2.0,14.7±1.1 vs 14.2±1.3,15.3±1.7 vs 14.4±1.2 and 15.7±1.5 vs 14.9±1.0;t=2.160,2.435,4.104 and 3.946;all P<0.05),respectively.The scores of Self-efficacy of Breastfeeding Questionnaires during labor and the puerperium were also higher in the intervention group (123.5±4.7 vs 118.5±5.7 and 128.4±4.2 vs 119.0±6.5,t=6.170 and 10.959,both P<0.01).Compared to the control group,the intervention group had higher exclusive breastfeeding rate at discharge and on 42 d after delivery [78.3%(65/83) vs 61.2%(49/80),χ^2=5.641;57.8%(48/83) vs 38.8%(31/80),χ^2=5.938;both P<0.05].Conclusions The mobile application-based continuous breastfeeding intervention program may effectively improve breastfeeding outcomes.