分娩方式与产后住院期间和6个月内纯母乳喂养相关性的meta分析

Association between delivery mode and exclusive breastfeeding during hospitalization and within six months after birth: a meta-analysis

目的:评价分娩方式与产后住院期间和6个月内纯母乳喂养的相关性。方法:系统检索PubMed、Web of Science、Cochrane Library、EBSCO、中国生物医学文献数据库、中国知网、万方数据库、维普数据库中分娩方式与产后住院期间/6个月内纯母乳喂养关系的观察性研究文献,检索时限均从建库至2022年10月。由2名研究者根据纳入排除标准独立筛选文献、提取资料后,根据乔安娜布里格斯研究所文献质量评价工具或纽卡斯尔-渥太华量表对纳入文献进行质量评价,并采用R 4.1.0软件进行系统评价,采用固定效应或随机效应模型进行数据合并,采用Egger检验和漏斗图判断发表偏倚。结果:最终纳入34篇文献,包括22项横断面研究和12项队列研究,共597203例产妇。22项横断面研究质量评价均为B级,11项队列研究质量评价≥7分,纳入文献质量较高。Meta分析结果显示,剖宫产产妇住院期间的纯母乳喂养可能性比经阴道分娩的产妇低(OR=0.33,95%CI:0.22~0.50,P<0.001);产后6个月内的纯母乳喂养可能性也低于经阴道分娩的产妇(OR=0.61,95%CI:0.47~0.79,P<0.001)。结论:剖宫产是产后住院期间和6个月内纯母乳喂养的不利因素。

Objective To systematically review the association between delivery mode and exclusive breastfeeding rate during hospitalization and within the first six months of life.Methods Observational studies on the association between delivery mode and feeding pattern were searched from PubMed,Web of Science,Cochrane Library,EBSCO,China Biomedical Literature Database,CNKI,Wanfang Database,and VIP Database from inception to October 2022.Two independent reviewers screened the literature,extracted data,and assessed the quality of included studies using Critical Appraisal Tools published by Joanna Briggs Institute or Newcastle-Ottawa Quality Scale(NOS).This meta-analysis was performed using R 4.1.0 software.Fixed-effect or random-effect models were used to pool data.Egger test and funnel plot were used to assess publication bias.Results A total of 34 studies involving 597203 subjects were included,including 22 cross-sectional studies and 12 cohort studies.All of the 22 cross-sectional studies were B-level quality,and eleven out of the 12 included cohort studies scored 7 points or above on the NOS scale with high quality.The results of meta-analysis showed that the likelihood of exclusive breastfeeding during hospitalization of women who had cesarean section was lower than those who delivered vaginally(OR=0.33,95%CI:0.22-0.50,P<0.001);and so was the likelihood of exclusive breastfeeding at six months postpartum(OR=0.61,95%CI:0.47-0.79,P<0.001).Conclusion Current evidence suggests that cesarean section is a disadvantage to exclusive breastfeeding during hospitalization and within six months after delivery.