摘要
目的探索孕早中期压力知觉及血浆5-羟色胺水平对产后母乳喂养的影响,为提高纯母乳喂养率提供科学依据。方法基于前瞻性队列研究设计,于2019年4月至2020年3月在南京市鼓楼区妇幼保健所招募建立孕产妇保健手册的孕20周前孕妇,使用压力知觉量表(Perceived Stress Scale,PSS)评估孕妇入组时的压力感知状况,同时检测孕妇血浆5-羟色胺水平,并在产后42 d开展电话随访,调查产妇分娩信息及母乳喂养情况。采用χ^(2)检验、两独立样本t检验、logistic回归分析非纯母乳喂养的危险因素。结果共有366例孕妇入组,353例(96.4%)完成随访纳入分析,根据产后42 d喂养方式分为纯母乳喂养组(n=194)和非纯母乳喂养组(n=159)。单因素分析显示纯母乳喂养组PSS总分[(19.4±6.9)与(21.1±6.9)分,t=-2.25,P=0.026]和高压力孕妇所占比例[23.7%(46/194)与34.0%(54/159),χ^(2)=4.03,P=0.045]均显著低于非纯母乳喂养组。以是否纯母乳喂养为因变量,将单因素分析中P<0.200(PSS总分或PSS分组、血浆5-羟色胺水平、年龄、分娩方式)及临床可能的影响因素(产次、是否足月分娩)为自变量纳入logistic回归分析。结果显示,PSS作为连续型变量时,孕早中期PSS总分为产后非母乳喂养的独立危险因素(OR=1.043,95%CI:1.010~1.077,P=0.011);PSS作为分类变量(PSS分组)时,PSS高压力是非纯母乳喂养的独立危险因素(OR=1.765,95%CI:1.097~2.854,P=0.020)。结论孕早中期压力过大会影响产后母乳喂养,在孕早中期开展心理健康咨询,为孕妇减轻围产期压力可能有利于提高纯母乳喂养率。
Objective To explore the effect of maternal stress perception and plasma serotonin level in the first or second trimester on breastfeeding behavior,and to provide evidence for promoting exclusive breastfeeding.Methods This prospective cohort study recruited pregnant women(≤20 gestational weeks)from Maternal and Child Health Center of Gulou District from April 2019 to March 2020.Stress perception at study enrollment was evaluated using Perceived Stress Scale(PSS)and the maternal plasma serotonin level was detected.Telephone interviews were conducted 42 d after delivery to collect information on childbirth and breastfeeding.Chi-square test,two independent samples t-test,and logistic regression model were used to analyze the risk factors of non-exclusive breastfeeding.Results A total of 366 pregnant women were enrolled and 353(96.4%)of them completed telephone interviews,who were divided into the exclusive(n=194)and non-exclusive breastfeeding group(n=159).Univariate analysis showed that the PSS scores[(19.4±6.9)vs(21.1±6.9)scores,t=-2.25,P=0.026]and the proportion of high-stress perception[23.7%(46/194)vs 34.0%(54/159),χ^(2)=4.03,P=0.045]in the exclusive group were all significantly lower than those in non-exclusive group.In the logistic regression analysis,exclusive breastfeeding was set as the dependent variable and the independent variables included factors with P<0.200 in the univariate analysis(PSS scores or PSS rating,plasma serotonin level,age,delivery mode)and potential clinical risk factors(parity,preterm birth).The results showed that when PSS was considered as a continuous variable,total PSS scores in the first or second trimester was an independent risk factor for non-exclusive breastfeeding(OR=1.043,95%CI:1.010-1.077,P=0.011)and so was the high-stress perception when PSS was considered as a categorical variable(PSS rating)(OR=1.765,95%CI:1.097-2.854,P=0.020).Conclusions Overstress in the first or second trimester will affect breastfeeding patterns.Mental health counseling may help relieve perinatal stress,which will further increase the exclusive breastfeeding rate.
作者
周旭
洪翔
胡燕
丁小玲
赵君
王蓓
于红
Zhou Xu;Hong Xiang;Hu Yan;Ding Xiaoling;Zhao Jun;Wang Bei;Yu Hong(Department of Epidemiology and Health Statistics,School of Public Health,Southeast University,Nanjing 210009,China;Department of Obstetrics and Gynecology,Zhong Da Hospital,Southeast University,Nanjing 210009,China;Maternal Health Care Department,Maternal and Child Health Center of Gulou District,Nanjing 210009,China;National Research Institute for Family Planning,Beijing 100081,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2022年第7期513-518,共6页
Chinese Journal of Perinatal Medicine
基金
国家自然科学基金(81872634)。
关键词
应激
心理学
血清素
母乳喂养
妊娠初期
妊娠中期
Stress,psychological
Serotonin
Breast feeding
Pregnancy trimester,first
Pregnancy trimester,second
