Dificuldades com a amamentação e desmame antes de dois meses de idade: estudo de coorte em Botucatu/SP
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Data
2021-09-02
Autores
Anholetto, Ana Caroline
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O aleitamento materno tem diversos benefícios para o lactente, para a mãe e para a sociedade, recomendando-se sua manutenção até a criança completar dois anos, ou até mais, de acordo com as recomendações internacionais e brasileiras. No entanto, o desmame nos primeiros meses de vida ainda acontece para parcela expressiva dos bebês, não sendo totalmente conhecidos os fatores que levam a essa situação. Objetivos: Investigar a ocorrência e fatores associados ao desmame antes dos dois meses de idade em coorte de lactentes brasileiros participantes do estudo CLaB. Secundariamente, investigar fatores associados à presença de dificuldades no início do aleitamento materno. Métodos: Trata-se de estudo de coorte prospectiva, de base populacional. Dados sobre a situação de aleitamento e dificuldades com essa prática no primeiro mês de vida, além de variáveis sociodemográficas e relativas a saúde materna e do recém-nascido, foram obtidos presencialmente, mediante entrevista conduzida em unidade de triagem neonatal. Uma entrevista telefônica foi conduzida quando o lactente completou dois meses, envolvendo questões sobre a situação de aleitamento e dificuldades apresentadas no segundo mês de vida. Foram investigados dois desfechos: interrupção do aleitamento materno antes de dois meses (sim, não) e presença de dificuldades com o aleitamento (sim, não). Foram consideradas dificuldades as seguintes condições: demora ou leite não descia, falta de orientação, motivos relacionados com a mãe, motivos relacionados ao bebe, percepção de leite insuficiente/fraco, problemas com a mama (mastite, ingurgitamento, fissuras), problemas com mamilo, relacionados a pega, sangramento no peito. Mediante análises de regressão logística múltiplas, testou-se a associação com tais desfechos das seguintes variáveis: auto eficácia, contato pele a pele, problemas no início da amamentação, mamou no peito na maternidade, paridade, mamou na primeira hora. No caso da interrupção do aleitamento materno, a presença de dificuldades também foi investigada como variável de exposição. Para considerar uma variável como associada com o desfecho, adotou-se p<0,05 como nível crítico. As análises foram realizadas com o programa SPSS. Resultados: A coorte teve início com 640 lactentes e aos dois meses foi possível obter dados de 623 lactentes. Aos dois meses, 11,3% não estavam mais em aleitamento materno. Ter problemas com o início da amamentação (Odds ratio = 2,811, IC95%=1,605 – 4,992), não ter sido amamentado na maternidade (Odds ratio = 31,130, IC95%= 7,059 – 137,286) e menor autoeficácia materna na amamentação (Odds ratio = 6,992, IC95%= 3,139 – 15,575) aumentaram o risco do lactente ter sido desmamado antes dos dois meses de idade. Estar no menor tercil de autoeficácia aumentou 3,2 vezes (IC95%=1,989 - 5165) a chance de a mãe ter apresentado problemas no início do aleitamento materno. Da mesma forma, não ter amamentado na primeira hora de vida aumentou a chance (Odds ratio = 1,755, IC95%= 1,148 – 2,687) de apresentar dificuldades. Conclusões: O desmame antes de dois meses de idade acometeu cerca de 10% da coorte, sendo apontados como fatores associados a maiores chances desse evento, condições passíveis de prevenção ou controle pela atenção pré-natal, ao parto e nascimento e, ao binômio puérpera/recém-nascido, na maternidade.
Introduction: Breastfeeding has several benefits for the infant, for the mother and for the society, it is recommended until the child reaches two years of age, or older, according to Brazilian and international recommendations. However, the weaning during the first months of life still happens for an expressive portion of babies, and the reasons that lead to this situation are unknown. Objectives: Investigate the occurrence and factors associated to weaning before the baby reaches two months of age in cohort of Brazilian infant participants in the study CLaB. Secondarily, investigate factors associated with the presence of difficulties in the beginning of breastfeeding. Methods: this is a prospective population-based cohort study. Data concerning breastfeeding and difficulties in performing it in the first month of life, besides sociodemographic variables related to maternal and newborn health were obtained in person by means of interview conducted in neonatal screening unit. A phone interview was carried out when the infant reached two months of age; it evolved questions about the breastfeeding situation and difficulties presented in the second month of life. Two conclusions were investigated: interruption of breastfeeding before two months of life (yes, no) and presence of difficulties in breastfeeding (yes, no). The following conditions were considered difficulties: delay or not flowing of milk, lack of guidance, motives related to the mother, motives related to the baby, perception of insufficient/ weak milk, problems with breast (mastitis, engorgement, fissures), problems with nipples, problems related to suckling, and bleeding nipple. Through multiple logistic regression analyses, the association with such outcomes was tested for the following variables: self-efficacy, contact skin-to-skin, problems at the beginning of breastfeeding, breastfed in maternity hospital, childbirth, and breastfed in the first hour. In case of breastfeeding interruption, the presence of difficulties was also investigated as a variable of exposition. To consider a variable as associated with the outcome, it was adopted p<0,05 as critical level. The analyses were carried out using the software SPSS. Results: The cohort started with 640 infants and when they reached two months of age it was possible to obtain data from 623 infants. At two months of age, 11,3% were no longer breastfeeding. Having problems with the beginning of breastfeeding (Odds ratio = 2,811, IC95%=1,605 – 4,992), not having been breastfed in the maternity (Odds ratio = 31,130, IC95%= 7,059 – 137,286) and lower maternal efficiency in breastfeeding (Odds ratio = 6,992, IC95%= 3,139 – 15,575) increased the risk of the infant had been weaned before two months of age. Being at the lowest tertile of efficiency increased 3,2 times (IC95%=1,989 - 5165) the chance of the mother had presented problems at the beginning of breastfeeding. Moreover, not having breastfed at the first hour of life increased the chance (Odds ratio = 1,755, IC95%= 1,148 – 2,687) of presenting difficulties. Conclusion: The weaning before two months of age attacked about 10% of the cohort and, conditions possible to be prevented or controlled by prenatal care, delivery and birth and puerperal/ newborn binomial in maternity were highlighted as factors associated with greater chance of this event.
Introduction: Breastfeeding has several benefits for the infant, for the mother and for the society, it is recommended until the child reaches two years of age, or older, according to Brazilian and international recommendations. However, the weaning during the first months of life still happens for an expressive portion of babies, and the reasons that lead to this situation are unknown. Objectives: Investigate the occurrence and factors associated to weaning before the baby reaches two months of age in cohort of Brazilian infant participants in the study CLaB. Secondarily, investigate factors associated with the presence of difficulties in the beginning of breastfeeding. Methods: this is a prospective population-based cohort study. Data concerning breastfeeding and difficulties in performing it in the first month of life, besides sociodemographic variables related to maternal and newborn health were obtained in person by means of interview conducted in neonatal screening unit. A phone interview was carried out when the infant reached two months of age; it evolved questions about the breastfeeding situation and difficulties presented in the second month of life. Two conclusions were investigated: interruption of breastfeeding before two months of life (yes, no) and presence of difficulties in breastfeeding (yes, no). The following conditions were considered difficulties: delay or not flowing of milk, lack of guidance, motives related to the mother, motives related to the baby, perception of insufficient/ weak milk, problems with breast (mastitis, engorgement, fissures), problems with nipples, problems related to suckling, and bleeding nipple. Through multiple logistic regression analyses, the association with such outcomes was tested for the following variables: self-efficacy, contact skin-to-skin, problems at the beginning of breastfeeding, breastfed in maternity hospital, childbirth, and breastfed in the first hour. In case of breastfeeding interruption, the presence of difficulties was also investigated as a variable of exposition. To consider a variable as associated with the outcome, it was adopted p<0,05 as critical level. The analyses were carried out using the software SPSS. Results: The cohort started with 640 infants and when they reached two months of age it was possible to obtain data from 623 infants. At two months of age, 11,3% were no longer breastfeeding. Having problems with the beginning of breastfeeding (Odds ratio = 2,811, IC95%=1,605 – 4,992), not having been breastfed in the maternity (Odds ratio = 31,130, IC95%= 7,059 – 137,286) and lower maternal efficiency in breastfeeding (Odds ratio = 6,992, IC95%= 3,139 – 15,575) increased the risk of the infant had been weaned before two months of age. Being at the lowest tertile of efficiency increased 3,2 times (IC95%=1,989 - 5165) the chance of the mother had presented problems at the beginning of breastfeeding. Moreover, not having breastfed at the first hour of life increased the chance (Odds ratio = 1,755, IC95%= 1,148 – 2,687) of presenting difficulties. Conclusion: The weaning before two months of age attacked about 10% of the cohort and, conditions possible to be prevented or controlled by prenatal care, delivery and birth and puerperal/ newborn binomial in maternity were highlighted as factors associated with greater chance of this event.
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Palavras-chave
Desmame, Autoeficácia, Aleitamento materno, Leite humano, Weaning, Self-efficacy, Breastfeeding, Human milk