Associação do aleitamento materno exclusivo e uso de bicos artificiais com variáveis pré e pós-natais: estudo de coorte
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Data
2022-02-18
Autores
Melo, Letícia Santos Alves De
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Universidade Estadual Paulista (Unesp)
Resumo
O aleitamento materno exclusivo (AME) durante os seis primeiros meses de vida do bebê é importante para um desenvolvimento ideal. Por sua vez, o uso de bicos artificiais é frequentemente apontado como um estimulador do desmame precoce. Devido à escassez de estudos longitudinais sobre a duração do AME e do uso de bicos artificiais e seus determinantes, especialmente daqueles com acompanhamento desde a gestação, os objetivos deste trabalho foram: a) investigar a prevalência do AME e sua associação com a intenção materna de amamentar (IMA) e outras variáveis de interesse (Publicação 1); b) determinar a prevalência e os fatores associados com o uso de chupeta e mamadeira por lactentes com até seis meses de vida (Publicação 2). Um estudo de coorte foi conduzido com mulheres grávidas no 3º trimestre de gestação (baseline), acompanhadas após o parto até os seis meses de vida do bebê (follow-up). A coleta de dados no baseline, realizada mediante entrevista e questionário, envolveu 653 gestantes que realizaram pré-natal em uma maternidade pública de direito privado, situada na região central do estado de São Paulo, Brasil. Foram coletados dados sobre: características sociodemográficas e gestacionais; informações sobre o aleitamento materno (AM); pretensão de ofertar chupeta e mamadeira; e IMA — utilizando a escala Infant Feeding Intentions (IFI), traduzida, testada e adaptada para o português do Brasil. Após o parto, as participantes foram contatadas por ligações telefônicas no primeiro (T1; n=467), terceiro (T3; n=333), e sexto (T6; n=217) mês de vida do bebê ou até o desmame, para coletar informações sobre o AM, parto, características do bebê, familiares e hábitos orais. Análises de associação foram realizadas utilizando modelos de regressão logística com um nível de significância de 5%, tendo como desfechos o AME (Publicação 1) e o uso de chupeta e mamadeira (Publicação 2). As prevalências de AME encontradas foram 81,2% em T1, 64,0% em T3, e 35,9% em T6. As variáveis associadas ao AME em T1, T3 e T6 foram: não uso de mamadeira (OR=612,59; OR=139,08; OR=15,05) e o não uso de chupeta (OR=2,94; OR=2,78; OR=2,93). Forte IMA (OR=1,71) em T1; baixo peso ao nascer (OR=1,62), suporte nos cuidados com o bebê (OR=2,59), idade materna (OR=0,54), ter um companheiro (OR=1,82) em T3; e não ter retornado ao trabalho (OR=2,39) em T6 também estiveram associadas ao AME (Publicação 1). Com relação ao uso de bicos artificiais, 52,5% dos bebês acompanhados usaram mamadeira, 48,2% chupeta e 33,4% ambos os dispositivos, respectivamente, durante os 6 primeiros meses. Não morar em residência própria (OR=1,53) e ter pretensão gestacional de ofertar chupeta para o bebê (OR=2,50) estiveram associados ao uso de chupeta. As variáveis associadas ao uso de mamadeira foram o retorno da mãe ao trabalho (OR=2,48), baixo peso do bebê ao nascer (OR=1,58) e a pretensão de usar mamadeira (OR=2,51) (Publicação 2). Conclui-se, portanto, que a prevalência do AME foi maior no primeiro mês e apresentou declínio até o sexto mês de vida dos bebês. A IMA influenciou a iniciação do AME e a ausência de mamadeira foi o mais forte preditor do AME. Já a prevalência do uso de chupeta e/ou mamadeira foram altas e estiveram associadas à pretensão pré-natal de oferecer esses dispositivos e a fatores socioeconômicos. Sendo assim, é importante a criação de estratégias para favorecer a construção de conhecimento entre gestantes sobre os benefícios do AME e os riscos do uso de chupeta e mamadeira para a saúde do bebê.
Exclusive breastfeeding (EBF) during the first six months of a baby's life is important for optimal development. In turn, the use of artificial nipples is often pointed out as an enabler of early weaning. Due to the scarcity of longitudinal studies on the duration of EB and feeding and its determinants, especially those with follow-up from pregnancy, the objectives of this study were: a) to investigate the prevalence of EB and its association with maternal intention to breastfeed (MAI) and other variables of interest (Publication 1); b) to determine the prevalence and factors associated with the use of pacifiers and bottles by infants up to six months of age (Publication 2). A cohort study was conducted with pregnant women in the 3rd trimester of gestation (baseline), followed delivery until the infant is six months old (follow-up). Data collection at baseline involved 653 pregnant women who underwent prenatal care in a public private maternity hospital in the central region of the state of São Paulo, Brazil. Data were collected on sociodemographic and gestational characteristics, information on breastfeeding (BF), intention to offer pacifier and bottle, and IMA using the Infant Feeding Intentions (IFI) scale, translated, tested, and adapted to Brazilian Portuguese. After delivery, participants were contacted by telephone calls at the first (T1; n=467), third (T3; n=333), and sixth (T6; n=217) months of the baby's life or until weaning, to collect information on breastfeeding, delivery, baby characteristics, family members, and oral habits. Association analyses were performed using logistic regression models with a 5% significance level, using EBF (Publication 1) and pacifier and bottle feeding (Publication 2) as outcomes. The prevalences of EBF found were 81.2% at T1, 64.0% at T3, and 35.9% at T6. The variables associated with SMA at T1, T3, and T6 were: no bottle use (OR=612.59; OR=139.08; OR=15.05) and no pacifier use (OR=2.94; OR=2.78; OR=2.93). Strong IMA (OR=1.71) at T1; low birth weight (OR=1.62), infant care support (OR=2.59), maternal age (OR=0.54), having a partner (OR=1.82) at T3; and not having returned to work (OR=2.39) at T6 were also associated with EBF (Publication 1). Regarding the use of artificial nipples, 52.5% of the followed infants used a bottle, 48.2% used a pacifier and 33.4% used both devices, respectively, during the first 6 months. Not living in a private home (OR=1.53) and having the intention to offer a pacifier to the baby during pregnancy (OR=2.50) were associated with pacifier use. The variables associated with pacifier use were mother's return to work (OR=2.48), low birth weight (OR=1.58), and intention to use a pacifier (OR=2.51) (Publication 2). It is therefore concluded that the prevalence of EBF was highest in the first month and showed a decline by the sixth month of infants' life. The IMA influenced the initiation of EBF and the absence of bottle feeding was the strongest predictor of EBF. The prevalence of pacifier and/or bottle use was high and was associated with prenatal intention to offer these devices and with socioeconomic factors. Thus, it is important to create strategies to promote the construction of knowledge among pregnant women about the benefits of EBF and the risks of pacifiers and bottle use for the baby's health
Exclusive breastfeeding (EBF) during the first six months of a baby's life is important for optimal development. In turn, the use of artificial nipples is often pointed out as an enabler of early weaning. Due to the scarcity of longitudinal studies on the duration of EB and feeding and its determinants, especially those with follow-up from pregnancy, the objectives of this study were: a) to investigate the prevalence of EB and its association with maternal intention to breastfeed (MAI) and other variables of interest (Publication 1); b) to determine the prevalence and factors associated with the use of pacifiers and bottles by infants up to six months of age (Publication 2). A cohort study was conducted with pregnant women in the 3rd trimester of gestation (baseline), followed delivery until the infant is six months old (follow-up). Data collection at baseline involved 653 pregnant women who underwent prenatal care in a public private maternity hospital in the central region of the state of São Paulo, Brazil. Data were collected on sociodemographic and gestational characteristics, information on breastfeeding (BF), intention to offer pacifier and bottle, and IMA using the Infant Feeding Intentions (IFI) scale, translated, tested, and adapted to Brazilian Portuguese. After delivery, participants were contacted by telephone calls at the first (T1; n=467), third (T3; n=333), and sixth (T6; n=217) months of the baby's life or until weaning, to collect information on breastfeeding, delivery, baby characteristics, family members, and oral habits. Association analyses were performed using logistic regression models with a 5% significance level, using EBF (Publication 1) and pacifier and bottle feeding (Publication 2) as outcomes. The prevalences of EBF found were 81.2% at T1, 64.0% at T3, and 35.9% at T6. The variables associated with SMA at T1, T3, and T6 were: no bottle use (OR=612.59; OR=139.08; OR=15.05) and no pacifier use (OR=2.94; OR=2.78; OR=2.93). Strong IMA (OR=1.71) at T1; low birth weight (OR=1.62), infant care support (OR=2.59), maternal age (OR=0.54), having a partner (OR=1.82) at T3; and not having returned to work (OR=2.39) at T6 were also associated with EBF (Publication 1). Regarding the use of artificial nipples, 52.5% of the followed infants used a bottle, 48.2% used a pacifier and 33.4% used both devices, respectively, during the first 6 months. Not living in a private home (OR=1.53) and having the intention to offer a pacifier to the baby during pregnancy (OR=2.50) were associated with pacifier use. The variables associated with pacifier use were mother's return to work (OR=2.48), low birth weight (OR=1.58), and intention to use a pacifier (OR=2.51) (Publication 2). It is therefore concluded that the prevalence of EBF was highest in the first month and showed a decline by the sixth month of infants' life. The IMA influenced the initiation of EBF and the absence of bottle feeding was the strongest predictor of EBF. The prevalence of pacifier and/or bottle use was high and was associated with prenatal intention to offer these devices and with socioeconomic factors. Thus, it is important to create strategies to promote the construction of knowledge among pregnant women about the benefits of EBF and the risks of pacifiers and bottle use for the baby's health
Descrição
Palavras-chave
Aleitamento materno, Chupetas, Mamadeira, Gravidez, Breast Feeding, Pacifiers, Nursing Bottles, Pregancy