Autoeficácia na amamentação e aleitamento materno no primeiro ano de vida: um estudo de coorte
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Data
2018-02-20
Autores
Minharro, Michelle Cristine de Oliveira
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Universidade Estadual Paulista (Unesp)
Resumo
Um aspecto capaz de influenciar na duração do aleitamento materno (AM) é a confiança materna em sua habilidade de amamentar. O objetivo principal do estudo foi avaliar a autoeficácia na amamentação e sua relação com a duração do AM no primeiro ano de vida, em coorte populacional de lactentes e mães acompanhados em município paulista. Trata-se de estudo integrante do estudo CLaB – Coorte de Lactentes de Botucatu, voltado a coletar e analisar dados, eventos e situações relacionadas à saúde de mães e crianças no primeiro ano de vida. Participaram puérperas e seus recém-nascidos do município que compareceram para atendimento em serviço público de triagem neonatal e primeira consulta clínica, com alta cobertura populacional. A captação foi de julho 2015 a fevereiro de 2016. As entrevistas ocorreram quando o lactente tinha menos de um mês de idade (na captação), seguidas de entrevistas telefônicas aos 2 e 4 meses e domiciliares aos 3, 6, 9 e 12 meses. A Escala de Autoeficácia na Amamentação – Forma Abreviada (BSES-SF), com escore variando de 14 a 70 pontos, foi aplicada na captação e a situação dos lactentes em relação ao aleitamento materno exclusivo (AME) e aleitamento materno foi avaliada em todos os momentos do estudo. Dados socioeconômicos e demográficos, história obstétrica, atenção e situação de saúde de mães e lactentes foram coletados para caracterização da amostra e controle de possíveis confundidores. Foram excluídos os gemelares. Foram testadas as associações brutas entre variáveis socioeconômicas, maternas e dos lactentes com a autoeficácia. As associações com p<0,20 foram analisadas em modelos de regressão logística multinomial, com p<0,05 como nível crítico. Para a investigação da associação entre AM e autoeficácia a mesma foi avaliada com 3 versões: escore contínuo; categorizada e em tercis. A idade do lactente na cessação do AME e do AM e a situação de AME aos 3 e 6 meses e do AM aos 3, 6, 9 e 12 meses foram os desfechos analisados, respectivamente, por modelos de regressão múltipla de Cox e Regressão Logística multivariada, incluindo os fatores com p<0,20 nas análises bivariadas. Resultados: A coorte teve início com 644 bebês e 573 completaram o seguimento até doze meses. 66% dos lactentes nasceram em maternidade do SUS e o restante em serviço privado/convênio. 77,9% das puérperas apresentaram alta autoeficácia; 1/5 apresentou média; apenas 1,7% baixa autoeficácia. Destacaram-se como fatores independentemente e positivamente associados com maior autoeficácia, gestação bem aceita e contato pele a pele após o parto; dificuldades com o início do aleitamento contribuiram para menor autoeficácia. A magnitude do efeito da autoeficácia sobre o risco de desmame foi considerável, sendo que a alta autoeficácia reduziu em 70% o risco de cessação do AM no primeiro ano e em 66% o de cessação do AME antes de seis meses. Estar no maior tercil em comparação ao menor reduziu em 45% e 30% as chances de cessação do AM e do AME, respectivamente. Nas três formas da variável, quanto maior a autoeficácia na amamentação maiores as chances de as crianças estarem em AM/AME nas idades de 3, 6, 9 e 12 meses. Conclusão: A autoeficácia materna na amamentação tem efeito próprio sobre a duração do AM e AME, resultado que apoia sua avaliação na atenção à saúde, em particular no pré-natal, puerpério imediato e primeira consulta clínica do lactente após a alta da maternidade.
One aspect capable of influencing the breastfeeding (BF) duration is maternal confidence in her ability to breastfeed. The main objective of the study was to evaluate the self-efficacy of breastfeeding and its relationship with duration of breastfeeding in the first year of life in a population cohort of infants and mothers accompanied in the paulista county. This is study is part of the study CLaB - Botucatu Infant Cohort study, aimed at collecting and analyzing data, events and situations related to the health of mothers and children living in Botucatu / SP in the first year of life. Participants were mothers and their newborns from the municipality who attended for public service of neonatal screening and first clinical consultation, with high population coverage. The capture was from July 2015 to February 2016, with follow-up until the child reaches 12 months. Interviews occurred when the infant was less than one month old (at the capture), followed by telephone interviews at 2 and 4 months and at theirs home at 3, 6, 9 and 12 months. The Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), with a score varying from 14 to 70 points, was applied on capture and the situation of infants in relation to exclusive breastfeeding (EBF) and breastfeeding was evaluated in all moments. Socioeconomic and demographic data, obstetric history, attention and health status of mothers and infants were collected to characterize the sample and to control possible confounders. Twins were excluded. The crude associations between socioeconomic, maternal and infant variables with self-efficacy were tested. Associations with p <0.20 were analyzed in multinomial logistic regression models, with p <0.05 as the critical level. The association between breastfeeding and self-efficacy it was evaluated with 3 versions: continuous score; categorized and in tertiles. The age of the infant in the cessation of EBF and BF and the situation of EBF at 3 and 6 months and BF at 3, 6, 9 and 12 months were the outcomes analyzed by Cox multiple regression models and logistic regression multivariate analysis, including factors with p <0.20 in the bivariate analyzes. Results: The cohort started with 644 infants and 573 infants completed a 12-month follow-up. 66% of the infants were born in the maternity unit of public health system (SUS) and the remainder in private service / health insurance. 77.9% of the puerperae presented high self-efficacy; 1/5 presented mean; and only 1.7% low self-efficacy. Some factors stand out as independently associated with higher self-efficacy: planned or unplanned gestation was well accepted and the presence of skin-to-skin contact after delivery; the difficulties with starting breastfeeding contributed to lower self-efficacy. The magnitude of the effect of self-efficacy on the risk of weaning was considerable, and the high self-efficacy reduced the risk of cessation of BF in the first year by 70% and of the cessation of EBF by six months by 66%. Being in the highest tertile compared to the lowest reduced 45% and 30% the chance of cessation of BF and EBF respectively. In the three forms of the variable, the greater the self-efficacy in breastfeeding the greater the chances of the children being in BF / EBF at the ages of 3, 6, 9 and 12 months. Conclusion: Maternal self-efficacy in breastfeeding has its own effect on the duration of BF and EBF, a result that supports its evaluation in health care, particularly in the prenatal, immediate puerperium and first clinical consultation of the infant after discharge from maternity.
One aspect capable of influencing the breastfeeding (BF) duration is maternal confidence in her ability to breastfeed. The main objective of the study was to evaluate the self-efficacy of breastfeeding and its relationship with duration of breastfeeding in the first year of life in a population cohort of infants and mothers accompanied in the paulista county. This is study is part of the study CLaB - Botucatu Infant Cohort study, aimed at collecting and analyzing data, events and situations related to the health of mothers and children living in Botucatu / SP in the first year of life. Participants were mothers and their newborns from the municipality who attended for public service of neonatal screening and first clinical consultation, with high population coverage. The capture was from July 2015 to February 2016, with follow-up until the child reaches 12 months. Interviews occurred when the infant was less than one month old (at the capture), followed by telephone interviews at 2 and 4 months and at theirs home at 3, 6, 9 and 12 months. The Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF), with a score varying from 14 to 70 points, was applied on capture and the situation of infants in relation to exclusive breastfeeding (EBF) and breastfeeding was evaluated in all moments. Socioeconomic and demographic data, obstetric history, attention and health status of mothers and infants were collected to characterize the sample and to control possible confounders. Twins were excluded. The crude associations between socioeconomic, maternal and infant variables with self-efficacy were tested. Associations with p <0.20 were analyzed in multinomial logistic regression models, with p <0.05 as the critical level. The association between breastfeeding and self-efficacy it was evaluated with 3 versions: continuous score; categorized and in tertiles. The age of the infant in the cessation of EBF and BF and the situation of EBF at 3 and 6 months and BF at 3, 6, 9 and 12 months were the outcomes analyzed by Cox multiple regression models and logistic regression multivariate analysis, including factors with p <0.20 in the bivariate analyzes. Results: The cohort started with 644 infants and 573 infants completed a 12-month follow-up. 66% of the infants were born in the maternity unit of public health system (SUS) and the remainder in private service / health insurance. 77.9% of the puerperae presented high self-efficacy; 1/5 presented mean; and only 1.7% low self-efficacy. Some factors stand out as independently associated with higher self-efficacy: planned or unplanned gestation was well accepted and the presence of skin-to-skin contact after delivery; the difficulties with starting breastfeeding contributed to lower self-efficacy. The magnitude of the effect of self-efficacy on the risk of weaning was considerable, and the high self-efficacy reduced the risk of cessation of BF in the first year by 70% and of the cessation of EBF by six months by 66%. Being in the highest tertile compared to the lowest reduced 45% and 30% the chance of cessation of BF and EBF respectively. In the three forms of the variable, the greater the self-efficacy in breastfeeding the greater the chances of the children being in BF / EBF at the ages of 3, 6, 9 and 12 months. Conclusion: Maternal self-efficacy in breastfeeding has its own effect on the duration of BF and EBF, a result that supports its evaluation in health care, particularly in the prenatal, immediate puerperium and first clinical consultation of the infant after discharge from maternity.
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Palavras-chave
aleitamento materno, autoeficácia, saúde da criança, breastfeeding, self-efficacy, child health