Gebelik Öncesi Maternal Obezitenin Anne Sütü ile Beslenme Üzerine Etkisi: Prospektif Kohort Pilot Çalışması

Öz

Amaç: Bu prospektif kohort araştırması, gebelik öncesi dönemde beden kütle indeksi (BKI)’ne göre obezitesi olan kadınların doğum sonrası altı aylık dönemde bebeklerini sadece anne sütü ile beslenme üzerine olan etkisinin incelenmesi amacıyla yürütülmüştür. Gereç ve Yöntem: Araştırma örneklemi, Türkiye İzmir’de bir Aile Sağlığı Merkezine kayıtlı 44 obezitesi olan ve 44 obezitesi olmayan anne ve bebeğinden oluşmuştur. Veriler, doğum sonrası 1. hafta, 1. ay, 3. ay ve 6. ay izleminde Birey Tanılama Formu, LATCH Emzirme Değerlendirme Aracı ve Emzirme Durumunu İzlem Formu ile toplanmıştır. Veri analizinde independent t test, ki kare, Cochran’s Q testi ve Cox’s regresyon analizi kullanılmıştır. Bulgular: Tüm izlem haftalarında obez ve obez olmayan annelerin bebeklerinin sadece anne sütü ile beslenme durumları arasında istatistiksel olarak anlamlı farklılık saptandı. Cox regresyon modelinde, yalnızca anne sütü ile beslenmeye ilişkin istatistiksel olarak tek anlamlı açıklayıcı değişken annelerin gebelik öncesi BKI değeriydi. Obez annelerin bebekleri, obez olmayan annelerin bebeklerine göre; doğum sonrası 1. haftada 2.25 kat, 1. ayda 4.50 kat, 3. ayda 2.20 kat ve 6. ayda 1.69 kat daha az sadece anne sütü ile beslenmiştir. Sonuç: Gebelik öncesi obezitenin, sadece anne sütü ile beslenme durumunu istatistiksel olarak azalttığı belirlendi. Gebelik öncesi takiplerde üreme çağındaki kadınların obezite açısından izlenmesi ve obeziteyi azaltmaya yönelik sağlık eğitimi, danışmanlık gibi hemşirelik girişimlerinin uygulanması önerilebilir.

Anahtar Kelimeler

• Gebelik öncesi obezite
• emzirme
• kohort çalışması

The Effect of Maternal Pre-Pregnancy Obesity on Breastfeeding: A Pilot Prospective Cohort Study

Öz

Objective: This prospective cohort study was conducted to investigate the effect of mothers who have obesity according to body mass index (BMI) in the pre-pregnancy period on their infant’s exclusive breastfeeding status six months after delivery. Material and Methods: The study sample consisted of 44 obese and 44 non-obese mother-infant pairs registered to a Family Health Center in Izmir, Türkiye. The data were collected during the 1st week, 1st, 3rd, and 6th months after delivery using the Individual Identification Form, LaTCH Tool, and Breastfeeding Status Follow-up Form. Independent t-test, Chi-square and Cochran’s Q tests, and Cox’s regression analysis were used. Results: A significant difference was found between the exclusive breastfeeding status of the infants of obese and non-obese participants in all follow-up weeks. In the Cox regression model, the only significant explanatory variable on exclusive breastfeeding in all follow-ups was prepregnancy BMI of the participants. The infants of obese participants were exclusively breastfed by 2.25 times less in the 1st week, 4.50 times less in the 1st month, 2.20 times less in the 3rd month, and 1.69 times less in the 6th month than the infants of non-obese participants. Conclusion: It was determined that maternal obesity statistically decreased the exclusive breastfeeding status. It can be recommended to monitor women of the reproductive age for obesity during pre-pregnancy follow-ups and to implement nursing interventions such as health education and counselling to reduce obesity.

Anahtar Kelimeler

• Maternal obesity
• breastfeeding
• cohort study.

Kaynakça

1. Centers for Disease Control and Prevention. Obesity, 2018. Available from : https://www.cdc.gov/nchs/data/hus/2018/026.pdf.
2. World Health Organization. Obesity, 2016. Available from: https:// www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
3. Ballesta-Castillejos A, Gomez-Salgado J, Rodriguez-Almagro J, Ortiz- Esquinas I, Hernandez-Martinez A. Relationship between maternal body mass index with the onset of breastfeeding and its associated problems: an online survey. Int Breastfeed J. 2020; 15(1): 1-13.
4. Skouteris H, Nagle C, Fowler M, Kent B, Sahota P, Morris H. Interventions designed to promote exclusive breastfeeding in high-income countries: a systematic review. Breastfeed Med. 2014; 9(3):113- 127.
5. World Health Organization. (2020). Breastfeeding. Available from: https://www.who.int/health-topics/breastfeeding#tab=tab_2.
6. Global Breastfeeding Scorecard (2017). Available from : https:// www.who.int/nutrition/publications/infantfeeding/global-bf-scorecard2017.
7. Turkey Demographic and Health Survey (TDHS) (2018). The Results of Study. Available from: http://www.hips.hacettepe.edu.tr/tnsa2013/ rapor/TNSA_2013_ana_rapor.pdf.
8. Aung ZK, Grattan DR, Ladyman SR. Pregnancy-induced adaptation of central sensitivity to leptin and insulin. Mol Cell Endocrinol. 2020:110933. https://doi:10.1016/j.mce.2020.110933.

9. Marshall NE, Lau B, Purnell JQ, Thornburg KL. Impact of maternal obesity and breastfeeding intention on lactation intensity and duration. Matern Child Nutr. 2019;15(2):e12732. https://doi:10.1111/ mcn.12732.
10. Ruager-Martin R, Hyde MJ, Modi N. Maternal obesity and infant outcomes. Early Hum Dev 2010; 86(11):715-722 DOI: 10.3109/00016489.2013.841991.
11. Carlsen EM, Kyhnaeb A, Renault KM, Cortes D, Michaelsen KF, Pryds O. Telephone-based support prolongs breastfeeding duration in obese women: a randomized trial. Am J Clin Nutr. 2013; 98(5):1226-1232.
12. Martin H, Thevenet-Morrison K, Dozier A. Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes: a cross-sectional analysis. BMC Pregnancy and Childbirth. 2020; 20(1): 1-10.
13. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. For the STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet. 2007; 37: 1453–1457.
14. Baker JL, Michaelsen KF, Sørensen TI, Rasmussen K.M. High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women. Am J Clin Nutr. 2007;86(2):404-411.
15. World Health Organization. Obesity: preventing and managing the global epidemic. report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253
16. Guelinckx I, Devlieger R, Bogaerts A, Pauwels S, Vansant G. The effect of pre-pregnancy BMI on intention, initiation and duration of breast-feeding. Public Health Nutr. 2012; 15(5):840-848.
17. Lucas R, Judge M, Sajdlowska J, Cong X, McGrath JM, Brandon D. Effect of maternal body mass index on infant breastfeeding behaviors and exclusive direct breastfeeding. J Obstet Gynecol Neonatal Nurs. 2015; 44(6):772-783.
18. Wojcicki JM. Maternal prepregnancy body mass index and initiation and duration of breastfeeding: a review of the literature. J Womens Health. 2011;20(3):341-347.
19. Jensen D, Wallace S, Kelsay, P. LATCH: a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs. 1994; 23(1):27-32.
20. Yenal K, Okumuş H. The relation between breastfeeding self-efficacy and breastfeeding success in mothers. JAREN. 2003;5(1):38-44.
21. Ministry of Health. 2013-2017 Strategic Action Plan. Available from: https://dosyamerkez.saglik.gov.tr/ Eklenti/9843,saglik-bakaligi-stratejik-plan--2013-2017pdf.pdf?0&_ g1=732DB6BBC0692DEE6FC458B05035CFCDB14F1F97.
22. Fan W Q, Molinaro A. Maternal obesity adversely affects early breastfeeding in a multicultural, multi‐socioeconomic Melbourne community. Aust N Z J Obstet Gynaecol. 2021;61(1):78-85.
23. Ballesta-Castillejos A, Gomez-Salgado J, Rodriguez-Almagro J, Ortiz-Esquinas I, Hernandez-Martinez A (2020). Relationship between maternal body mass index with the onset of breastfeeding and its associated problems: an online survey. Int. Breastfeed. J.2020; 15: 1-13.
24. Huang Y, Ouyang YQ, Redding SR. Maternal prepregnancy body mass index, gestational weight gain, and cessation of breastfeeding: a systematic review and meta-analysis. Breastfeed Med. 2019; 14(6): 366- 374.
25. Achike M, Akpinar-Elci M. The role of maternal prepregnancy body mass index in breastfeeding outcomes: a systematic review. Breastfeed Med 2021; 16(9): 678-686.
26. Kandeel WA, Rabah TM, Zeid DA, El-Din EMS, Metwally AM, Shaalan A, Shaaban SY. Determinants of exclusive breastfeeding in a sample of Egyptian infants. Open Access Maced J Med Sci. 2018; 6(10):1818.
27. Tanda R, Chertok IR, Haile ZT, Chavan BB. Factors that modify the association of maternal postpartum smoking and exclusive breastfeeding rates. Breastfeed Med. 2018;13(9): 614-621.