中国人群产后抑郁状态与纯母乳喂养关联的Meta分析

李璇; Obore Nathan; 陶昱辰; 胡燕; 王一枭; 洪翔; 王蓓; 于红

doi:10.16462/j.cnki.zhjbkz.2023.11.014

中国人群产后抑郁状态与纯母乳喂养关联的Meta分析

doi: 10.16462/j.cnki.zhjbkz.2023.11.014

李璇¹,
Obore Nathan¹,
陶昱辰¹,
胡燕²,
王一枭¹,
洪翔³,
王蓓³,
于红^2, ,

1.
东南大学医学院临床医学系，南京 210009
2.
东南大学附属中大医院妇产科，南京 210009
3.
东南大学公共卫生学院流行病与卫生统计学系，南京 210009

基金项目:

江苏省卫生健康委员会医学科研项目 2021, NO. 47

详细信息

通讯作者:
于红，E-mail: yuhong650325@sina.com

中图分类号: R714.7
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- 被引次数: 0
出版历程
- 收稿日期: 2022-06-14
- 修回日期: 2022-09-24
- 网络出版日期: 2023-11-20
- 刊出日期: 2023-11-10

A Meta-analysis of the association between postpartum depression and exclusive breastfeeding in the Chinese population

1.
Department of Clinical Medicine, Southeast University School of Medicine, Nanjing 210009, China
2.
Department of Obstetrics and Gynecology, Southeast University Affiliated Zhongda Hospital, Nanjing 210009, China
3.
Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China

Funds:

Medical Scientific Research Project of Jiangsu Provincial Health Commission 2021, NO. 47

More Information

Corresponding author: YU Hong, E-mail: yuhong650325@sina.com

摘要

摘要: 目的探究中国人群产后抑郁状态与纯母乳喂养的关联强度。方法检索万方、SinoMed、知网等数据库，查找中国人群产后抑郁状态与纯母乳喂养情况的观察性研究。采用Stata 12.0软件进行Meta分析。并根据地区、产后时间、分组依据及纳入人群进行亚组分析。结果共纳入16篇观察性研究。总体分析抑郁状态组较对照组纯母乳喂养比例低，差异有统计学意义(OR=0.44, 95% CI: 0.36~0.54, P＜0.001)。亚组分析提示处于产后抑郁状态的女性纯母乳喂养比例在东部地区显著降低(OR=0.45, 95% CI: 0.36~0.56, P＜0.001)，在中西部地区也降低(OR=0.41, 95% CI: 0.25~0.66, P＜0.001);产后42 d内处于产后抑郁状态的产妇中纯母乳喂养比例降低(OR=0.48, 95% CI: 0.37~0.61, P＜0.001)，在产后42 d~6月降低更为显著(OR=0.35, 95% CI: 0.21~0.60, P＜0.001);去除不同分组依据及纳入人群的研究，剩余研究结果与总体结果差异不大，差异均有统计学意义(OR=0.45, 95% CI: 0.36~0.56, P＜0.001)。Meta回归分析提示研究间的异质性地区(P=0.906)、产后时间(P=0.528)、分组依据及纳入人群(P=0.722)差异无统计学意义。结论与对照组相比较，产后抑郁状态人群中纯母乳喂养的比例低。为提高中国人群6个月内纯母乳喂养率、降低产后抑郁患病率，建议从产前开始进行孕产期抑郁筛查及多学科协作干预。
- 抑郁症 /
- 产后 /
- 母乳喂养 /
- Meta分析
Abstract: Objective To explore the relationship between postpartum depression and exclusive breastfeeding (EBF) in the Chinese population. Methods Observational studies about postpartum depression and feeding patterns were searched in databases including Wanfang, SinoMed, CNKI, and so on. Stata 12.0 was used for meta-analysis. Subgroup analysis for both the control and depression populations was performed according to region, postpartum time, and the groups and populations. Results A total of 16 observational studies were included. The rate of EBF in the postpartum depression group was lower than that in the control group, and the difference was statistically significant (OR=0.44, 95% CI: 0.36-0.54, P < 0.001). Subgroup analysis showed that the depression group had a lower EBF rate than the control group in eastern China (OR=0.45, 95% CI: 0.36-0.56, P < 0.001), as well as in central and western China (OR=0.41, 95% CI: 0.25-0.66, P < 0.001). There was a decreased rate of EBF among mothers that had depression within 42 days postpartum (OR=0.48, 95% CI: 0.37-0.61, P < 0.001) and more significantly between 42 days and 6 months postpartum (OR=0.35, 95% CI: 0.21-0.60, P < 0.001). Exclusion of some studies among the different groups and populations did not significantly alter the overall results and the differences were statistically significant (OR=0.45, 95% CI: 0.36-0.56, P < 0.001). Meta-regression analysis suggested that the source of heterogeneity among studies may not be related to the region (P=0.906), postpartum time(P=0.528), or the groups and populations (P=0.722). Conclusions The rate of EBF is lower in the postpartum depression population compared with the control group. To increase the EBF rate within 6 months and reduce the prevalence of postpartum depression in China, we recommend screening for depression during pregnancy and multidisciplinary collaborative intervention starting from the prenatal period.
- Depression /
- Postpartum /
- Breast Feeding /
- Meta-analysis

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图 1 文献检索流程

Figure 1. Flow diagram of articles included

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图 2 中国人群产后抑郁状态与纯母乳喂养关联的森林图(A)与漏斗图(B)

Figure 2. Forest plot (A) and funnel plot (B) of the association between postpartum depression and EBF in the Chinese population

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表 1 纳入文献基本特征

Table 1. Characteristics of included studies

年份 Year	地区 District	研究 Research	产后调查时间/d Postpartum investigation time /d	NOS评分 NOS score	抑郁状态组Depressive state group			对照组Control group
年份 Year	地区 District	研究 Research	产后调查时间/d Postpartum investigation time /d	NOS评分 NOS score	例数 Number	纯母乳喂养 Exclusive breastfeeding	混合喂养+人工喂养 Mixed feeding+Artificial feeding	例数 Number	纯母乳喂养 Exclusive breastfeeding	混合喂养+人工喂养 Mixed feeding+Artificial feeding
2009	广东广州 Guangdong, Guangzhou	王利, 等 ^[9] Wang Li, et al ^[9]	42	8	17	3	14	93	50	43
2012	江苏南京 Jiangsu, Nanjing	吴江平, 等 ^[10] Wu Jiangping, et al ^[10]	42	8	59	13	46	455	176	279
2014	北京 Beijing	陈涵 ^[11] Chen Han ^[11]	7	7	53	11	42	331	124	207
2014	海南海口 Hainan, Haikou	汤琼瑶, 等 ^[12] Tang Qiongyao, et al ^[12]	7	7	195	97	98	1 048	714	334
2016	广东深圳 Guangdong, Shenzhen	孟利平, 等 ^[13] Meng Liping, et al ^[13]	42	8	357	165	192	1 843	1 006	837
2017	江苏苏州 Jiangsu, Suzhou	吴贻红, 等 ^[14] Wu Yihong, et al ^[14]	14~42	7	114	58	56	508	280	228
2017	广东深圳 Guangdong, Shenzhen	王月云, 等 ^[15] Wang Yueyun, et al ^[15]	14~60	7	313	100	213	3 221	1 527	1 694
2018	天津 Tianjin	宋春华 ^[16] Song Chunhua ^[16]	21	8	123	30	93	8 151	3 659	4 492
2018	广东深圳 Guangdong, Shenzhen	陈丽珊, 等 ^[17] Lishan Chen, et al ^[17]	14~21	7	49	8	41	1 117	551	566
2020	四川泸州 Sichuan, Luzhou	张青, 等 ^[18] Zhang Qing, et al ^[18]	180	7	111	57	54	337	217	120
2020	上海 Shanghai	Ying Liu, et al ^[19]	42	8	279	134	145	925	504	421
2020	四川成都 Sichuan, Chengdu	赖立, 等 ^[20] Lai Li, et al ^[20]	30	7	38	28	10	42	37	5
			60		38	23	15	42	35	7
			90		38	17	21	42	35	7
			120		38	14	24	42	31	11
2021	湖北十堰 Hubei, Shiyan	李莉, 等 ^[7] Li Li, et al ^[7]	60	8	179	27	152	644	98	546
2021	浙江杭州 Zhejiang, Hangzhou	马明月, 等 ^[21] Ma Mingyue, et al ^[21]	7	7	116	41	75	268	170	98
2021	浙江嘉兴 Zhejiang, Jiaxing	王箫, 等 ^[22] Wang Xiao, et al ^[22]	42	7	63	32	31	209	150	59
			90		63	30	33	211	153	58
			180		63	18	45	209	140	69
2022	陕西西安 Shaanxi, Xi′an	巨娣, 等 ^[8] Ju Di, et al ^[8]	0~90	7	86	16	70	594	227	367
注：NOS, 纽卡斯尔-渥太华量表。 Note: NOS, Newcastle-Ottawa Quality Assessment Scale.

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表 2 中国人群产后抑郁状态与纯母乳喂养关联强度的亚组分析

Table 2. Subgroup analysis of the association between postpartum depression and EBF in the Chinese population

亚组 Subgroups	纳入研究数 Number of included researched	样本量 Number of sample	抑郁状态组例数 Number of depressive state group	对照组例数 Number of the control group	I²/%	异质性检验(P值) Heterogeneity test (P value)	OR值value (95% CI)	P值 value
地区District
东部地区East District	12	19 907	1 738	18 169	73.40	＜0.001	0.45(0.36~0.56)	＜0.001
中西部地区Middle and West District	4	2 031	414	1 617	68.20	0.004	0.41(0.25~0.66)	＜0.001
时间Time
产后≤42 d Postpartum ≤42 d	12	16 453	1 463	14 990	69.80	＜0.001	0.48(0.37~0.61)	＜0.001
产后42 d~6月Postpartum 42 d-6 months	4	2 057	530	1 527	77.80	＜0.001	0.35(0.21~0.60)	＜0.001
分组依据及纳入人群 Grouping standards and including population
相同Identical	13	20 996	1 908	19 088	71.6	＜0.001	0.45(0.36~0.56)	＜0.001
不同Unidentical	3	942	244	698	61.9	0.072	0.38(0.22~0.67)	0.001

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