探討母乳哺育型態和早期母乳哺育困難對產後憂鬱風險的影響

Abstract

研究背景：產後憂鬱的影響因子多元，導致既有文獻知識對於母乳哺育型態、早期母乳哺育困難與產後憂鬱之間的關係的說法歧異，故本研究在控制已知風險因子之下，檢驗母乳哺育型態和早期母乳哺育困難對產後三個月憂鬱風險的影響。 研究方法：本研究採縱向式研究設計，於台北市某醫學中心的婦產科門診進行收案，招募對象為懷孕滿24週的新手準母親，招募98位，以自擬結構式問卷內容蒐集資料，包含中文版愛丁堡產後憂鬱量表(Edinburgh postnatal depression scale, EPDS)、人口學特性資料、孕產史、母乳哺育型態與早期母乳哺育困難。收集資料時間點分別為孕期滿24週、產後3-5天、4-6週、三個月，有效問卷回收率為92%，共90位。資料將以統計軟體SPSS 26.0版進行廣義估計模式(GEE)分析及解釋。 研究結果：如研究假設所預期，產前憂鬱高風險(OR = 1.36, p = .012)、產後子宮收縮痛(OR = 1.04, p = .037)和出院動向為返家(OR = 2.12, p = .001)皆為產後憂鬱的相關影響因子。在控制上述已知影響因素後(如產前憂鬱情形、產後疼痛狀況與出院動向)，早期母乳哺育困難中的乳頭平或凹陷(OR = 1.08, p = .039)則對於產後憂鬱高風險有顯著影響。然而，母乳哺育型態對於產後三個月的憂鬱風險無顯著影響(OR = 1.03, p = .813)。 結論：在考量產前憂鬱情形、產後疼痛狀況與出院動向後，當孕產婦發生早期母乳哺育困難中的乳頭平或凹陷時，產後憂鬱的風險會增加，但是，母乳哺育型態與產後憂鬱的風險無關。故此研究建議透過於孕期乳房評估給予適時的介入與指導，針對孕期篩檢產前憂鬱高風險群、產後子宮收縮為中強度疼痛(≧4分)者，產婦出院動向為回家者，持續追蹤產後高憂鬱風險，並早期介入，以期降低發生率。

Background: Postpartum depression is affected by various factors, resulting in divergent views on the relationship among breastfeeding patterns, early breastfeeding difficulties and postpartum depression. Therefore, the study aims to examine the effects of breastfeeding pattern and early breastfeeding difficulties on the risk of postpartum depression during three months after birth, while controlling the known risk factors. Method: This study adopts a longitudinal study design. Participants were recruited in an antenatal clinic of a medical center in Taipei. Inclusion criteria were new expectant mother after gestational week 24. Data were collected by self-administrated questionnaires, including Edinburgh postnatal depression scale (EPDS), demographic characteristics, obstetric history, breastfeeding pattern, and early breastfeeding difficulties. The data were collected during the recruitment (GA 24 week), 3-5 days, 4-6 weeks and three months postpartum. Data were analyzed by statistical software SPSS version 26.0. Results: As predicted, a higher risk of antenatal depression (OR = 1.36, p = .012), postpartum uterine contraction pain (OR = 1.04, p = .037), and stayed at home (OR = 2.12, p = .001) were associated with postpartum depression. After controlling for above variables, early breastfeeding difficulties due to flat or indented nipples (OR = 1.08, p = .039) was significantly associated with higher risk of postpartum depression. However, breastfeeding pattern (OR = 1.03, p = .813) showed no significant association with the risk of postpartum depression within three months postpartum. Contribution: After considering prenatal depression, postpartum pain, and accommodation after discharge, early breastfeeding difficulties (i.e., nipple flattening or indenting) increases the risk of postpartum depression. However, breastfeeding pattern was not significantly associated with the risk of postpartum depression. Therefore, the study recommends breast assessment during pregnancy. Further, we also recommend screening and follow-up women with high-risk factors, including high-risk prenatal depression, moderate to severe pain of uterine contractions after delivery, and accommodation as back home after maternal discharge, to reduce the incidence and risk of postpartum depression.