Study On The Association Between The Dietary Nutrition Status Of Pregnant Women In The Third Trimester And Delayed Onset Of Lactogenesis

Objective To investigate the association between the dietary nutrition status of pregnant women in the third trimester and delayed onset of lactogenesis(DOL),to explore the factors influencing delayed onset of lactogenesis,in order to provide a foundation for the clinical application.Methods Maternal births were performed in the first affiliated hospital of Anhui Medical University,the fourth affiliated hospital of Anhui Medical University,and the provincial hospital of Anhui Provincial Hospital(South District)from January 2018 to January 2019.Questionnaires,medical records,and telephone follow-up surveys included maternal basic data,clinical data,dietary nutritional status(including food intake frequency and average food intake per day),and Postpartum lactation(including milk secretion Start time,lactation start time,daily self-assessment of breast milk level for 3 days after delivery),calculate daily food intake and nutrient intake.According to whether or not lactation start delay occurs,it was divided into lactation delay group and non-lactation delay group,and then single factor and multiple factor analysis were performed.Differences between data were analyzed by t test or t ’test,chi-square test or Fisher’s exact probability method;the factors influencing delayed onset of lactogenesis were analyzed by multivariate binary logistic regression.Results 1.Among 340 maternal women,107 had delayed lactation onset after giving birth,with an incidence of 31.5%;233 cases did not occur with delayed onset of lactation,accounting for 68.5%.The start time of milk secretion was 0-120 h,and the median and quartile were 3.0(1.0,19.5)h.The onset time of lactation was 4-288 h,with an average of(66.0±29.7)h.In the 24 hours after childbirth,42 cases(12.4%)of breast milk were rated as "not",183(53.8%)were "rare",and 103(30.3%)were "generalized".12 cases(3.5%)were "more" and 0 cases(0%)were "many".There were 18 cases(5.3%)of self-assessed breast milk levels from 24 to 48 hours postpartum,108 cases(31.8%)of "rare",and 162 cases(47.6%)of "generalized".There were 49 cases(14.4%)of "more" and 3 cases(0.9%)of "many".48-72 hours postpartum self-assessment of breast milk in 9 cases(2.6%),53 cases(31.8%)in "rare",144 cases(42.4%)in"generalized"," There were 100 cases(29.4%)of "more" and 34 cases(10.0%)of"many".2.Compared with the non-lactation-delayed group,the age,pre-pregnancy BMI,nationality,occupation,family per capita monthly income,education level,current residence,exercise frequency,sleep quality,smoking or second-hand smoke,depression and anxiety,mother’s milk condition and gestational hypertension of the maternal women in the lactation-delayed group showed no statistical significance(p >0.05),The incidence of delayed onset of lactogenesis in primary and GDM women was significantly higher than that in multipara and the women without GDM(p < 0.05).3.The ingestion of cereals and crisps,fruits,livestock and poultry,soybeans and nuts by maternal women in the third trimester of Hefei was too much,and the intake of other food categories basically met the recommended standards.The overall nutrient intake of pregnant women in Hefei City in the third trimester is high,the intake of protein,carbohydrates,vitamin A,B2,E,calcium,zinc are excessive,and vitamin B6 intake is seriously insufficient.The percentage of energy supplied by protein,fat,and carbohydrates is 17.3%,22.6%,and 60.1%,respectively.The energy supply ratio of protein is slightly high,the energy supply ratio of fat and carbohydrate meets the standard.This shows that the composition of energy overall is more reasonable.4.The intake of cereals and crisps,eggs,energy,protein,fat,carbohydrates,vitamins (B2,B6,E),iron and selenium in maternal women of the lactation-delayed group was lower than that of non-lactation-delayed group,and the difference was statistically significant(p<0.05).The intake of vegetables,fruits,milk,livestock and poultry,aquatic products,beans,nuts,dietary fiber,vitamins(A,B1),calcium,zinc and the three macronutrient energy supply ratio of the two groups were compared,and the difference was not statistically significant(p >0.05).5.In univariate analysis,GDM,parity,cereals and crisps,eggs,energy,protein,fat,carbohydrates,vitamin B2,B6,E,iron and selenium were the influencing factors of delayed onset of lactogenesis(p<0.05);In multivariate Logistic regression analysis,GDM and parity were independent influencing factors of delayed onset of lactogenesis(p<0.05).Nutrition interrelated indicators did not involve in the multivariate Logistic regression.Conclusions The dietary nutritional ingestion level of maternal women in the third trimester in Hefei City is generally high.The ingestion of cereals and crisps,fruits,livestock and poultry,soybeans and nuts is overabundance.The intake of other food categories basically meets the standard.Protein,carbohydrate,vitamin A,B2,E,calcium,and zinc intakes were all excessive,but vitamin B6 intake was seriously insufficient.The three macronutrient energy supply ratios basically meet the standards.The incidence of delayed onset of lactogenesis is higher.GDM,parity,cereals and crisps,eggs,energy,protein,fat,carbohydrates,vitamin B2,B6,E,iron,and selenium are factors that affect delayed onset of lactogenesis;GDM,parity are independent Influencing factors of delayed onset of lactogenesis.