| Objective1.To understand the physical activity level of pregnant women in the third trimester and delayed onset of lactogenesis,compare the differences in delayed onset of lactogenesis between pregnant women in sufficient physical activity group and insufficient physical activity group,analyze the association between physical activity in the third trimester and delayed onset of lactogenesis,and explore the factors affecting delayed onset of lactogenesis;2.To understand the current status of maternal exclusive breastfeeding,and compare the differences in postpartum feeding methods between pregnant women with sufficient physical activity and pregnant women with insufficient physical activity,so as to provide a basis for improving the breastfeeding status and ensuring the health of mother and baby.MethodsThis study was divided into two parts.Part Ⅰ of the study: Longitudinal follow-up method was used to recruit 358 pregnant women as the study subjects through the inclusion,exclusion and elimination criteria in the third trimester of pregnancy from a third A hospital in Hefei,Anhui Province in October 2020.Prenatal data and physical activity level of pregnant women in the third trimester（0 days 28 weeks to 6 days 38 weeks）were collected through the general data questionnaire and International Physical Activity Questionnaire-short;Intrapartum and postnatal data were collected after delivery by reviewing medical records and face-to-face follow-up.Maternal postpartum depressive mood occurrence was measured by the Edinburgh Postnatal Depression Scale on day 1 after delivery and delayed onset of lactogenesis was determined within 3 days after delivery and the maternal self-perceived lactation initiation time was asked.The incidence of delayed onset of lactogenesis in different populations was compared by Chi-square test.Binary logistic regression was used to analyze the effect of physical activity on delayed onset of lactogenesis,and t test was used to compare the difference in lactation initiation time of pregnant women with different level of physical activity.Part Ⅱ of the study: 358 pregnant women in a third A hospital in Hefei,Anhui Province from October 2020 to November 2021 were investigated through a questionnaire survey combined with postpartum follow-up.General data,physical activity level,and level of depression in the third trimester were collected in the third trimester（0 days 28 weeks to6 days 38 weeks）.Obstetrical data on maternal and neonatal infants,delayed onset of lactogenesis were collected within 3 days after delivery.Feeding methods was recorded by telephone follow-up within 2 weeks of delivery.The rates of breastfeeding breastfeeding at 2 weeks postpartum in different populations was compared by Chi-square test.Binary logistic regression was used to analyze the effect of physical activity on breastfeeding breastfeeding at 2 weeks postpartum.ResultsPart Ⅰ of the study:1.A total of 382 pregnant women were recruited in this survey,excluding 24 women with abnormal childbirth and postpartum maternal and infant separation,and 358 women finally underwent the whole survey from the third trimester to postpartum.2.261（72.9%）and 97（27.1%）were sufficient and insufficient physical activity level,respectively during the third trimester.The total energy consumption of weekly physical activity was 1275.75（2057）Met-min/w,and energy consumption of low intensity physical activity（walking）,moderate intensity physical activity and high intensity physical activity accounted for 65.5%,32.8% and 1.7% of the total energy consumption,respectively.The main form of activity in the third trimester of pregnancy was walking.The average sedentary behavior time for pregnant women was（5.47±2.678）h/d and the sedentary behavior time of 29.3% pregnant women was ≥7h/d.3.The incidence of delayed onset of lactogenesis in this study was 33.2%（119/358）.There were no significant differences between delayed onset of lactogenesis group and non-delayed onset of lactogenesis group in age,education,prepregnancy constitution index,diabetes during pregnancy,the fear of delivery,parity,mode of delivery,premature birth,birth weight,sex of newborn,and receiving breastfeeding education（P>0.1）.There was statistically significant difference between the two groups in occupation,weight gain,postpartum depression,physical activity,sedentary behavior,and whether formula was added within 48 h after delivery（P<0.1）.After adjusting for confounding factors,the incidence of delayed onset of lactogenesis in pregnant women with sufficient physical activity level was lower than that in pregnant women with insufficient physical activity level（OR=0.424,95%CI: 0.246～0.730）.The incidence of delayed onset of lactogenesis was lower in pregnant women with lower sedentary level（<7h/d）compared with pregnant women with higher level（≥7h/d）sedentary behavior（OR=0.248,95%CI: 0.147～0.420）.The risk of delayed onset of lactogenesis was lower in women without postpartum depression than those with postpartum depression（OR=0.468,95%CI: 0.282～0.776）.The lactation initiation time of pregnant women with sufficient physical activity level was（46.19±14.271）h earlier than insufficient physical activity level（57.10±13.241）h（P<0.01）.Part Ⅱ of the study:1.Among all the respondents,131 women（36.6%）were exclusively breastfed for 2weeks after delivery.2.Binary logistic regression results showed that,without controlling for other variables,pregnant women with adequate physical activity had a higher rate of exclusive breastfeeding for 2 weeks after delivery（OR=1.968,95%CI:1.213～3.192）,after controlling depression in the third trimester of pregnancy,receiving breastfeeding knowledge education and age,the rate of exclusive breastfeeding in pregnant women with inadequate physical activity level was lower 2 weeks postpartum（OR=1.757,95%CI: 1.069～2.888）.ConclusionsThe form of physical activity in the third trimester of pregnancy was relatively simple,and the energy consumption mainly came from walking.The risk of delayed onset of lactogenesis in women with sufficient physical activity level was lower than that in women with insufficient physical activity level.The initiation time of lactation in the group with insufficient physical activity level was later than that in the group with sufficient physical activity level.Pregnant women with lower level of sedentary behavior had a lower risk of delayed onset of lactogenesis than women with higher level of sedentary behavior.In addition,postpartum depression is a risk factor for delayed onset of lactogenesis.Therefore,medical staff and pregnant women should pay more attention to individual behavior and mental health.Under the premise of safety,pregnant women should also improve physical activity level,reduce sedentary behavior during pregnancy,avoid excessive weight gain during pregnancy,and improve depression,thereby reducing the risk of delayed onset of lactogenesis and improving breastfeeding status. |
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