美国儿科学会：母乳喂养对母亲的作用

母乳喂养能为母亲的健康带来长期和短期两方面的益处。哺乳母亲产后出血量更少、子宫复旧更快。持续母乳喂养引起的哺乳期闭经则有助于增加生育间隔。一些前瞻性队列研究发现，不喂母乳或过早结束母乳喂养的母亲产后抑郁症的发病率增高。一项关于母亲长期虐待和忽视儿童的大型前瞻性研究发现，潜在的混杂因素校正后，与母乳喂养的母亲相反，那些没有哺乳过的母亲对儿童的虐待/忽视率有着明显的增加（OR：2.6；95％CI：1.7-3.9）。 母乳喂养对母亲恢复孕前体重的整体效果如何？由于影响体重控制的混杂因素过多（例如饮食、活动量、种族和基线体重指数），关于这一问题的研究尚无定论。13通过对14000余名产后女性的协变量调整研究，表明产后纯母乳喂养时间超过6个月的母亲比不哺乳的母亲体重降低了1.38公斤。70在没有妊娠糖尿病史的母亲中，母乳喂养持续时间与Ⅱ型糖尿病的风险降低相关；每进行一年母乳喂养，这种风险就会降低4％至12％。而在曾确诊患有妊娠糖尿病的母亲中，母乳喂养的这种益处尚无记载。 纵向的护士健康研究 (Nurses Health Study) 指出，一生中母乳喂养的累计时间和类风湿关节炎的发病之间成反比关系。如果母乳喂养的累计时间超过12个月，类风湿关节炎的相对危险性为0.8（95％CI：0.8-1.0），如果母乳喂养的累计时间超过24个月，类风湿关节炎的相对危险性为0.5（95％CI：0.3-0.8）。妇女健康倡议计划（Women’s Health Initiative）的一项关于139000多名绝经后女性的纵向研究表明，累计的哺乳时间和成人心血管疾病的发病率之间是有关联的。74拥有12至23个月的累计哺乳史的女性在高血压（OR：0.89；95％CI：0.84-0.93）、高脂血症（OR ：0.81；95％CI：0.76-0.87）、心血管疾病（OR：0.90； 95％CI：0.85-0.96），及糖尿病（OR：0.74；;95％CI：0.65-0.84）方面的患病风险显著降低。 累计的哺乳经历也和罹患乳腺癌（主要是绝经前的女性）和卵巢癌的风险降低有关。母乳喂养时间累计超过12个月的母亲与乳腺癌（OR：0.72；95％CI：0.65-0.8）和卵巢癌（OR：0.72；95％CI：0.54-0.97）发病率降低28％有关。有计算结果得出，每进行一年母乳喂养时间，可以使母亲患乳腺癌的几率减少4.3％。 Both short- and long-term health benefits accrue to mothers who breastfeed. Such mothers have decreased postpartum blood loss and more rapid involution of the uterus. Continued breastfeeding leads to increased child spacing secondary to lactational amenorrhea. Prospective cohort studies have noted an increase in postpartum depression in mothers who do not breastfeed or who wean early. A large prospective study on child abuse and neglect perpetuated by mothers found, after correcting for potential confounders, that the rate of abuse/neglect was significantly increased for mothers who did not breastfeed as opposed to those who did (OR: 2.6; 95% CI: 1.7–3.9). Studies of the overall effect of breastfeeding on the return of the mothers to their pre-pregnancy weight are inconclusive, given the large numbers of confounding factors on weight loss (diet, activity, baseline BMI, ethnicity).In a covariate-adjusted study of more than 14 000 women postpartum, mothers who exclusively breastfed for longer than 6 months weighed 1.38 kg less than those who did not breastfeed. In mothers without a history of gestational diabetes, breastfeeding duration was associated with a decreased risk of type 2 diabetes mellitus; for each year of breastfeeding, there was a decreased risk of 4% to 12%.No beneficial effect for breastfeeding was noted in mothers who were diagnosed with gestational diabetes. The longitudinal Nurses Health Study noted an inverse relationship between the cumulative lifetime duration of breastfeeding and the development of rheumatoid arthritis. If cumulative duration of breastfeeding exceeded 12 months, the relative risk of rheumatoid arthritis was 0.8 (95% CI: 0.8–1.0), and if the cumulative duration of breastfeeding was longer than 24 months, the relative risk of rheumatoid arthritis was 0.5 (95% CI: 0.3–0.8). An association between cumulative lactation experience and the incidence of adult cardiovascular disease was reported by the Women’s Health Initiative in a longitudinal study of more than 139 000 postmenopausal women.Women with a cumulative lactation history of 12 to 23 months had a significant reduction in hypertension (OR: 0.89; 95% CI: 0.84–0.93), hyperlipidemia (OR: 0.81; 95% CI: 0.76–0.87), cardiovascular disease (OR: 0.90; 95% CI: 0.85–0.96), and diabetes (OR: 0.74; 95% CI: 0.65–0.84). Cumulative lactation experience also correlates with a reduction in both breast (primarily premenopausal) and ovarian cancer.13,14,75 Cumulative duration of breastfeeding of longer than 12 months is associated with a 28% decrease in breast cancer (OR: 0.72; 95% CI: 0.65–0.8) and ovarian cancer (OR: 0.72; 95% CI: 0.54–0.97). Each year of breastfeeding has been calculated to result in a 4.3% reduction in breast cancer. 来源：http://pediatrics.aappublications.org/content/129/3/e827.full 翻译：http://www.weibo.com/2514526082/zvv2Aev2H