徐宵寒, 张娇, 虞雪融, 李旭, 黄宇光. 我国麻醉住院医师产假后母乳喂养的职业相关影响因素分析[J]. 协和医学杂志, 2023, 14(4): 820-825. DOI: 10.12290/xhyxzz.2023-0165
引用本文: 徐宵寒, 张娇, 虞雪融, 李旭, 黄宇光. 我国麻醉住院医师产假后母乳喂养的职业相关影响因素分析[J]. 协和医学杂志, 2023, 14(4): 820-825. DOI: 10.12290/xhyxzz.2023-0165
XU Xiaohan, ZHANG Jiao, YU Xuerong, LI Xu, HUANG Yuguang. Occupational Factors Associated with Breastfeeding Continuation after Maternity Leave Among Female Anesthesia Residents in China[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 820-825. DOI: 10.12290/xhyxzz.2023-0165
Citation: XU Xiaohan, ZHANG Jiao, YU Xuerong, LI Xu, HUANG Yuguang. Occupational Factors Associated with Breastfeeding Continuation after Maternity Leave Among Female Anesthesia Residents in China[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(4): 820-825. DOI: 10.12290/xhyxzz.2023-0165

我国麻醉住院医师产假后母乳喂养的职业相关影响因素分析

Occupational Factors Associated with Breastfeeding Continuation after Maternity Leave Among Female Anesthesia Residents in China

  • 摘要:
      目的  分析我国麻醉住院医师产假后母乳喂养的职业相关影响因素。
      方法  本研究基于一项由中华医学会麻醉学分会发起的"女性麻醉医师母乳喂养及工作/家庭平衡状况"全国性调研, 纳入全国2015年1月1日后生育过的女性麻醉专业住院医师。通过匿名在线填写问卷的方式收集麻醉住院医师基本信息、母乳喂养时长和哺乳期工作情况。以赤池信息标准最小原则筛选纳入变量, 将事件定义为"终止母乳喂养", 将可能影响母乳喂养的职业相关因素作为解释变量, 将可能影响母乳喂养的个人影响因素亦作为解释变量纳入模型, 以调整其潜在的混杂效应, 采用Schoenfeld残差图评估各解释变量是否满足等比例风险假设, 对于不满足者, 则在模型中加入该变量的时间依存协变量, 采用分步Cox回归分析影响母乳喂养持续时间的职业因素。
      结果  本研究共纳入436名麻醉住院医师, 所在地区包括除宁夏回族自治区和黑龙江省以外的29个省份; 372名(85.3%, 372/436)已终止母乳喂养, 其中268名(72.0%, 268/372)由于工作原因提前结束母乳喂养; 419名(96.1%, 419/436)工作后母乳显著减少, 133名(30.5%, 133/436)在工作中无机会吸奶; 中位母乳喂养时长为10(8, 12)个月; 住院医师年资越高, 母乳喂养终止时间越早(HR=1.09, 95% CI: 1.03~1.15, P=0.004);产假时间长(HR=0.85, 95% CI: 0.78~0.93, P < 0.001)、三级医院(HR=0.56, 95% CI: 0.43~0.73, P < 0.001)、工作中吸奶机会多(HR=0.02, 95% CI: 0~0.08, P < 0.001)和哺乳期工作量减少(HR=0.47, 95% CI: 0.26~0.86, P=0.014)可能与母乳喂养时间延长相关。
      结论  应适当延长我国麻醉住院医师产假、调整轮转计划、提供专用哺乳室、保障工作中的吸奶时间等, 以保证麻醉住院医师的母婴健康。

     

    Abstract:
      Objective  To analyze the current status and occupational factors associated with breastfeeding continuation after maternity leave among female anesthesia residents in China.
      Methods  Our study was based on a nationwide survey "Breastfeeding and Work/Family Balance Among Female Anesthesiologists" conducted by Chinese Society of Anesthesiology, which was targeted to female anesthesia residents giving birthsince January 1, 2015.An anonymous online questionnaire was developed to collect basic information, breastfeeding practices and workload.The inclusion variables were screened using the akaike information criterion (AIC), with the event defined as "termination of breastfeeding".Occupational factors that may affect breastfeeding were included as explanatory variables and non-occupational related factors that may affect breastfeeding were also included in the model to adjust for potential confounding effects.Schoenfeld were used to assess whether the variables were satisfied for each explanatory variable, and for those that were not, the time-dependent covariate for that variable was added to the model, occupational factors affecting breastfeeding duration were analyzed using stepwise Cox regression.
      Results  A total of 436 anesthesia residents from 29 provinces were included.According to the survey, 372(85.3%, 372/436) terminated breastfeeding, of which 268(72.0%, 268/372) ended breastfeeding early due to work, 419(96.1%, 419/436) significantly reduced breast milk after work, and 133(30.5%, 133/436) had no opportunity to breastfeed at work.Their median breastfeeding duration was 10(8, 12) months.Longer work experience at childbirth was associated with a higher risk of discontinuing breastfeeding (HR=1.09, 95% CI: 1.03-1.15, P=0.004).The following occupational factors were associated with a longer breastfeeding duration: prolonged maternity leave (HR=0.85, 95% CI: 0.78-0.93, P < 0.001), tertiary hospital (HR=0.56, 95% CI: 0.43-0.73, P < 0.001), more opportunities for breast pumping during worktime (HR=0.02, 95% CI: 0-0.08, P < 0.001) and reduced workload during the breastfeeding period (HR=0.47, 95% CI: 0.26-0.86, P=0.014).
      Conclusion  Hospital administrators can make efforts to offer prolonged maternity leave, modified rotation plan, breastfeeding rooms, and breastfeeding breaks, which are beneficial to both maternal and fetal health.

     

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