Idade gestacional e sucesso de amamentação em recém-nascidos a termo nascidos de cesariana eletiva

Abstract

Breastmilk represents the best source of nutrition for children and provides extensive benefits to every developmental process. Breastfeeding has effects on children's health, contributing to improved survival. Recent meta-analyzes indicate that breastfeeding confers protection against infections and gastrointestinal changes in childhood, promotes potential reduction of overweight and diabetes, and positively influences the development of the intellect. In addition, it can also co-affect outcomes in maternal health. Breastfeeding for infants is associated with protection against breast and ovarian cancer and reduction of type 2 diabetes. The benefits of breastfeeding reach populations living in countries of all income brackets. The World Health Organization recommends exclusive breastfeeding up to six months of age and its maintenance, accompanied by other foods, until the age of two. And even with all these initiatives going on for more than 25 years, overall breastfeeding rates remain well below international targets. The influence of the type of delivery on the duration of breastfeeding and the maintenance of exclusive breastfeeding is highly questioned. Studies involving the subject are controversial. Some studies have shown better results of exclusive breastfeeding and duration of breastfeeding among babies born vaginally, while others did not detect these differences. However, breastfeeding has multifactorial determinants. In recent years, evidence has emerged of differences in the success of breastfeeding among full-term newborns. Also, recognizing the vulnerability of children born at term between 37 weeks and 38 weeks, when compared to term newborns born between 39 and 41 weeks. How to recognize the behavior and particularities of full-term babies can provide adequate support before and after birth. And thus, contribute fundamentally to the maintenance of exclusive and continued breastfeeding. The purpose of this study was to evaluate the results of breastfeeding of newborns by cesarean section and to verify the differences between the gestational age ranges at birth. Methods: A retrospective study of a cohort that included term newborns and their mothers, whose deliveries occurred by elective cesarean section at the Moinhos de Vento Hospital (HMV), in Porto Alegre, Rio Grande do Sul, Brazil, from October 2011 to April 2013. Among the inclusion criteria are delivery by elective cesarean section (previously scheduled for various reasons) and minimum gestational age of 37 weeks. The database consisted of initial data obtained in the records of the newborns and through interviews with the mothers in the recovery room, after delivery. Follow-up data were obtained by telephone contact with each mother at the end of the second week of life, in the third month and in the sixth month after birth. Results: In this study, 954 term newborns were borned by elective caesarean section. Most of the newborns included in the research were gestational age between 38 and 39 weeks. The analyzes were performed according to the gestational age ranges that comprise full term birth. Exclusive breastfeeding at 3 months and being breastfed at 6 months presented a statistically significant correlation with gestational age variability (p=0.024 and p=0.004, respectively). Another analysis categorized the participants in early term (born between 37-38 weeks and 6 days) and full term (born between 39-40 weeks and 6 days). A significant statistical association of exclusive breastfeeding at 3 months (p=0.008) and 6 months of breastfeeding (p=0.001) was demonstrated in the correlation between early term and full term. The elaboration of trend test evidenced a significant progressive tendency of the breastfeeding versus gestational age curve. Conclusion: Gestational age has an impact on breastfeeding. Our results demonstrate that there are differences, within full-term births, between 37 weeks and 41 weeks of gestation in relation to breastfeeding outcomes. Variations from one to two weeks of gestation imply better breastfeeding results at 3 months and continuity of breastfeeding at 6 months.