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In-Hospital Feeding Practices of Infants Born to Mothers With Gestational Diabetes Mellitus or Type 2 Diabetes Mellitus: Evaluating Policy Implementation Effectiveness

Published:October 29, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.10.008

      Abstract

      Objectives

      Women with diabetes in pregnancy may experience unique breastfeeding challenges. Few studies have examined the effectiveness of hospital policy to support breastfeeding in this patient population. This study aimed 1) to describe infant feeding practices of mother-infant pairs with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy before and after introduction of an in-hospital policy and, 2) to compare feeding practices before and after policy introduction.

      Methods

      A retrospective chart audit of mother-infant pairs (n=120) was performed: 60 at 1 year before and 60 after policy introduction. The primary outcome was provision of breast milk at discharge; a chi-square test was completed to compare pre- and postpolicy groups. Secondary outcomes included participant and infant feeding characteristics.

      Results

      There was no significant difference in the number of infants receiving breast milk at discharge between pre- (58% [35 of 60]) and postpolicy (58% [35 of 60]) groups (p=0.64). The number of infants receiving breast milk exclusively throughout the hospital stay also did not differ by group (37% [22 of 60] before; and 43% [26 of 60] after; p=0.39). Information for each feed was infrequently recorded in charts for the method of feeding (34% [704 of 2,064]), infant state (96% [1,991 of 2,064]) and feeding description (96% [1,987 of 2,064]).

      Conclusions

      This practice-based research has highlighted a need for continuation of this work, examining an in-hospital policy to support breastfeeding in those with GDM or type 2 diabetes in pregnancy. Initially, feedback could be collected from health-care providers to understand perceived facilitators and barriers to policy application and the use of job aids (e.g. record keeping tools).

      Résumé

      Objectifs

      Les femmes atteintes de diabète durant la grossesse peuvent éprouver des difficultés particulières à allaiter. Peu d’études ont porté sur l’efficacité des politiques hospitalières qui encouragent l’allaitement chez cette population de patientes. La présente étude visait : 1) à décrire les pratiques d’alimentation du nourrisson de paires mère-nourrisson ayant eu un diabète sucré gestationnel (DSG) ou un diabète de type 2 durant la grossesse avant et après l’introduction d’une politique hospitalière; 2) à comparer les pratiques d’alimentation avant et après l’introduction de la politique.

      Méthodes

      Une vérification rétrospective de dossiers de paires mère-nourrisson (n = 120) a été réalisée : 60 paires 1 an avant l’introduction de la politique et 60 paires après. Le critère d’évaluation principal était l’apport en lait maternel à la sortie de l’hôpital; un test du chi carré a été rempli pour faire la comparaison entre les groupes avant et après l’introduction de la politique. Les critères d’évaluation secondaires étaient les caractéristiques des participantes et des nourrissons.

      Résultats

      Il n’y avait aucune différence significative dans le nombre de nourrissons qui recevaient du lait maternel à la sortie de l’hôpital entre les groupes avant l’introduction de la politique (58 % [35 sur 60]) et les groupes après l’introduction de la politique (58 % [35 sur 60]) (p = 0,64). Le nombre de nourrissons qui recevaient exclusivement du lait maternel durant tout le séjour à l’hôpital ne différait également pas entre les groupes (37 % [22 sur 60] avant; 43 % [26 sur 60] après; p =0,39). Les renseignements sur la méthode d’alimentation (34 % [704 sur 2064]), l’état du nourrisson (96 % [1991 sur 2064]) et la description de l’alimentation (96 % [1987 sur 2064]) à chacune des tétées étaient rarement notés dans les dossiers.

      Conclusions

      Cette recherche axée sur les pratiques a fait valoir la nécessité de poursuivre ces travaux par l’examen des politiques hospitalières qui encouragent l’allaitement chez les femmes atteintes du DSG ou du diabète de type 2 durant la grossesse. Initialement, on pourrait recueillir les commentaires des prestataires de soins de santé pour comprendre les facilitateurs et les obstacles perçus dans l’application des politiques et l’utilisation des outils de travail (p. ex. des outils sur la tenue des dossiers).

      Keywords

      Mots clés

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