Comprehensive evaluation of the risk of lactational mastitis in Chinese women: combined logistic regression analysis with receiver operating characteristic curve

Abstract

Objective: To identify the potential risk factors for acute mastitis during lactation comprehensively. Subsequently, to evaluate logistic regression model in predicting the risk of lactational mastitis in Chinese women by applying receiver operating characteristic (ROC) curve. Methods: A case–control study among Chinese women enrolled 652 patients with mastitis and 581 healthy women with breastfeeding experience as control. The retrospective information was obtained by questionnaires that included medical history of pregnancy, delivery, puerperium and breastfeeding behaviors. Univariate analysis and multivariate logistic regression model were performed to investigate the relationship between these factors and the occurrence of lactational mastitis. Using ROC curve to evaluate the prognostic value of these selected indicators in the risk of acute mastitis. Results: The multivariate logistic regression analysis showed that the primiparity (P < 0.001), mastitis in previous breastfeeding (P < 0.001), nipple’s heteroplasia (P < 0.001), cracked nipple (P < 0.001), breast trauma by external force (P = 0.002), lateral position (P = 0.007), breast pump (P = 0.039), nipple sucking (P = 0.007), sleep with sucking (P = 0.007), and tongue-tie (P = 0.013) were risk variables independently and significantly related with mastitis. While vaginal delivery (P = 0.015), clean nipple before breastfeeding (P = 0.015), first contact with child within 1 h (P = 0.027) were protective factors. The ROC analysis demonstrated that the area under the curve of model 2 was 0.8122 (95%CI = 0.7885–0.8360), which stated that the model presented a high sensitivity and specificity. Conclusion: By means of collecting and summarizing the risk factors associated with the occurrence of breast mastitis in Chinese women, we established risk discriminant model to identify and warn the individuals susceptible to acute mastitis early, which will allow practitioners to provide appropriate management advice and effective individual care.

Risk factors for lactation mastitis in China: A systematic review and meta-analysis

“…All the mothers who participated in the included studies were recruited at local hospitals or health facilities and a questionnaire was developed to collect data on general sociodemographic, psychosocial and puerperium characteristics, except for one study [ 28 ] only involved a retrospective review of medical records. Eleven of the included studies were published in Chinese [ 29 – 36 , 38 , 40 , 41 ] and three studies were published in English [ 28 , 37 , 39 ]. The basic information of included studies was shown in Table 1 .…”

“…There was obvious heterogeneity among the following risk factors ( I 2 >50%): improper milking method (P = 0.07, I 2 = 69%), little or no nipple cleaning before breastfeeding (P = 0.007, I 2 = 70%), each breastfeeding duration>0.5 h (P<0.0001, I 2 = 83%) and nipple sucking (P<0.0001, I 2 = 98%), the random effect model was used for the analysis of these variables. The pooled risks showed that the improper milking method [ 30 , 31 ] (OR 6.79, 95%CI [3.45, 13.34]) and little or no nipple cleaning before breastfeeding [ 29 – 32 , 34 , 35 , 37 – 39 ] (OR 2.05, 95%CI [1.58, 2.65]) were identified as the important risk factors for LM. No statistically significant differences were found for the other two risk factors: each breastfeeding duration>0.5 h [ 29 , 31 , 32 , 34 , 35 , 39 ] (OR 0.77, 95%CI [0.48, 1.24]) and nipple sucking [ 29 – 31 , 33 – 38 ] (OR 0.90, 95%CI [0.29, 2.72]).…”

“…In total, fourteen studies were included, involving a combined total of 8032 participants. Eleven of the studies [28][29][30][31][32][33][34][35][36][37][38] were case-control studies (case groups were patients with mastitis in lactation and control groups were healthy women with previous breastfeeding experience). One [39] was a prospective cohort study (mothers who had delivered healthy babies at seven health facilities were recruited to participate in a face-to-face interview before discharge and then follow-up interviews were conducted at 1, 3, and 6 months postpartum by telephone.…”

“…There was no significant heterogeneity among the following risk factors (I 2 �50%): cesarean section (P = 0.16, I 2 = 41%), breast massage experience of non-medical staff (P = 0.15, I 2 = 47%), history of diabetes (P = 0.16, I 2 = 46%) and history of mastitis (P = 0.8, I 2 = 0%), the data of these factors were pooled using the fixed effect model. The pooled risks showed that cesarean section [31,36,37,39] (OR 1.51,…”

“…There was obvious heterogeneity among the following risk factors (I 2 >50%): abnormal nipple or crater nipple (P<0.00001, I 2 = 87%), primipara (P = 0.02, I 2 = 64%), breast trauma (P = 0.01, I 2 = 62%) and low education level (P = 0.002, I 2 = 77%), the data of these factors were pooled using the random effect model. The pooled risks showed that abnormal nipple or crater nipple [28,32,[36][37][38][39] Similarly, the result from one cross-sectional study [40] involving 864 participants reported that primipara (OR 3.46, 95%CI [1.04, 11.46]) and a mother with low education level (high school or below) (OR 2.2, 95%CI [1.11, 4.35]) experienced a higher risk of LM.…”