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

Abstract

Background Lactation mastitis (LM) affects approximately 3% to 33% of postpartum women and the risk factors of LM have been extensively studied. However, some results in the literature reports are still not conclusive due to the complexity of LM etiology and variation in the populations. To provide nationally representative evidence of the well-accepted risk factors for LM in China, this study was aimed to systematically summary the risk factors for LM among Chinese women and to determine the effect size of individual risk factor. Material and methods Six major Chinses and English electronic literature databases (PubMed, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan fang Database and China Science Technology Journal Database) were searched from their inception to December 5st, 2020. Two authors extracted data and assessed the quality of included trials, independently. The strength of the association was summarized using the odds ratio (OR) with 95% confidence intervals (CI). The population attributable risk (PAR) percent was calculated for significant risk factors. Results Fourteen studies involving 8032 participants were included. A total of 18 potential risk factors were eventually evaluated. Significant risk factors for LM included improper milking method (OR 6.79, 95%CI 3.45–13.34; PAR 59.14%), repeated milk stasis (OR 6.23, 95%CI 4.17–9.30; PAR 49.75%), the first six months postpartum (OR 5.11, 95%CI 2.66–9.82; PAR 65.93%), postpartum rest time less than 3 months (OR 4.71, 95%CI 3.92–5.65; PAR 56.95%), abnormal nipple or crater nipple (OR 3.94, 95%CI 2.34–6.63; PAR 42.05%), breast trauma (OR 3.07, 95%CI 2.17–4.33; PAR 15.98%), improper breastfeeding posture (OR 2.47, 95%CI 2.09–2.92; PAR 26.52%), postpartum prone sleeping position (OR 2.46, 95%CI 1.58–3.84; PAR 17.42%), little or no nipple cleaning (OR 2.05, 95%CI 1.58–2.65; PAR 24.73%), primipara (OR 1.73, 95%CI 1.25–2.41; PAR 32.62%), low education level (OR 1.63, 95%CI 1.09–2.43; PAR 23.29%), cesarean section (OR 1.51, 95%CI 1.26–1.81; PAR 18.61%), breast massage experience of non-medical staff (OR 1.51, 95%CI 1.25–1.82; PAR 15.31%) and postpartum mood disorders (OR 1.47, 95%CI 1.06–2.02; PAR 21.27%). Conclusions This review specified several important risk factors for LM in China. In particular, the incidence of LM can be reduced by controlling some of the modifiable risk factors such as improper breastfeeding posture, improper milking method, repeated milk stasis, nipple cleaning, breast massage experience of non-medical staff and postpartum sleeping posture.

Analysis of risk factors leading to multiple breast abscesses during lactation

“…This can result in breast injuries after receiving a breast massage, especially in patients with lactation-related mastitis and breast abscesses. [15]…”

“…This can result in breast injuries after receiving a breast massage, especially in patients with lactation-related mastitis and breast abscesses. [15] Studies have shown that intensive deep tissue massage in the setting of ductal narrowing and inflammatory mastitis may promote phlegmon formation because deep tissue massage can exacerbate edema and microvascular injury. [16] Although breast massage may reduce pain, it should not be recommended as a standard of care because it requires extensive training to master an atraumatic approach.…”

Analysis of relevant factors influencing size of breast abscess cavity during lactation: a cross-sectional study

“…This study also found that non-medical breast massage was an independent influencing factor for breast abscess with a maximum diameter > 5 cm during lactation. A large-scale research on the risk factors of mastitis during lactation in China [ 20 ] had confirmed that non-medical breast massage increases the incidence of mastitis. The utilization rate of the non-medical breast massage of the lactating postpartum women is 21.8–36% in China [ 21 ], which indicated that a great many of the postpartum women suffering from lactation difficulties.…”

Risk factors and prognosis of acute lactation mastitis developing into a breast abscess: A retrospective longitudinal study in China

“…This injury is also often located in the area of the nipple and areola, which also leads to the formation of breast abscesses. A meta-analysis from China also found that non-professional massage history was a risk factor for mastitis [ 23 ].…”