產後抹片發炎結果與哺餵方式之關係：回溯性研究

The Relationship between the Inflammatory Results of Postpartum Papanicolaou Test and Breastfeeding Methods: a Retrospective Study

背景與目的：產後婦女子宮頸抹片檢查常呈現發炎反應。本研究採回溯性研究，主要探討產後子宮頸抹片檢查與哺餵方式之關係，以進一步了解執行產後子宮頸抹片之最佳時機。方法：我們收集2008年到2010年台灣南部某區域教學醫院之產後子宮頸抹片檢查數據，排除流產及無法獲得哺餵資料者，有效資料共得3014筆。子宮頸抹片結果分為正常、無感染性發炎及感染性發炎三類。產後接受子宮頸抹片檢查時間區分為小於6週、6-8週、8-12週、大於12週，而哺餵方式分為全母乳、混餵、全配方奶。所得數據以SPSS 21.0軟體進行分析。結果：產後子宮頸抹片發炎結果與生產方式、胎次、母親年齡無關，而產後越晚接受子宮頸抹片檢查，發生無感染性發炎情形遞減(≤6週: 14.2%; 6‐8週: 10.7%; 8‐12週: 7.4%; >12週: 6.8%; p<0.001)，而發生感染性發炎情形則遞增(≤6週: 1.2%; 6‐8週: 1.2%; 8‐12週: 2.5%; >12週: 3.1%; p<0.001)，再者，全母乳哺餵者較餵食配方奶者有較高的無感染性發炎比例(OR, 95%CI: 1.54, 1.07-2.21)及較低的感染性發炎情形(OR, 95%CI: 0.33, 0.15-0.76)。結論：此前驅性研究發現哺餵方式與子宮頸抹片發炎結果及採檢時間呈顯著相關性。

Background & Aim. “Inflammation” is frequently found among postpartum Pap smear. We conducted a retrospective study to explore the postpartum inflammatory Papanicolaou (Pap) test whether be affected by the breastfeeding behavior and the timing for postpartum Pap test. Methods. Postpartum women received the Pap test examination within 6 months after delivery from 2008-2010 (n=3014). All Pap test interpretation data were collected from a regional teaching hospital. Individuals who had miscarriages and whose feeding information could not be obtained were excluded. The Pap results were classified into 3 groups: normal group, non-infectious inflammation group, and infectious inflammation group. The postpartum timing receiving Pap test were category into ≤6, 6-8, 8-12, and >12 weeks. The breastfeeding methods were classified as exclusive, mixed, and formula milk. The data were further analyzed using the statistical software SPSS 21.0. Results. The Pap result of “inflammation” showed no relationship with the mode of delivery, nulliparous status and maternal age. As the postpartum examination timing increased, the rate of non-infectious inflammation decreased (≤6 weeks: 14.2%; 6‐8 weeks: 10.7%; 8‐12 weeks: 7.4%; >12weeks: 6.8%; p<0.001) and the rate of infectious inflammation increased (≤6 weeks: 1.2%; 6‐8 weeks: 1.2%; 8‐12 weeks: 2.5%; >12weeks: 3.1%; p<0.001). Comparing with the women with formula milk, the women with exclusive breastfeeding method during the study period had significant higher OR of non-infectious inflammation (OR, 95%CI: 1.54, 1.07-2.21) and lower OR of infectious inflammation (OR, 95%CI: 0.33, 0.15-0.76).Conclusion. This pilot study showed the breastfeeding methods had significant association with the Pap test result and collection timing.