Construction of warning model of maternal lactation initiation delay based on breast milk biomarkers and its verification

Objective To construct an early warning model of delayed initiation of maternal lactation based on breast milk biomarkers and to evaluate its effectiveness.

Methods A total of 486 puerperae were selected as study objects, and were divided into modeling group (340 cases) and verification group (146 cases) according to a ratio of 7∶3, the modeling group was further divided into delayed lactation initiation group (85 cases) and successful lactation initiation group (255 cases) according to whether the lactation initiation was successful. Logistic regression was used to analyze risk factors for delayed initiation of maternal stage Ⅱ lactation. R software was applied to construct a nomogram model for predicting the risk of delayed initiation of maternal stage Ⅱ lactation. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the differentiation and consistency of the nomogram models.

Results The proportions of patients aged 31 to 40 years old, primipara, cesarean section, and the sodium ion concentration and protein level in the delayed lactation initiation group were greatly higher than those in successful lactation initiation group, the lactose and citrate levels were lower than those in the successful lactation initiation group (P < 0.05). The multivariate Logistic analysis showed that sodium ion, lactose and citrate levels were the influencing factors of delayed initiation of stage Ⅱ lactation (P < 0.05). ROC curve showed that the area under the curve (AUC) of the nomogram model for predicting lactation stage Ⅱ initiation delay was 0.998 in both the modeling group and the validation group. Hosmer-Lemeshow goodness of fit test showed that the predicted value of calibration curve of the nomogram model was basically consistent with the actual value (modeling group: χ²=6.062, P=0.511; verification group: χ²=7.288, P=0.506).

Conclusion The nomogram model based on lactose, sodium ion and citrate of breast milk biomarkers to predict the risk of delayed initiation of puerpera lactation stage Ⅱ has good consistency and discrimination.