Fears allayed over antenatal breastmilk expressing in diabetic women
medwireNews: A randomized trial published in The Lancet finds no harm associated with antenatal expressing of breastmilk in low-risk women with diabetes.
The researchers say the practice is “an increasingly widespread phenomenon,” recommended because infants born to women with diabetes are at increased risk for hypoglycemia and to being separated from their mothers and admitted to the neonatal intensive-care unit (NICU) for intravenous glucose.
Colostrum (the milk produced during pregnancy) “stabilises infant glucose concentrations more effectively than infant formula milk, and ensures infants maintain exclusive breastfeeding to enable optimum health outcomes,” observe Della Forster (La Trobe University, Melbourne, Victoria, Australia) and study co-authors.
But pilot studies highlighted possible risks associated with the practice, and the researchers’ trial, which they say was “controversial from its inception,” was designed to test whether antenatal milk expression might affect neonatal outcomes or provoke oxytocin release and earlier onset of labor.
This proved not to be the case; the proportion of infants admitted to the NICU was 15% of those born to the 317 women in the antenatal expressing group and 14% of those born to the 315 women in the control, non-expressing group.
Most (93%) women had gestational diabetes, with just 7% having type 1 or type 2 diabetes. Women in the expressing group expressed milk twice a day from week 36 of gestation, and 42% of this group succeeded in expressing at least 20 times, but the average gestational age of their infants at birth was not significantly different from that in the control group, at 38.6 and 38.7 weeks, respectively.
The strategy of antenatal expressing resulted in a significant increase in the proportion of infants receiving exclusive breastmilk during the first 24 hours after birth, at 69% versus 60% in the control group, and a trend toward an increase between birth and discharge or 7 days, at 57% versus 49%, but did not influence rates of exclusive breastfeeding at 3 months, which were a corresponding 60% and 55%.
In an accompanying commentary, Pamela Berens (University of Texas, Health Science Center, Houston, USA) says that the results “provide reassurance” about the risks associated with antenatal milk expression, but cautions against the strategy in women at risk for placental dysfunction or preterm birth, given previous findings linking expressing to earlier delivery.
And she notes that women excluded from the trial included those with conditions linked to poor diabetes control, “thus limiting the application of antenatal milk expression from women with diabetes whose infants are at highest risk for neonatal hypoglycaemia.”
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