Evaluating antenatal breastmilk expression outcomes: a scoping review

Abstract

Background Antenatal breastmilk expression (aBME) is recommended by some healthcare providers to improve lactation, breastfeeding, and newborn outcomes, particularly for women with diabetes as they face unique challenges with breastfeeding. However, there is limited evidence of the potential harms and benefits of this practice. Our objective was to conduct a scoping review to map the literature describing maternal and newborn outcomes of aBME. Methods We searched Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, British Library E-Theses Online Services (EThOS) database, OpenGrey, and Clinical trials.gov from inception to January 2020. Studies in English that reported on the effect of aBME on maternal and newborn outcomes, and the experiences of women who have engaged in the practice were included for screening. Titles, abstracts, and full-text articles were screened by two independent reviewers. A critical appraisal and clinical consultation were conducted. Key findings were extracted and summarized. Results We screened 659 studies and 20 met the inclusion criteria. The majority of included studies (n = 11, 55.0%) were published after 2015, and seven (35.0%) originated from Australia. Ten (50.0%) studies provided data on high-risk obstetrical populations, including those with diabetes (n = 8), overweight or obesity (n = 1), and preeclampsia (n = 1). Commonly reported outcomes included breastfeeding status at discharge or follow-up, mode of delivery, newborn blood glucose, and time to establishing full lactation. Maternal experiences were related to challenges with aBME, confidence and mastery, perceived impact, security and altruism, learning and resources, and physical symptoms as a result of aBME. The critical appraisal demonstrated limited high-quality evidence surrounding aBME. Conclusions Our findings demonstrate increasing interest in the safety, efficacy, and acceptability of aBME. Existing studies are heterogenous with variable research questions, outcomes, study designs, and methodology. The recommendations made in this review can be used to help inform future studies evaluating aBME.

Structured Antenatal Milk Expression Education for Nulliparous Pregnant People: Results of a Pilot, Randomized Controlled Trial in The United States

“…AME is often a part of prenatal education in countries including Australia 15 and the UK 16 and involves rhythmic self-massage of breasts with one's hands, usually commencing between 36 and 37 weeks of gestation, at which point early milk (colostrum) is available and may be collected and frozen for later use. 17 Research and clinical opinions published by our group and others suggests that AME, particularly among nulliparous and diabetic pregnant people, may increase breastfeeding con dence, reduce early formula supplementation, accelerate the transition to lactogenesis-II (copious milk production typically occurring 48-72 postpartum), 18 and contribute to more abundant postpartum milk production. [19][20][21][22][23][24] A common concern about AME is that potential nipple stimulation may increase endogenous circulating oxytocin, contributing to uterine irritability and onset of labor.…”

“…The majority of the research on AME to date, including its feasibility, acceptability, and effect on lactation outcomes, has been conducted outside the U.S. and among women with diabetes, whose infants are at risk for formula supplementation after birth due to hypoglycemia. 17 In this paper, we describe the implementation of a structured AME intervention among nulliparous, pregnant people in the U.S. without diabetes in the context of a pilot randomized controlled trial. We discuss feasibility related to recruitment, retention, and delivery/uptake of the AME intervention, as well as the relationship between breastfeeding outcomes and the AME intervention.…”

Evaluation of a breastmilk hand expression toolkit: the M.I.L.K survey study

“…This technique can be used to promote lactation, soften to assist latching, relieve painful breast engorgement, and collect milk for future infant feedings [ 16 , 17 ]. Hand expression during the antenatal period may also be recommended to improve mothers’ breastfeeding confidence before delivery [ 18 , 19 ] and collect colostrum for use for infant feedings shortly after delivery. Antenatal colostrum collection has been recommended to individuals with diabetes who have low risk pregnancies to support infant feeds in the early hours and days post-delivery, prevent neonatal hypoglycemia and reduce the need for infant formula use [ 20 ].…”

Evaluation of a Breastmilk Hand Expression Toolkit: The M.I.L.K Survey Study

“…Hand expression, speci cally during the antenatal period, allows individuals to collect colostrum that can be stored and made available for infant feedings shortly after delivery. This may speci cally be recommended to individuals with highrisk pregnancies to use postpartum for infant feeds to prevent neonatal hypoglycemia and reduce the need for formula use [5], as well as to improve mothers' breastfeeding con dence before delivery [21,22]. The current literature suggests that individuals who hand express breastmilk antenatally may encounter fewer challenges when initiating breastfeeding and are less likely to discontinue breastfeeding before six months [19,21].…”