Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States
Abstract Background Hand-expression, collection, and storage of breast milk during pregnancy (i.e., antenatal milk expression or AME) is a safe, potentially effective practice to reduce early, undesired infant formula supplementation among women with diabetes. The feasibility and potential impact of...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | International Breastfeeding Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13006-022-00491-8 |
| _version_ | 1811323413404319744 |
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| author | Jill R. Demirci Melissa Glasser Katherine P. Himes Susan M. Sereika |
| author_facet | Jill R. Demirci Melissa Glasser Katherine P. Himes Susan M. Sereika |
| author_sort | Jill R. Demirci |
| collection | DOAJ |
| description | Abstract Background Hand-expression, collection, and storage of breast milk during pregnancy (i.e., antenatal milk expression or AME) is a safe, potentially effective practice to reduce early, undesired infant formula supplementation among women with diabetes. The feasibility and potential impact of AME on lactation outcomes in the United States (U.S.) and among non-diabetic birthing people is unknown. Methods The purpose of this study was to examine the feasibility of a structured AME intervention among nulliparous birthing people in the United States. We recruited 45 low-risk, nulliparous individuals at 34–366/7 weeks of gestation from a hospital-based midwife practice. Participants were randomized to AME or a control group receiving lactation education handouts. Interventions were delivered at weekly visits at 37–40 weeks of pregnancy. The AME intervention involved technique demonstration and feedback from a lactation consultant and daily independent practice. Lactation outcomes were assessed during the postpartum hospitalization, 1–2 weeks postpartum, and 3–4 months postpartum. Results Between December 2016 and February 2018, 63 individuals were approached and screened for eligibility, and 45 enrolled into the study (71%). Of 22 participants assigned to AME, 18 completed at least one AME study visit. Participants reported practicing AME on at least 60% of days prior to their infant’s birth. Most were able to express milk antenatally (15/18), more than half collected and froze antenatal milk (11/18), and 39% (7/18) supplemented their infants with antenatal milk after birth. No major problems were reported with AME. Perinatal and lactation outcomes, including infant gestational age at birth, neonatal intensive care unit admissions, delayed onset of lactogenesis II, and use of infant formula were similar between AME and control groups. Among participants in both groups who were feeding any breast milk at each assessment, breastfeeding self-efficacy increased and perceptions of insufficient milk decreased over the postpartum course. Conclusions In a small group of nulliparous birthing people in the U.S., AME education and independent practice beginning at 37 weeks of pregnancy was feasible. In some cases, AME provided a back-up supply of milk when supplementation was indicated or desired. The relationship between AME and lactation outcomes requires further study with adequately powered samples. Trial Registration This trial was retrospectively registered at ClinicalTrials.gov on May 11, 2021 under the following registration ID: NCT04929301. https://clinicaltrials.gov/ct2/show/NCT04929301 . |
| first_indexed | 2024-04-13T13:54:41Z |
| format | Article |
| id | doaj.art-a1add2786afe4ce892e642e40060680d |
| institution | Directory Open Access Journal |
| issn | 1746-4358 |
| language | English |
| last_indexed | 2024-04-13T13:54:41Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | International Breastfeeding Journal |
| spelling | doaj.art-a1add2786afe4ce892e642e40060680d2022-12-22T02:44:14ZengBMCInternational Breastfeeding Journal1746-43582022-07-0117111210.1186/s13006-022-00491-8Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United StatesJill R. Demirci0Melissa Glasser1Katherine P. Himes2Susan M. Sereika3Department of Health Promotion & Development, University of PittsburghDepartment of Health Promotion & Development, University of PittsburghDepartment of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of PittsburghDepartment of Health & Community Systems, University of PittsburghAbstract Background Hand-expression, collection, and storage of breast milk during pregnancy (i.e., antenatal milk expression or AME) is a safe, potentially effective practice to reduce early, undesired infant formula supplementation among women with diabetes. The feasibility and potential impact of AME on lactation outcomes in the United States (U.S.) and among non-diabetic birthing people is unknown. Methods The purpose of this study was to examine the feasibility of a structured AME intervention among nulliparous birthing people in the United States. We recruited 45 low-risk, nulliparous individuals at 34–366/7 weeks of gestation from a hospital-based midwife practice. Participants were randomized to AME or a control group receiving lactation education handouts. Interventions were delivered at weekly visits at 37–40 weeks of pregnancy. The AME intervention involved technique demonstration and feedback from a lactation consultant and daily independent practice. Lactation outcomes were assessed during the postpartum hospitalization, 1–2 weeks postpartum, and 3–4 months postpartum. Results Between December 2016 and February 2018, 63 individuals were approached and screened for eligibility, and 45 enrolled into the study (71%). Of 22 participants assigned to AME, 18 completed at least one AME study visit. Participants reported practicing AME on at least 60% of days prior to their infant’s birth. Most were able to express milk antenatally (15/18), more than half collected and froze antenatal milk (11/18), and 39% (7/18) supplemented their infants with antenatal milk after birth. No major problems were reported with AME. Perinatal and lactation outcomes, including infant gestational age at birth, neonatal intensive care unit admissions, delayed onset of lactogenesis II, and use of infant formula were similar between AME and control groups. Among participants in both groups who were feeding any breast milk at each assessment, breastfeeding self-efficacy increased and perceptions of insufficient milk decreased over the postpartum course. Conclusions In a small group of nulliparous birthing people in the U.S., AME education and independent practice beginning at 37 weeks of pregnancy was feasible. In some cases, AME provided a back-up supply of milk when supplementation was indicated or desired. The relationship between AME and lactation outcomes requires further study with adequately powered samples. Trial Registration This trial was retrospectively registered at ClinicalTrials.gov on May 11, 2021 under the following registration ID: NCT04929301. https://clinicaltrials.gov/ct2/show/NCT04929301 .https://doi.org/10.1186/s13006-022-00491-8BreastfeedingHuman milkMilk expressionPregnancyAntenatal colostrum expressionAntenatal milk expression |
| spellingShingle | Jill R. Demirci Melissa Glasser Katherine P. Himes Susan M. Sereika Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States International Breastfeeding Journal Breastfeeding Human milk Milk expression Pregnancy Antenatal colostrum expression Antenatal milk expression |
| title | Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States |
| title_full | Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States |
| title_fullStr | Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States |
| title_full_unstemmed | Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States |
| title_short | Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States |
| title_sort | structured antenatal milk expression education for nulliparous pregnant people results of a pilot randomized controlled trial in the united states |
| topic | Breastfeeding Human milk Milk expression Pregnancy Antenatal colostrum expression Antenatal milk expression |
| url | https://doi.org/10.1186/s13006-022-00491-8 |
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