Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial

“It gave me so much confidence”: First‐time U.S. mothers' experiences with antenatal milk expression

“…In the latter, a multicentre, unblinded RCT including 635 diabetic participants, AME twice per day from 36 weeks of pregnancy was found to be feasible and safe (not associated with increased incidence of preterm births, NICU admissions, or neonatal or maternal morbidity). AME was also found to have a beneficial effect on exclusive breast milk feeding in the first 24 hr post birth (aRR 1.15) and during hospitalization (aRR 1.16; Forster et al, ). In addition to these studies, a small RCT conducted among healthy nulliparous and multiparous women in India found that significantly more women randomized to antenatal hand expression of colostrum after 37 weeks established “full lactation” where no “top feed” was required within 6 hr postpartum, as compared with usual care (Lamba, Chopra, & Negi, ).…”

“…In the latter, a multicentre, unblinded RCT including 635 diabetic participants, AME twice per day from 36 weeks of pregnancy was found to be feasible and safe (not associated with increased incidence of preterm births, NICU admissions, or neonatal or maternal morbidity). AME was also found to have a beneficial effect on exclusive breast milk feeding in the first 24 hr post birth (aRR 1.15) and during hospitalization (aRR 1.16; Forster et al, 2017).…”

“…Women with diabetes are considered prime candidates for AME, as their infants often require formula supplementation due to post‐birth hypoglycemia. Two pilot studies (Forster et al, ; Soltani & Scott, ) and one large RCT (Forster et al, ; Forster et al, ) have been conducted on the safety and efficacy of antenatal hand expression of colostrum among diabetic women in the United Kingdom and Australia. In the latter, a multicentre, unblinded RCT including 635 diabetic participants, AME twice per day from 36 weeks of pregnancy was found to be feasible and safe (not associated with increased incidence of preterm births, NICU admissions, or neonatal or maternal morbidity).…”

“…Antenatal milk expression (AME) has emerged as a potential intervention to address these issues. AME involves rhythmic self-massage of breasts, 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 (Forster et al, 2017;Singh, Chouhan, & Sidhu, 2011;Soltani & Scott, 2012). Hand expression, rather than an electric breast pump, is the preferred milk removal strategy when milk volumes are small (as in pregnancy), yielding higher milk output (Ohyama, Watabe, & Hayasaka, 2009).…”

Abstracts

“…Our results indicate that ABE is acceptable to childbearing women, including those in overweight or obese subgroups. A recent large randomised controlled trial, evaluated the safety and efficacy of ABE among women with diabetes, and showed no adverse neonatal outcomes with some small benefits in increasing the incidence of exclusive breastfeeding in the first 24 hr after birth (Forster et al, ). Further investigation into the benefits and safety of ABE is warranted to address the needs of childbearing women, particularly those with a raised BMI.…”