Evaluation of the impact of breast milk expression in early postpartum period on breastfeeding duration: a prospective cohort study

Jiang, Beiqi; Hua, Jing; Wang, Yijing; Fu, Yao‐Shi; Zhuang, Zhixiong; Zhu, Li

doi:10.1186/s12884-015-0698-6

Cited by 50 publications

(73 citation statements)

References 36 publications

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“…This observation is consistent with those reported previously in Shanghai, Hong Kong, and the U.S. [4,12,20], despite differences in time at which expression of breast milk was ascertained (ranging from one to six months postpartum). Even among our study mothers who were fully breastfeeding, those who expressed breast milk exclusively at three months postpartum had a higher hazard of early weaning than those who breastfed directly.…”

Section: Discussionsupporting

confidence: 92%

Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding

et al. 2017

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Background: Studies examining direct vs. expressed breast milk feeding are scarce. We explored the predictors of mode of breastfeeding and its association with breastfeeding duration in a multi-ethnic Asian population. Methods: We included 541 breastfeeding mother—infant pairs from the Growing Up in Singapore Toward healthy Outcomes cohort. Mode of breastfeeding (feeding directly at the breast, expressed breast milk (EBM) feeding only, or mixed feeding (a combination of the former 2 modes)) was ascertained at three months postpartum. Ordinal logistic regression analyses identified predictors of breast milk expression. Cox regression models examined the association between mode of breastfeeding and duration of any and of full breastfeeding. Results: Maternal factors independently associated with a greater likelihood of breast milk expression instead of direct breastfeeding were Chinese (vs. Indian) ethnicity, (adjusted odds ratio, 95% CI; 3.41, 1.97–5.91), tertiary education (vs. secondary education or lower) (2.22, 1.22–4.04), primiparity (1.54, 1.04–2.26) and employment during pregnancy (2.53, 1.60–4.02). Relative to those who fed their infants directly at the breast, mothers who fed their infants EBM only had a higher likelihood of early weaning among all mothers who were breastfeeding (adjusted hazard ratio, 95% CI; 2.20, 1.61–3.02), and among those who were fully breastfeeding (2.39, 1.05–5.41). Mothers who practiced mixed feeding, however, were not at higher risk of earlier termination of any or of full breastfeeding. Conclusions: Mothers who fed their infants EBM exclusively, but not those who practiced mixed feeding, were at a higher risk of terminating breastfeeding earlier than those who fed their infants directly at the breast. More education and support are required for women who feed their infants EBM only.

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Section: Discussionsupporting

confidence: 92%

Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding

et al. 2017

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“…In cases where milk expression minimizes potential formula use, however, these risks may be balanced. While we did not find an association between early milk expression and reduced breastfeeding exclusivity or duration, two studies powered to assess this relationship found that women expressing frequently between six and eighteen weeks were at higher risk for shortened breastfeeding duration compared to women not expressing or expressing less often (Felice et al, 2016; Jiang et al, 2015). …”

Section: Discussioncontrasting

confidence: 83%

An Ecological Momentary Assessment of Primiparous Women’s Breastfeeding Behavior and Problems From Birth to 8 Weeks

Demirci

Bogen

2017

J Hum Lact

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Background Primiparous women are at-risk for early, unintended breastfeeding reduction and cessation. Breastfeeding patterns that contribute to these outcomes require further exploration. Research Aim/Questions To describe early, “real time” breastfeeding behaviors and perceived problems of primiparous women. Methods First-time mothers intending to exclusively breastfeed downloaded a commercial infant feeding app during their postpartum hospitalization. Women logged feedings and their breastfeeding experiences, as they occurred, through eight weeks postpartum. Additional feeding and background data were collected via EMR and questionnaires administered at enrollment, two, and eight weeks postpartum. Summary statistics were compiled to examine weekly breastfeeding behaviors and problems. Results In this sample of 61 primarily highly-educated, White women committed to breastfeeding, 38% (n=23) used formula during the postpartum hospitalization and 68% (n=34) used formula at least once by two weeks. Nine women stopped breastfeeding during the study. Women using any formula in the hospital and those with less positive baseline attitudes toward breastfeeding were less likely to be exclusively breastfeeding at two and eight weeks, respectively (p<0.05). There was a trend toward declining at-breast feeds and high rates of milk expression during the study. Breastfeeding problems peaked at Week 2, with 81% of women (n=39) endorsing at least one problem at that time. The most prevalent problems included perception of inadequate milk, pain, latching, and inefficient feeds. Conclusions Interventions to address suboptimal breastfeeding in primiparous women should consider the pervasiveness of early milk expression and in-hospital formula supplementation in this population, as well as the trajectory of common problems.

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“…The risk of BMF interruption was three times higher among preterm infants who were receiving supplementation at the first outpatient visit than among those who were EBMF at the first consultation [ 41 ]. In general, EBMF is laborious, time-consuming and difficult and is marked by rather high discontinuance rates as time from delivery increases [ 16 , 42 , 43 ] or when maternity leave is short [ 43 , 44 , 45 , 46 , 47 ]. The results of the present study suggest that targeting prolonged BMF exclusivity may also help in achieving a longer duration of BMF among preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Direct Feeding at the Breast Is Associated with Breast Milk Feeding Duration among Preterm Infants

et al. 2017

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Background: In spite of high rates of initiating breast milk feeding (BMF) among preterm infants, a significant rate of discontinuation occurs shortly after discharge. Aim: To investigate the effect of mode (direct feeding at the breast vs. expressing) and exclusivity (breast milk combined with formula vs. breast milk only) as well as maternal perceptions on the duration of BMF among preterm infants. Methods: The study included mothers whose infants were born before 32 weeks gestation, between January 2012 and August 2015 at Sheba Medical Center (SMC). Perinatal data were collected retrospectively from infants’ computerized charts. Mothers were approached >12 months postpartum and were asked to complete a questionnaire. Those who agreed to participate were asked (during their visit to the follow-up clinic or by phone or mail) to complete a questionnaire regarding mode and duration of BMF as well as reasons for its discontinuation. Mothers were also asked about their pre-partum intentions to feed directly at the breast. Results: Out of 162 eligible mothers, 131 (80.8%) initiated BMF during their intensive care unit (ICU) hospitalization. Of these, 66 (50.3%) discontinued BMF earlier than six months postpartum. BMF ≥ 6 months was significantly associated with direct feeding at the breast, duration of exclusive BMF, and singleton birth. Regression analysis revealed that direct feeding at the breast (any or only) and duration of BMF exclusivity were the only significant variables associated with BMF duration (Odds ratio (OR) 5.5 and 95% confidence interval (CI) 2.00–15.37; OR 1.5 and 95% CI 1.25–1.88, respectively). Milk supply (inadequate or nonexistent) was the most commonly reported cause for BMF discontinuation <6 months. Direct feeding at the breast was significantly associated with BMF duration and was more common among singletons. Conclusions: Direct feeding at the breast and duration of exclusive BMF are associated with duration of BMF among infants born <32 weeks of gestational age (GA). These findings suggest that targeting these two factors may play a key role in prolonging BMF duration among preterm infants.

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Evaluation of the impact of breast milk expression in early postpartum period on breastfeeding duration: a prospective cohort study

Cited by 50 publications

References 36 publications

Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding

Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding

An Ecological Momentary Assessment of Primiparous Women’s Breastfeeding Behavior and Problems From Birth to 8 Weeks

Direct Feeding at the Breast Is Associated with Breast Milk Feeding Duration among Preterm Infants

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