Introduction: Antenatal breastmilk expression (BME) is recommended by some healthcare providers to improve breastfeeding, maternal, and infant outcomes postnatally, particularly for women with diabetes as they face unique challenges related to breastfeeding. However, there has been little evaluation of any potential harms and benefits of this practice in the general obstetrical and diabetic populations. Our objective was to conduct a scoping review to broadly examine the literature describing maternal and infant outcomes of antenatal BME.
Methods: A six-step approach was applied using the frameworks proposed by Arksey and O’Malley (2005) and Levac et al. (2010). We searched MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews for English language studies that reported on the effect of antenatal BME on maternal and infant outcomes, breastfeeding initiation and duration, and the experiences of women who have engaged in the practice. Articles were screened by two independent reviewers. Key findings were extracted and summarized with attention paid to high-risk obstetrical populations such as women with diabetes.
Results: A total of 656 studies were screened and 17 met the inclusion criteria. The majority of included studies (n=11, 64.7%) were published after 2015, and 7 (41%) originated from Australia. Ten (58.9%) studies provided data on high-risk obstetrical populations, including those with diabetes (n=8), overweight or obesity (n=1) and pre-eclampsia (n=1). The most commonly reported outcomes were breastfeeding status at discharge or follow-up, infant receipt of formula milk, infant blood glucose, and time to establishing full lactation. Reported outcomes are represented diagrammatically in Figure 1. Emerging themes of the review related to maternal experiences included difficulty/annoyance, confidence/mastery, and perceived beliefs and impacts of antenatal BME.
Conclusion: Our findings demonstrate a rising interest in the safety, efficacy, and acceptability of antenatal BME. These results can guide future studies evaluating antenatal BME in pregnant women.
Malia Murphy– Research Associate, Ottawa Hospital Research Institute
Darine El-Chaâr– Physician, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada
Erin Keely– Physician, Division of Endocrinology and Metabolism, University of Ottawa