Antenatal Colostrum Expressing: What Does the Research Tell Us?

Antenatal Colostrum Expressing: What Does the Research Tell Us?

You may have heard about expressing and collecting colostrum during the final weeks of pregnancy. It’s something that is increasingly discussed during antenatal care, particularly for women with diabetes in pregnancy.

But is it safe? When should you start? And does it actually help?

One important Australian study that looked at these questions was the Diabetes and Antenatal Milk Expressing (DAME) trial.

What is antenatal colostrum expressing?

Colostrum is the first milk your breasts produce. It is concentrated, rich in nutrients and antibodies, and is produced in small amounts that are well suited to a newborn baby.

Antenatal expressing involves hand expressing small amounts of colostrum towards the end of pregnancy, collecting it in a suitable container or syringe, and freezing it for use after your baby is born if needed.

Some families may be advised to consider antenatal expressing when there is a greater chance that their baby could need additional milk after birth.

Why was the DAME trial carried out?

Babies born to women with diabetes in pregnancy have a greater risk of developing low blood glucose levels (hypoglycaemia) after birth.

For this reason, some maternity services had begun recommending that women with diabetes express and store colostrum before birth. This meant their own expressed breast milk could potentially be available if their baby required additional milk after birth.

However, there had been uncertainty about whether expressing during pregnancy was safe.

The DAME trial, led by researchers from La Trobe University in Melbourne, was designed to investigate this.

What did the study involve?

The DAME trial included 635 women with diabetes in pregnancy who were considered at low risk of pregnancy complications.

Women were randomly allocated to either receive usual care or to be taught how to hand express breast milk twice a day from 36 weeks of pregnancy until their baby was born.

Any colostrum collected was stored and could then be used for their baby after birth if needed.

What did the researchers find?

The findings were reassuring.

Women who were advised to express from 36 weeks did not give birth earlier than women who received usual care.

Their babies were also no more likely to require admission to a special care or intensive care nursery.

Importantly, babies whose mothers were in the expressing group were more likely to receive only breast milk during the first 24 hours after birth and during their hospital stay.

The amount of colostrum collected varied considerably between women. Some collected very little — and this is completely normal.

Collecting only drops or small amounts does not tell us how much milk you will produce once your baby is born.

So, is antenatal expressing safe?

The DAME trial provides reassuring evidence that for women with diabetes in pregnancy who are otherwise considered low risk, advising antenatal expressing from 36 weeks did not appear to cause harm to mothers or babies.

However, this is an important distinction: the study findings should not automatically be applied to pregnancies with additional risk factors or complications.

Antenatal expressing may not be recommended for everyone, so it is important to discuss your individual circumstances with your midwife, obstetrician or maternity care provider before beginning.

What if I can't express much colostrum?

This is such an important point.

Some people collect several syringes of colostrum before birth, while others may see only a tiny drop — or nothing at all.

The amount you can express during pregnancy is not a measure of your future milk supply or your ability to breastfeed your baby.

Antenatal expressing can also be useful for reasons beyond collecting colostrum. It provides an opportunity to become familiar with your breasts, learn the technique of hand expressing and feel a little more prepared before your baby arrives.

Preparing for breastfeeding before your baby arrives

Pregnancy can be a lovely time to learn about breastfeeding before you are also navigating a newborn, recovery and everything that comes with those early days.

An antenatal breastfeeding consultation can include discussing what to expect in the first hours and days after birth, positioning and attachment, how milk production works, hand expressing and collecting colostrum where appropriate, and creating a feeding plan that takes your individual circumstances into account.

A little preparation can make those early days feel much less unfamiliar.

If you're pregnant and would like some individual support preparing for breastfeeding, you can book an antenatal consultation with Latch & Learn.

References

Forster DA, Moorhead AM, Jacobs SE, et al. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. The Lancet. 2017;389(10085):2204–2213.

La Trobe University, Judith Lumley Centre. Diabetes and Antenatal Milk Expressing: the DAME trial.

This information is general in nature and does not replace individual medical or maternity care. Speak with your healthcare provider before commencing antenatal expressing to ensure it is appropriate for your pregnancy.