Does antenatal expression of breastmilk reduce the risk of neonatal hypoglycaemia?

Question 1

PICO (Population, Intervention, Comparison, Outcome): Should antenatal expression of breastmilk vs. no expression of breast milk be used for preventing neonatal hypoglycaemia?

Recommendation

Expression of breastmilk may be considered after 36 weeks’ gestation in pregnant women whose baby is likely to be at risk of neonatal hypoglycaemia and who have no contraindications. [Conditional recommendation]

Justifications

Moderate to very low certainty of evidence suggests that antenatal expression of breastmilk may lead to a small reduction in neonatal hypoglycaemia, a moderate increase in fully breastfeeding at hospital discharge, and a moderate decrease in the duration of the initial hospital stay.

The acceptability of this practice varies due to some women experiencing difficulties and discomfort with antenatal expression.

Antenatal expression of breast milk may encourage mothers to breastfeed, and have an additional positive effect on their hinengaro (mental health) through providing nutrition for their baby.

Implementation considerations

Breast pumps are not appropriate for antenatal expression; hand expression suffices for this purpose.

Expression of breastmilk should not be considered in at risk pregnancies. For contraindications consult local guidelines, LMC, diabetes specialist, obstetrician or lactation consultant.

Monitoring and evaluation

Nil

Research priorities

Studies are needed on:

  • The effects of expressing milk on maternal well-being, including factors such as stress from the inability to express colostrum.
     

Health equity

Provide mother and the whānau she wishes to involve with resources and support for antenatal expression of breastmilk that align with their cultural values. Ensure whānau have access to reliable refrigeration or freezer for storing expressed breastmilk.