Short summary

In this pilot study, the investigators aim to examine if antenatal breastmilk expression from week 34 of pregnancy is a safe and feasible procedure for the mother and fetus. Furthermore, the investigators want to evaluate breastfeeding rates.

Rationale

Mother's own milk (MOM) is the best feeding option for all newborn infants, including those born preterm. Besides being a source of macronutrient nutrition, MOM is also a source of vitamins, minerals and bioactive components, such as growth factors, immunoglobulins, lactoferrin, antioxidants and cytokines. These bioactive components contribute, among others, to activate the immune system, maturate the infant intestine and promote neurodevelopment. In addition, breastfeeding has health benefits for both mother and infant.

Breastfed children have a reduced risk for various diseases later in life e.g. cardiovascular and metabolic diseases and obesity. Furthermore, women who breastfeed seem to have a reduced risk for breast- and ovarian cancer, osteoporosis as well as diabetes later in life.

We know that receiving MOM as primary enteral feeding is critical for preterm infants both during infancy and later in life, but the mothers are often struggling with breastfeeding establishment in the Neonatal Intensive Care Unit (NICU) due to environmental factors, stress and maternal disease or blood loss related birth.

Within the last couple of years, a rising interest is seen in expression and storage of breastmilk before birth (antenatal breastmilk expression = aBME), to ensure an exclusive mother's milk diet and enhance the process of lactogenesis. It has been a general concern that aBME, could induce preterm labor due to rising oxytocin levels. However, recent studies indicate that this does not seem to be the case. Allthough, it has never been investigated before week 36 of gestation.

In this pilot study, we want to investigate if aBME from week 34 of pregnancy is a safe and feasible procedure for the mother and fetus. Furthermore as secondary outcomes, we want to evaluate breastfeeding rates and mother's experiences with aBME. The evaluation of the mothers experience with aBME will be a separate study conducting qualitative methods.

Description of the cohort

Participants are nulliparous pregnant women from the island of Funen who plan to give birth at Odense University Hospital. We intend to include 60 pregnant women, 30 in each group.

Data and biological material

Demographic data on the mothers (maternal age, education level, ethnic background, parity and smoking status) will be obtained through medical files. Infant data on gestational age, complications such as preterm contractions or birth and feedings from birth, will be obtained from medical records after birth.

To obtain data on aBME and breastfeeding rates after birth, we will use SMS tracking via an app based in the RedCap system. From intervention start until 8 weeks after birth participants in the intervention group will receive a weekly sms, with questions on how many times they stimulated and if they were capable of expressing any milk. The control group will receive a weekly message which regards if they have been giving birth, to be able to initiate the questions on breastfeeding. After birth questions will regard breastfeeding initiation. After eight weeks the mothers experience and evaluation on the study will be evaluated in an online questionnaire.

Collaborating researchers and departments

Department of Pediatrics, Odense University Hospital

• Gitte Zachariassen

Department of Obstetrics, Odense University Hospital

• Christina Anne Vinter