Expressing breast milk in late pregnancy: women with diabetes in pregnancy

Advising women with diabetes in pregnancy to express breast milk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial – Della Forster et al, 2017, The Lancet.

Quite a few media headlines about this long-awaited work have been misleading as were some of the images attached to the media stories.

For example – images of pumps in stories – this study is only about hand expression.

Plus the study is about women with diabetes.  Lots of headlines missed the ‘diabetes’ part.

Findings

Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [<1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [<1%] of 315).

Interpretation

There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks’ gestation.

Full abstract is here

The researchers also wrote a very accessible piece for The Conversation – link here