Supporting women with diabetes to breastfeed: use of antenatal breastmilk expression
Antenatal breastmilk expression is recommended in many practice settings to overcome challenges to breastfeeding for women with diabetes.
This narrative literature review aimed to examine how antenatal breastmilk expression supports women with diabetes to breastfeed.
A search was undertaken of the CINAHL database, Scopus, Medline, Excerpta Medica DataBASE and the Cochrane Library to identify quantitative and qualitative primary research studies. Eight studies met the inclusion criteria.
Findings were examined within a framework of informational, emotional and motivational and practical aspects of antenatal breastmilk expression. Information on infant wellbeing is important, as concerns about admission to neonatal care have emerged. However, for women at low risk of complications, their infants were not at greater risk of being admitted to neonatal care following antenatal expression in comparison to standard care, and there was no evidence of increased neonatal hypoglycaemia. Emotional support is important, as although the experience is rewarding it can also be challenging. Breastfeeding rates were higher following antenatal expression, although the differences were not always statistically significant. Practical aspects, including the optimum gestation at commencement, require further research.
Although the evidence is not conclusive on how antenatal breastmilk expression can support women with diabetes to breastfeed, the results are promising.
Breastfeeding is recommended as the optimal method of infant feeding. The World Health Organization recommends that all babies are exclusively breastfed for the first 6 months of life and continue to breastfeed for up to 2 years of age and beyond (World Health Organization (WHO) and United Nations Children's Fund (UNICEF), 2018). The benefits associated with breastfeeding are extensive. Specific health benefits have been identified in cases of maternal diabetes (Victoria et al, 2016; Doughty and Taylor, 2021). Results from a meta-analysis and a number of systematic reviews indicate that breastfeeding offers protection to mothers against type 2 diabetes and may protect infants against diabetes in later life (Victoria et al, 2016). These benefits are compelling, given the increased risk of morbidity and mortality that exist for the woman and her developing fetus from maternal diabetes (National Institute for Health and Care Excellence (NICE), 2015; Nelson Piercy, 2020; Vause et al, 2020).
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