Dear Lactnet Friends:

43 isn't such a small sample.

Women often have sex during the last trimester; the only ones to worry about
are the ones at risk for preterm labor.



Midwifery. 2009 Jul 15. [Epub ahead of print]
Diabetes and antenatal milk expressing: a pilot project to inform the
development of a randomised controlled trial.

Forster DA<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Forster%20DA%22%5BAuthor%5D>
, McEgan K<http://www.ncbi.nlm.nih.gov/pubmed?term=%22McEgan%20K%22%5BAuthor%5D>
, Ford R<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ford%20R%22%5BAuthor%5D>
, Moorhead A<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Moorhead%20A%22%5BAuthor%5D>
, Opie G<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Opie%20G%22%5BAuthor%5D>
, Walker S<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Walker%20S%22%5BAuthor%5D>
, McNamara C<http://www.ncbi.nlm.nih.gov/pubmed?term=%22McNamara%20C%22%5BAuthor%5D>
.

Mother and Child Health Research, La Trobe University, Melbourne, Australia;
Royal Women's Hospital, Parkville, Australia.
 Abstract

OBJECTIVE: infants of women with diabetes in pregnancy are at increased risk
of hypoglycaemia. If the infant's blood glucose is low and the mother is
unable to breast feed/provide sufficient expressed breast milk, infants are
often given formula. Some hospitals encourage women with diabetes to express
breast milk before birth. However, there is limited evidence for this
practice, including its impact on labour and birth, e.g. causing premature
birth may be a concern. A pilot study was undertaken to establish the
feasibility of conducting an adequately powered randomised controlled trial
to evaluate this practice.

DESIGN: consecutive eligible women with pre-existing or gestational diabetes
(requiring insulin), planning to breast feed and attending the study
hospital were offered participation. Inclusion criteria: 34-36 weeks of
gestation; singleton pregnancy; cephalic presentation; and able to speak,
read and write in English. Exclusion criteria: history of spontaneous
preterm birth, antepartum haemorrhage, placenta praevia and suspected fetal
compromise. Women were encouraged to express colostrum twice a day from 36
weeks of gestation, and advised how to store the colostrum, which was frozen
for their infant's use after birth. They were asked to keep a diary
documenting their expressing. Data: demographic questionnaire, telephone
interview at six and 12 weeks postpartum and medical record data.

SETTING: a public, tertiary, women's hospital in Melbourne, Australia.

PARTICIPANTS: 43 women with diabetes in pregnancy (requiring insulin).

FINDINGS: cardiotocographs were undertaken after the first expressing
episode and none of the infants showed any sign of fetal compromise. Forty
per cent of infants received formula in the 24hours postpartum. The
proportion of infants receiving any breast milk at six weeks was 90%, and
this decreased to 75% at 12 weeks. No women showed evidence of hypoglycaemia
post expressing. The intervention was positively received by most women; 95%
said that they would express antenatally again if the practice proved to be
beneficial. The amount of colostrum varied according to the number of
expressions, the length of time in the study and the time spent expressing,
with a median of 14 days expressing and 39.6ml of colostrum obtained.

KEY CONCLUSIONS: the small number of women in this pilot was not an adequate
number to examine safety or efficacy, but this study does provide evidence
that it would be feasible and desirable to conduct a randomised controlled
trial of antenatal milk expressing for women with diabetes requiring insulin
in pregnancy.

IMPLICATIONS FOR PRACTICE: it is important that this widespread practice
undergoes rigorous evaluation to assess both efficacy and safety. Until such
evidence is available, the authors suggest that the routine encouragement of
antenatal milk expressing in women with diabetes in pregnancy should cease.



Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome