Authors (including presenting author) :
LAI KW, LAU WC, LAM KY, CHAU MCM
Affiliation :
Department of Obstetrics and Gynaecology, Prince of Wales Hospital
Introduction :
It is evidenced that diabetes mothers are found with up to 24-hour delay in lactogenesis II compared with mothers without diabetes, which might decrease the likelihood of establishing breastfeeding. Newborns of diabetes women are at increased risk of hypoglycaemia after birth, which could have associated with increased admission to the neonatal units leading to separation of mother and babies as well as formula supplementation. Studies found that expressing colostrum from 36 weeks gestation is safe in low risk pregnant women with diabetes. The collected antenatal colostrum given postnatally may also reduce the reliance on formula supplementation. Lactation performance of these mothers may also be improved in postnatal period due to antenatal expression.
Objectives :
The aim of this program is to improve breastfeeding performance in postnatal diabetes mothers, and to minimize mother-infant separation and formula supplementation due to infant hypoglycaemia after birth. Outcome objectives of this project are as follows:
Women will be able to
- understand the benefits of expressing colostrum in antenatal period;
- practice manual expression of colostrum in antenatal period;
- practice manual expression of colostrum after the baby is born; and
- be enhanced of breast milk coming-in in postnatal period.
Newborns will be experience avoidance of:
- hypoglycaemia after delivery;
- formula supplement due to hypoglycamia; and
- mother-infant separation due to admission to neonatal units.
Methodology :
Gestational diabetes pregnant women were recruited with inclusion criteria as below:
- on diet control
- term pregnancy
- singleton
- cephalic presentation
- no obstetric complication
- no medical complication
The recruited cases are taught to practice manual expression of antenatal colostrum 2 times per day, 10 minutes per session. Expressed antenatal colostrum would be collected in a sterile syringe and was kept frozen in a milk freezer. After baby was delivered, the frozen colostrum would be defrosted immediately and would be given to newborn. Haemoglucostix would be checked for newborns 1 hour after birth. Feeding mode on discharge would be recorded. Questionnaires would be collected before women discharge for evaluation.
Result & Outcome :
101 cases were recruited from May 2021 to Jan 2022. 66% of cases could be able to collect antenatal colostrum. 23% of newborns of the recruited cases are noted with hypoglycamia at birth, while the overall percentage of hypoglycemic babies was around 30%. 100% of recruited mothers breastfed their babies after delivery. Upon discharge, 23% of cases were exclusively breastfeeding, while the overall percentage of exclusive breastfeeding was 19%. Mothers reflected that they had increased confidence in breastfeeding after practicing manual expression during antenatal period. In this project, it was found that breastfeeding rate and maternal breastfeeding confidence could be improved through the use of antenatal colostrum. Incidence of newborn hypoglycamia was also reduced with providing antenatal colostrum to them, which could help reduce admission to neonatal unit, maternal-infant separation, and the need of formula supplementation in neonatal unit.
