Practices, predictors and consequences of expressed breast-milk feeding in healthy full-term infants

Abstract

Objective: To investigate the prevalence and predictors of expressed breast-milk feeding in healthy full-term infants and its association with total duration of breast-milk feeding.

Design: Prospective cohort study.

Setting: In-patient postnatal units of four public hospitals in Hong Kong.

Subjects: A total of 2450 mother-infant pairs were recruited in 2006-2007 and 2011-2012 and followed up prospectively for 12 months or until breast-milk feeding had stopped.

Results: Across the first 6 months postpartum, the rate of exclusive expressed breast-milk feeding ranged from 5·1 to 8·0 % in 2006-2007 and from 18·0 to 19·8 % in 2011-2012. Factors associated with higher rate of exclusive expressed breast-milk feeding included supplementation with infant formula, lack of previous breast-milk feeding experience, having a planned caesarean section delivery and returning to work postpartum. Exclusive expressed breast-milk feeding was associated with an increased risk of early breast-milk feeding cessation when compared with direct feeding at the breast. The hazard ratio (95 % CI) ranged from 1·25 (1·04, 1·51) to 1·91 (1·34, 2·73) across the first 6 months.

Conclusions: Mothers of healthy term infants should be encouraged and supported to feed directly at the breast. Exclusive expressed breast-milk feeding should be recommended only when medically necessary and not as a substitute for feeding directly at the breast. Further research is required to explore mothers' reasons for exclusive expressed breast-milk feeding and to identify the health outcomes associated with this practice.

Keywords: Breast milk; Breast-feeding; Chinese; Expression; Pumping.

Fig. 1

Different levels of expressed breast-milk feeding (, 100 %; , >50–99 %; , >0–50 %; , 0 %) over the first 6 months of life, by study cohort (cohort 1, recruited 2006–2007; cohort 2, recruited 2011–2012), in mother–infant pairs from in-patient postnatal units of four public hospitals in Hong Kong. Sample sizes were as follows: 1 month, n 1584; 2 months, n 1249; 3 months, n 1027; 6 months, n 710

Fig. 2

Kaplan–Meier survival estimates of breast-milk feeding duration by different levels of expressed breast-milk feeding (———, 0 %; – – – – –, >0–50 %; - - - - -, >50–99 %; — · — · —, 100 %) at (a) 1 month (P trend < 0·001), (b) 2 months (P trend < 0·001), (c) 3 months (P trend < 0·001) and (d) 6 months (P trend=0·01) in mother–infant pairs from in-patient postnatal units of four public hospitals in Hong Kong. Sample sizes were as follows: 1 month, n 1584; 2 months, n 1249; 3 months, n 1027; 6 months, n 710