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Case Reports
. 2018 Mar 15;18(1):68.
doi: 10.1186/s12884-018-1693-5.

Delayed Lactogenesis II and potential utility of antenatal milk expression in women developing late-onset preeclampsia: a case series

Jill Demirci  1   2 , Mandy Schmella  3 , Melissa Glasser  3 , Lisa Bodnar  4   5 , Katherine P Himes  5   6
Affiliations
Case Reports

Delayed Lactogenesis II and potential utility of antenatal milk expression in women developing late-onset preeclampsia: a case series

Jill Demirci et al. BMC Pregnancy Childbirth. .

Abstract

Background: Preeclampsia is a multi-system, hypertensive disorder of pregnancy that increases a woman's risk of later-life cardiovascular disease. Breastfeeding may counteract the negative cardiovascular sequela associated with preeclampsia; however, women who develop preeclampsia may be at-risk for suboptimal breastfeeding rates. In this case series, we present three cases of late-onset preeclampsia and one case of severe gestational hypertension that illustrate a potential association between hypertensive disorders of pregnancy and suboptimal breastfeeding outcomes, including delayed onset of lactogenesis II and in-hospital formula supplementation.

Case presentation: All cases were drawn from an ongoing pilot randomized controlled trial investigating the impact of antenatal milk expression versus an education control on breastfeeding outcomes. All study participants were healthy nulliparous women recruited at 34-366/7 gestational weeks from a hospital-based midwife practice. The variability in clinical presentation among the four cases suggests that any effect of hypertensive disorders on breastfeeding outcomes is likely multifactorial in nature, and may include both primary (e.g., preeclampsia disease course itself) and secondary (e.g., magnesium sulfate therapy, delayed at-breast feeding due to maternal-infant separation) etiologies. We further describe the use of antenatal milk expression (AME), or milk expression and storage beginning around 37 weeks of gestation, as a potential intervention to mitigate suboptimal breastfeeding outcomes in women at risk for preeclampsia and other hypertensive disorders of pregnancy.

Conclusions: Additional research is needed to address incidence, etiology, and interventions, including AME, for breastfeeding issues among a larger sample of women who develop hypertensive disorders of pregnancy.

Keywords: Breast feeding; Breast milk expression; Hypertension, Pregnancy-induced; Lactation; Pre-eclampsia.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the University of Pittsburgh Institutional Review Board (PRO15120109), and all participants provided written, informed consent for study participation.

Consent for publication

All mothers had the opportunity to review and comment on this paper. All provided written consent to publish their individual case.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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