Maternal Complications of Pregnancy and Achievement of Secretory Activation and Coming to Volume in Breast Pump-Dependent Mothers of Preterm Infants

Abstract

Objective: Mother's own milk (MOM) sodium (Na) is an objective measure of secretory activation (SA), which is often delayed or impaired after preterm delivery. We sought to determine in pump-dependent mothers of preterm infants, impacts of maternal comorbidities on lactation outcomes using objective measures, including MOM Na, pumping frequency and MOM volumes for the first 14 postpartum days. Study Design: In this secondary analysis of four prospective cohorts, we examined outcomes using logistic and linear regression, survival analysis, and mediation and moderation sub-analyses. Results: A total of 143 mothers (57.3% Black, 30.8% Hispanic; 35.0% with hypertensive disorders of pregnancy [HDP]; 9.8% diabetic; 73.8% high body mass index [BMI]) delivered at 29.1 ± 2.8 weeks. Mothers pumped 4.7 ± 1.8 times/daily. Daily pumping frequency was a significant independent predictor of all modeled outcomes (p < 0.001 SA achievement, maintenance, and time to SA achievement; daily MOM volume; coming to volume [CTV; 500 mL/day]). 88.1% achieved SA by MOM Na ≤16 mM at postpartum day 5.6 ± 2.5. Only 41.3% of this subset continuously maintained SA until postpartum day 14. HDP was negatively associated with time to SA (p = 0.039). BMI values were negatively associated with MOM volume (p = 0.017) and CTV achievement (p = 0.02). Effects of daily pumping frequency were moderated by BMI (SA achievement and time to SA) and diabetes (CTV), with worse outcomes for higher BMI or diabetes despite similar pumping frequencies. Conclusion: Daily pumping frequency was the significant independent predictor for early lactation outcomes in a breast pump-dependent cohort of mothers of preterm infants. Further research on the interplay between modifiable and unmodifiable lactation risks in high-risk populations is needed.

Keywords: breastfeeding; coming to volume; human milk; maternal; neonatal; secretory activation.