Cox SG, Breastfeeding Review 2010; 18(3); 5-7.
A randomised controlled trial is being considered to examine the safety or efficacy of antenatal expressing and storage of colostrum. Considering that the practice is widespread an ethical dilemma would arise as the control group of mothers would not be educated about how to express and store their colostrum and if their infant became hypoglycaemic artificial infant milk based on cow’s milk, with all its proven association with Type 1 diabetes, would need to be given.
In considering whether antenatal expression and storing of colostrum by pregnant Type 1 diabetic women should continue, a number of criteria need to be assessed including: the original reason for implementing the procedure; the immunological value of colostrum in preventing autoimmunity and Type 1 diabetes in the infant; any differences in milk that women produce during pregnancy compared to colostrum; the importance of an extra glucose source for babies of hyperinsulinaemic mothers; the likelihood of nipple stimulation inducing labour; and the question of whether the women find the procedure a positive experience. Considering that antenatal expression and storage of colostrum by pregnant Type 1 diabetic women gives their babies an extra amount of fluid that biochemically compares with colostrum if needed for hypoglycaemia; that nipple stimulation has not been shown to induce labour unless the woman is at term; that women have been found to be positive about their antenatal experience of expressing and storing their colostrum; the practice should continue and women with Type 1 diabetes and other endocrine or autoimmune disorders should be educated about this easy, positive and empowering practice.
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