A Longitudinal Observation of Antenatal Milk Expression in Mothers of Infants with Congenital Anomalies

Background: For mothers of infants with congenital anomalies, antenatal milk expression (AME), known as hand expression during late pregnancy, allows mothers to contribute to their newborn's care through colostrum collection. However, research is limited by self-report of AME adherence and colostrum volume. Objective: This study examined the ability of participants to adhere to a recommended protocol on AME for any removal and measurement of colostrum during late pregnancy. Materials and Methods: A prospective, longitudinal, observational design was used. Our recommended protocol involved hand expression of 5 minutes per breast for a total of 10 minutes for each AME session twice per 24 hours for any colostrum from 37 ^0/7 weeks gestation until birth. Women received AME education, completed milk logs, and attempted AME. The study team verified all colostrum volumes. Results: Nineteen women (10 nulliparous) participated, with 13 (68%) carrying infants with major organ system defects and 6 (32%) carrying infants with congenital heart defects. Most participants (52.6%) completed more than half but fewer than all AME sessions. Seven participants (36.8%) fully adhered, completing two AME sessions daily until hospital admission. Eighteen participants (94.7%) could remove milk (80-100% of the time). The 24-hour colostrum volume (median 0.35 mL, interquartile range [IQR] 0.065-0.845) and the total colostrum volume (median 3.99 mL, IQR 1.35-6.82) from AME varied. Conclusions: Among a small group of women of infants with congenital anomalies, adherence to a recommended protocol is feasible but varied by AME session frequency. Most women could collect colostrum for future infant feeding.