Effect of antenatal milk expression on prenatal breastfeeding self-efficacy, lactogenesis onset, and early exclusive breastfeeding in pregnant women with gestational diabetes mellitus: a randomized controlled trial

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• Picked for Obstetrics and Gynecology (top studies of the week, 6 September 2026): Antenatal milk expression improves lactogenesis in GDM

Abstract

BACKGROUND: Pregnant women with gestational diabetes mellitus (GDM) frequently experience delayed onset of lactogenesis, insufficient breastfeeding self-efficacy, and low rates of early exclusive breastfeeding, highlighting the need for effective interventions. OBJECTIVE: To investigate the effects of antenatal milk expression (AME) on prenatal breastfeeding self-efficacy, lactogenesis onset, and early exclusive breastfeeding in pregnant women with GDM. METHODS: In this single-center randomized controlled trial conducted at Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital) in China, 240 women with GDM in late pregnancy were enrolled and randomly assigned in a 1:1 ratio to an intervention group or a control group. The control group received routine prenatal care, whereas the intervention group received routine care plus AME. Prenatal breastfeeding self-efficacy, time to lactogenesis onset, incidence of delayed onset of lactogenesis II, exclusive breastfeeding rates at 24 h postpartum and before hospital discharge, as well as social support and breastfeeding behavior prediction indicators, were compared between the two groups. RESULTS: A total of 233 participants completed the study. Compared with the control group, the intervention group showed significantly higher total and domain scores for prenatal breastfeeding self-efficacy; a significantly shorter time to lactogenesis onset [(41.15 ± 21.94) h vs. (55.74 ± 23.29) h]; a significantly lower incidence of delayed onset of lactogenesis II (8.6% vs. 24.8%); and significantly higher exclusive breastfeeding rates at 24 h postpartum and before discharge (81.9% vs. 66.7%, 43.1% vs. 28.2%). In addition, improvements in social support and breastfeeding behavior prediction indicators were more pronounced in the intervention group. No statistically significant differences in maternal or neonatal outcomes were observed between the groups, and no AME-related maternal or neonatal adverse events were identified during safety monitoring throughout the study period. CONCLUSION: AME improved prenatal breastfeeding self-efficacy in women with GDM, was associated with earlier lactogenesis onset and a lower incidence of delayed onset of lactogenesis II, and increased early in-hospital exclusive breastfeeding rates. These breastfeeding findings should be interpreted as early postpartum outcomes rather than evidence of sustained exclusive breastfeeding beyond discharge. When implemented with standardized instruction and safety monitoring in eligible women with GDM, AME may serve as a useful antenatal component of perinatal breastfeeding support.

Abstract as published, via PubMed.