Oral Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Diabetes and antenatal milk expressing (DAME): a multicentre randomised controlled trial (#7)

Della Forster 1 2 , AM Moorhead 1 2 , SE Jacobs 2 3 4 , PG Davis 2 , SP Walker 4 5 , K McEgan 5 , GF Opie 4 5 , SM Donath 6 , R Ford 1 2 , C McNamara 5 , A Aylward 2 , L Gold 7 , CE East 8 , LH Amir 1 2
  1. Judith Lumley Centre, La Trobe University, Melbourne, Australia
  2. Royal Women’s Hospital, Parkville, Australia
  3. Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Australia
  4. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
  5. Mercy Hospital for Women, Heidelberg, Australia
  6. Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Australia
  7. Deakin Health Economics, Deakin University, Burwood, Australia
  8. Monash University, Clayton, Australia

Background: Despite no evidence, many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy for use after birth (if required) to treat neonatal hypoglycaemia, thereby promoting early lactogenesis and exclusive breast milk feeding. The DAME trial investigated the safety and efficacy of this increasingly widespread practice.

Method:  A two-arm, multicentre, RCT was conducted. Women were randomised at 36 to 37 weeks gestation to standard care, or to twice daily hand expressing for 10 minutes until birth. All study sites agreed there would be no advice to women to express outside the trial. Randomisation was stratified by site, parity and diabetes type. The study was powered to detect a 10% difference in the proportion of babies admitted to special or neonatal intensive care (NICU, the primary outcome). Secondary perinatal outcomes included: gestation at birth, proportion of infants receiving exclusive breast milk during their hospital stay related to the birth, and women’s views. Analyses are by intention to treat.

Results: A total of 635 women were randomised to the trial between June 2011 and Oct 2015. The proportion of infants admitted to the NICU did not differ between groups (Adj. RR 1.06; 95% CI 0.66, 1.46), and no differences were found in any other neonatal outcome. The intervention was associated with increased exclusive breast milk feeding in the first 24 hours of life (Adj. RR 1.15; 95% CI 1.02, 1.28). There was no difference in mean maternal blood glucose after first three expressing episodes ((5.6 mmol/l; sd 1.0), and no difference in mean gestation at birth (mean diff. -0.05; 95%CI -0.21, 0.10).

Conclusion: There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breast milk from 36 weeks’ gestation.