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Nutrients 2017, 9(6), 547; doi:10.3390/nu9060547

Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding

1
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
2
Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
3
Department of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
4
Department of Neonatology, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
5
Department of Child Development, KK Women’s & Children’s Hospital, Singapore 229899, Singapore
6
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
7
Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore 119228, Singapore
8
Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore
9
Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
10
Duke-NUS Medical School, Singapore 169857, Singapore
11
Liggins Institute, University of Auckland, Auckland 1142, New Zealand
12
Medical Research Council Lifecourse Epidemiology Unit, Southampton SO16 6YD, UK
13
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
14
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
15
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
16
Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University Faculty of Medicine, Montreal, QC H3A 1A2, Canada
These authors are co-last authors for the paper.
*
Authors to whom correspondence should be addressed.
Received: 1 April 2017 / Revised: 16 May 2017 / Accepted: 23 May 2017 / Published: 27 May 2017
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Abstract

Background: Studies examining direct vs. expressed breast milk feeding are scarce. We explored the predictors of mode of breastfeeding and its association with breastfeeding duration in a multi-ethnic Asian population. Methods: We included 541 breastfeeding mother—infant pairs from the Growing Up in Singapore Toward healthy Outcomes cohort. Mode of breastfeeding (feeding directly at the breast, expressed breast milk (EBM) feeding only, or mixed feeding (a combination of the former 2 modes)) was ascertained at three months postpartum. Ordinal logistic regression analyses identified predictors of breast milk expression. Cox regression models examined the association between mode of breastfeeding and duration of any and of full breastfeeding. Results: Maternal factors independently associated with a greater likelihood of breast milk expression instead of direct breastfeeding were Chinese (vs. Indian) ethnicity, (adjusted odds ratio, 95% CI; 3.41, 1.97–5.91), tertiary education (vs. secondary education or lower) (2.22, 1.22–4.04), primiparity (1.54, 1.04–2.26) and employment during pregnancy (2.53, 1.60–4.02). Relative to those who fed their infants directly at the breast, mothers who fed their infants EBM only had a higher likelihood of early weaning among all mothers who were breastfeeding (adjusted hazard ratio, 95% CI; 2.20, 1.61–3.02), and among those who were fully breastfeeding (2.39, 1.05–5.41). Mothers who practiced mixed feeding, however, were not at higher risk of earlier termination of any or of full breastfeeding. Conclusions: Mothers who fed their infants EBM exclusively, but not those who practiced mixed feeding, were at a higher risk of terminating breastfeeding earlier than those who fed their infants directly at the breast. More education and support are required for women who feed their infants EBM only. View Full-Text
Keywords: direct breastfeeding; breast milk expression; duration of breastfeeding; Asian direct breastfeeding; breast milk expression; duration of breastfeeding; Asian
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Pang, W.W.; Bernard, J.Y.; Thavamani, G.; Chan, Y.H.; Fok, D.; Soh, S.-E.; Chua, M.C.; Lim, S.B.; Shek, L.P.; Yap, F.; Tan, K.H.; Gluckman, P.D.; Godfrey, K.M.; van Dam, R.M.; Kramer, M.S.; Chong, Y.-S. Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding. Nutrients 2017, 9, 547.

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