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Table 1 Studies exploring prevalence of breast milk expressing

From: Prevalence and outcomes of breast milk expressing in women with healthy term infants: a systematic review

Author, year, country

Design

Location, participants, year of study and recruitment

Study aims and outcome measures

Results

Strengths/Limitations

Geraghty et al. 2005 USA [1]

Retrospective cohort

Cincinnati, Ohio n = 346 2002 Random selection postal recruitment when infants were between 2 and 3 years old

Quantify breast pump use

77% (182/236) ever used a breast pump

Large sample size

 

Identify relationships between breast pump use and

No significant difference in expressing between 4 groups of mothers; those of

Clear differentiation between breastfeeding and breast milk feeding

 

- singleton vs. multiple pregnancy

- term singletons

Periodic reports re. proportion of expressing versus breastfeeding (at 1 day, 3 days, 2 weeks and monthly until 6 months)

 

- gestation at birth

- preterm singletons

Retrospective data, possible recall bias, initial contact made when children between 2–3 years of age-requesting detailed information about infant feeding at 24 hrs, 3 days, 2 weeks and then at monthly intervals to 6 months.

 

- breastfeeding outcomes

- term multiples

Expressing methods not distinguished between hand, manual or electric pump

- preterm multiples

- 68% (236/346) received at least some breast milk.

- 5% (12/236) exclusively expressed to feed – all mothers of premature babies

Binns et al. 2006 Australia [2]

Longitudinal

Perth, Western Australia

- Explore determinants of breastfeeding

- PIFS I 38% (211/556) expressing by 6 weeks

Large sample

PIFS I n = 556

- Measure and compare prevalence of expressing

- PIFS II 69% (405/587) expressing by 4 weeks

Comparison of similar groups 10 years apart

1992–93

 

- Expressing rates steadily decline after 6 weeks:

Limited detail about expressed breast milk/ breastfeeding proportions.

PIFS II n = 587

 

26% (145/556) at 24 weeks in PIFS I 28% (164/587) at 22 weeks in PIFS II

Public patients only, perhaps not representative

2002–03

  

Differing interview schedules – less clarity for comparison

Recruited in hospital in early postpartum period

   

Labiner-Wolfe et al. 2008 USA [3]

Longitudinal

National study

- Reasons why women express

- Most common reason: for someone else to feed baby

Large sample

n = 4606

- Amount and prevalence of milk expression

- 85% (1329 /1564) between 1.5 and 4.5 months postpartum had expressed at some time since birth

Maternal recall previous 7 days

2005–2007

- Associated socio-demographic factors

- 68% (1015/1493) of this group had expressed in 2 weeks before survey, 25% (373/1493) regularly

Measures frequency of expressing (asked how many times expressed in previous 2 weeks and if expressed on a regular schedule)

from IFPS II

 

- Expressing associated with: maternal employment, higher income, first breastfeeding experience

Not nationally representative: Older, more educated, more likely to be white, employed, higher income, less likely to smoke. More likely to breastfeed and for longer

Mail survey 2, 5 and 7 months postpartum

   

Shealy et al. 2008 USA [4]

Longitudinal

National study

Describe breastfeeding in first 12 months to identify:

- 0.06% of babies fed expressed breast milk exclusively – 2/3 of these ceased breast milk feeding by 4 weeks

Detailed analysis of feeding type/frequency/duration of individual feeds

n = 2587

- Prevalence of exclusive pumping and formula supplementing

 

Limited data re. expressing – except when it was exclusive

2005–2007

- Patterns and trends in breastfeeding related to common advice given

  

from IFPS II

   

Monthly postal questionnaires

   

Clemons & Amir 2010 Australia [5]

Cross-sectional

State-wide study, Victoria

- Prevalence of breast milk expression

- 67% (602/898) had fully breastfed prior to hospital discharge

Large study

n = 903

- Demographic characteristics of women who express, why and how they do it

- 14% (125/898) had breastfed and expressed to feed their baby

Possible selection bias (members of the Australian Breastfeeding Association)

2008

- Women’s experience of using breast pumps

- Of those whose youngest child was over six months 95% (628/661) fully breastfed for at least six months

Timing of questionnaire, possible recall bias

Online questionnaire sent to Australian Breastfeeding Association members who had an email address

 

- 4% (34/898) expressed and exclusively fed EBM

 

Baby any age

 

- 98% (885/903) ever expressed

 

Hornbeak et al. 2010 Singapore [6]

Retrospective cohort

Singapore

- Prevalence and patterns of breastfeeding in Singaporean Chinese mothers from birth to 6 months

- Initiation of breast milk feeding increased from 69% (144/210) in 2000-2001 to 82% (538/656) in 2006/2008

Large representative sample of Chinese Singaporean mothers

n = 3009

 

- Exclusive expressing increased from 9% (18/144) in 2000-2001 to 18% (118/538) in 2006/2008

Limited detail about expressed breast milk/breastfeeding proportions.

2006-2008

 

- Direct breast milk feeding decreased from 34% (72/210) in 2000–2001 to 27% (142/656) in 2006/2008

Possible recall bias - recruitment 6–72 months after birth

Recruited mothers of 6-72 month Chinese Singaporean children through Strabismus, Amblyopia and Refractive Error in Singaporean Children (STARS) Study

  

Gestational age not indicated

Mailed invitation

   

Face-to-face interview

   

Geraghty et al. 2012 USA [29]

Prospective longitudinal cohort

Cincinnati, Ohio

- Describe who commences expressing early

- 14% (8/59) commenced some expressing in first week

Prospective design assisting recall

n = 60

- Explore breastfeeding duration in women who express

- By four weeks: 63% (37/59) expressing

Initial weekly visits; used weekly and 24 hour recall to enquire about feeding and expressing

2004–2007

 

- Expressing had no effect on duration of breast milk feeding

Clear differentiation between ‘breastfeeding’ and ‘breast milk feeding’

Recruited face to face in first week after hospital discharge.

  

Small study

   

Recruitment of women who planned to breastfeed for 6 months or more

   

Mothers recruited for study knew they were going to be assisted to pump and may have been more likely to be comfortable with this.

     

Possible introduction of bias as weekly collection of breast milk was initiated at 1 week by research nurse using an electric breast pump