Colostrum Volumes
by Anne Eglash MD, IBCLC, FABM
There is a lack of recent data on colostrum volumes postpartum particularly among term infants. Kato et al’s 2022 study, one of the most recent, found that colostrum volumes were lower in NICU mothers at 24-48 hours compared to 0-24 hours. Surprisingly, multiparous mothers did not express higher volumes than primiparous mothers until after 30 hours.
A new study from India evaluated colostrum volumes expressed on day 1-3 among 391 mothers who gave birth either late preterm or at term with an average gestational age of 38 +/-1.5 weeks.
Mothers with a history of gestational hypertension, gestational diabetes, hemorrhage, receipt of medication, or admission to an intensive care unit were excluded. Among the participants, 53.4 were primiparous, 52.2% underwent cesarean birth, and the average age was 27 years.
A lactation counselor visited each mother and asked them to hand express colostrum from both breasts once a day in the morning. No information was provided about the timing of hand expression relative to feeding.
On average, mothers produced 5 ml/session on day 1, 10 ml on day 2, and 25 ml on day 3.
What else? See the question!
- The mothers who gave birth to term infants hand expressed higher volumes of colostrum compared to the mothers who gave birth to late preterm infants.
- There was no difference in expressed colostrum volumes between mothers who gave birth vaginally compared to those who gave birth via cesarean.
- Multiparous women hand expressed higher volumes of colostrum each day compared to primiparous mothers.
See the Answer
Abstract
Introduction
The volumes of colostrum have been quantified as 5mL and 25mL per feed on days 1 and 3, respectively, as per the data described about 20 years ago. However, the use of commercial formula is on the rise and ‘not enough milk’ is a common complaint by postnatal mothers.
Objectives
To determine the average volume of colostrum in one sitting per day on first three postnatal days among healthy late preterm and term gestational mothers and to compare the same among late preterm, term gestation and modes of delivery.
Design
Retrospective study
Setting
A tertiary care perinatal setting in South India.
Patients
Healthy late preterm and term gestational mothers whose babies were roomed in.
Interventions
A lactation consultant helped the mothers manually express breast milk.
Main outcome measures
Volumes of manually expressed colostrum on first three postnatal days.
Results
Of the 391 mothers analysed in the study, on first three postnatal days, the average volume of colostrum in one sitting each was 4.68mL, 8.87mL and 22.53mL, respectively. There was no statistically significant difference in volumes of colostrum secreted among term and late preterm mothers and also among mothers with different modes of delivery. As anticipated, multiparous mothers expressed significantly higher volumes as compared with primiparous mothers, on all three postnatal days.
Conclustions
The volumes of colostrum on first three postnatal days among healthy mothers were comparable with traditional volumes described about two decades ago. Gestational age and mode of delivery did not affect the volumes of colostrum in the present cohort.
In this study, mothers of term and late-preterm infants produced similar amounts of colostrum. The average colostrum volumes per session were consistent with older reports of 5 ml/feed day 1, 10ml/feed day 2, and 25ml/feed day 3. However, individual variations were significant, with some mothers hand expressing no colostrum days 1-2, and others as much as 30ml/session on day 3.
The Kato study mentioned above is a notable exception because they reported much lower colostrum volumes – 2.8 ml total for 0-24 hours, and 10.3 ml total for 24-48 hours, with no difference between primips and multips. Note that the subjects in the Kato study were mothers of preterm infants who were not breastfeeding, and were older, 27-35 years of age.
This study design could have been improved by documenting the timing of the last feeding before hand expression. Additionally, because of the wide range of colostrum volumes expressed, correlating volumes with confounding factors such as BMI, age, and infertility would help us identify the risk for excessive weight loss due to delay in secretory activation.