by Anne Eglash MD, IBCLC, FABM
Is breastfeeding safe during pregnancy? Breastfeeding during pregnancy is often not a planned event. At some point during lactation, many women resume menstruation and are at risk for pregnancy. Some breastfeeding women who become pregnant do not necessarily feel compelled or able to stop breastfeeding, but need information on whether continuing to breastfeed is safe and reasonable.
A systematic review of the sparse literature available, published in June 2017, found that common concerns about breastfeeding during pregnancy include the risk of spontaneous abortion, preterm labor, and nutritional risks for the fetus and mother.
A 1992 study among 17 countries in Africa, Asia, and Latin America found that 16.2% of pregnant mothers were nursing. A 1990 study showed that 50% of women in rural Guatemala had breastfed a child during pregnancy. Demographics in North America are not truly known because many mothers who are breastfeeding during pregnancy do not disclose this to others, including their physicians.
According to this systematic review of breastfeeding during pregnancy, what do you think are conclusions of current evidence? (choose one or more)
- Among 7 studies reviewed, the premature birth rate was not significantly different between pregnant women who breastfeeding, and those who were not.
- Breastfeeding during pregnancy does not increase the risk of low birth weight for the newborn.
- The majority of babies being breastfed during pregnancy are weaned by the end of the second trimester.
- Most pregnant women do not notice a drop in milk supply when they become pregnant.
- Pregnant mothers who are breastfeeding are at risk nutritionally, as measured by maternal weight gain, body fat, and hemoglobin.
- The mature milk of a pregnant breastfeeding mother transforms into colostrum towards the end of pregnancy.
See the Answer
The answers are A, C, E, F
Women Birth. 2017 Jun 19. pii: S1871-5192(17)30110-5. doi: 10.1016/j.wombi.2017.05.008. [Epub ahead of print]
Breastfeeding during pregnancy: A systematic review
López-Fernández G, Barrios M, Goberna-Tricas J, Gómez-Benito J.
BACKGROUND:
The consequences of breastfeeding during pregnancy (BDP) have not been clearly established. Available studies have addressed isolated aspects of this issue using different methodologies, often resulting in contradictory results. To our knowledge, no systematic review has assessed and compared these studies, making it difficult to obtain a clear picture of the consequences of BDP.
AIM:
To review and summarise all the scientific evidence relating to BDP, and determine whether this evidence is sufficient to establish clear implications for the mother, breastmilk, breastfed child, current pregnancy, and ultimately, the newborn.
METHODS:
We conducted a systematic review of the English and Spanish literature published between 1990 and 2015 using Cinahl, PubMed, IME, CUIDEN, Cochrane Library, Web of Science and PyscINFO.
FINDINGS:
3278 publications were identified from databases, their titles and abstracts were checked to ensure the studies were related to the subject and met the selection criteria. Only 19 studies met all requirements and were included in the review.
CONCLUSIONS AND IMPLICATIONS:
Data suggest that BDP does not affect the way pregnancies end or even birth weights. However, several questions remain unanswered. Specifically, it is unclear how BDP affects maternal nutritional status in developed countries, the growth and health of breastfed siblings, the composition of breastmilk, or the growth of the newborn after delivery. Further studies of BDP are needed with larger samples, adequate methodology and proper control of the main confounders.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
It is amazing that in 2017, we know more about the behavior of maggots in Sardinian cheese than we do about the incidence of breastfeeding during pregnancy in North America. As a result, we don’t have firm ground to stand on when we advise pregnant mothers about the ramifications of breastfeeding.
The most consistent findings are among the studies on preterm birth. This systematic review demonstrates that preterm-birth is generally not an issue for pregnant breastfeeding women who are at low risk.
For most of the other possible effects on maternal and child health, the research is not robust and the findings are mixed. Some studies have found that infants born to women who breastfed during pregnancy are at risk for low birth weight, and mothers are at risk of nutritional compromise as measured by weight gain, hemoglobin and body fat. These studies did not control for maternal diet.
The majority of breastfeeding mothers notice a drop in their milk supply when they become pregnant, and they are likely to wean their babies due to sore nipples, drop in milk supply, worries about miscarriage, and advice from others.
Studies done on the quality of milk towards the end of pregnancy consistently show a drop in lactose and fat, and an increase in protein, basically a reversion to colostrum.
Based on this systematic review, my suggestion for clinical practice is to reassure a pregnant breastfeeding woman without other risk factors that she is not at risk for preterm birth due to breastfeeding. However, it would be reasonable for her to consult with a dietitian for nutritional evaluation and recommendations. Close monitoring to ensure proper weight gain during pregnancy would be advisable. The nursing infant also would need frequent weight checks due to the drop in milk supply.