Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding
Wei Wei Pang,
Jonathan Y. Bernard,
Geetha Thavamani,
Yiong Huak Chan,
Doris Fok,
Shu-E Soh,
Mei Chien Chua,
Sok Bee Lim,
Lynette P. Shek,
Fabian Yap,
Kok Hian Tan,
Peter D. Gluckman,
Keith M. Godfrey,
Rob M. van Dam,
Michael S. Kramer,
Yap-Seng Chong
Affiliations
Wei Wei Pang
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Jonathan Y. Bernard
Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
Geetha Thavamani
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Yiong Huak Chan
Department of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Doris Fok
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Shu-E Soh
Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
Mei Chien Chua
Department of Neonatology, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
Sok Bee Lim
Department of Child Development, KK Women’s & Children’s Hospital, Singapore 229899, Singapore
Lynette P. Shek
Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
Fabian Yap
Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore
Kok Hian Tan
Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
Peter D. Gluckman
Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
Keith M. Godfrey
Medical Research Council Lifecourse Epidemiology Unit, Southampton SO16 6YD, UK
Rob M. van Dam
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
Michael S. Kramer
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Yap-Seng Chong
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
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.