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The Midwifery and Maternity Services Research Unit

Diabetes and antenatal milk expressing (DAME): a randomised controlled trial

Della Forster, Lisa Amir, Anita Moorhead; in collaboration with Susan Jacobs, Peter Davis and Amanda Aylward, Royal Women’s Hospital; Susan Walker, Kerri McEgan and Gillian Opie, Mercy Hospital for Women; Susan Donath, Murdoch Childrens Research Institute; Rachael Ford, Royal Women’s Hospital; Catherine McNamara, Mercy Hospital for Women; Christine East, Monash Medical Centre; Lisa Gold, Deakin University

The DAME study explored the safety and effectiveness of advising women with diabetes in pregnancy to commence expressing breast milk from 36 weeks of pregnancy. A total of 635 women were recruited and randomised to the study- and about half of these were advised to express. Women were recruited from six sites that provide pregnancy and birth care – the Royal Women’s Hospital, Mercy Hospital for Women, Monash Health, Barwon Health, the Women’s at Sandringham (part of the Royal Women’s Hospital), and Frankston Hospital, from June 2011 until October 2015. We collected data at recruitment in late pregnancy as well as from birth records, and then by telephone interview at two weeks and 12 weeks after birth. The study found that for women with diabetes in pregnancy who were considered of low obstetric risk, there was no harm in advising women to express in late pregnancy, and evidence that infants were more likely to receive only breast milk in the first 24 hours after birth. The results of our study should not be extrapolated to high-risk groups with diabetes in pregnancy. The study results were published in the Lancet in 2017, and clinical guidelines have been developed based on the study outcomes.

Related publications:

  1. Forster DA, McEgan K, Moorhead A, Ford R, Opie G, Walker S, McNamara C. Diabetes and  antenatal milk expressing: A pilot project to inform the development of a randomised controlled trial. Midwifery. 2011;27(2):209-14.
  2. Forster DA, Jacobs S, Amir LH, Davis P, Walker SP, McEgan K, Opie G, Donath SM, Moorhead AM, Ford R, McNamara C, Aylward A, Gold L. Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: Protocol for a randomised controlled trial. BMJ Open. 2014;4:e006571.
  3. East CE, Dolan WJ, Forster DA. Antenatal milk expression by women with diabetes for improving infant outcomes. Cochrane Database of Systematic Reviews. 2014;30:7.
  4. Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, East C, Ford R, Amir LH. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): A multicentre, unblinded, randomised controlled trial. Lancet. 2017;389(10085):2204-2213.