Individual Risk Factors Associated with Delayed Secretory Activation in a Cohort of First-Time Mothers in Western Australia

Infants of mothers who experience a delay in onset of copious breastmilk, or secretory activation (SA), are at risk of suboptimal feeding during infancy and early termination of breastfeeding, even if their mothers intend to exclusively breastfeed. The aim of this secondary data analysis was to identify individual risk factors associated with delayed SA in a cohort of 159 first-time mothers from a subset participating in an ongoing trial being conducted across multiple hospital sites in Western Australia. Low-risk nulliparous pregnant women were enrolled and followed until 1 week after birth. Maternal self-reported delayed SA status (onset ≥ 72 h postpartum) was examined in association with potential risk factors across five dimensions: maternal demographics; maternal anthropometry; obstetric and birth outcomes; newborn characteristics; and infant feeding. Any variable that was P < 0.1 in univariate analysis was retained for the multivariable analysis and analyzed with potential confounders maternal age and caesarean birth. The rate of delayed SA was 44% (n = 70). In the multivariable adjusted model mothers with gestational diabetes mellitus (GDM) were significantly more likely to experience delayed SA than mothers without GDM after adjusting for all other factors in the model, (OR = 4.35; 95% CI [1.05, 18.06]). Among mothers with GDM, 11 (79%) had delayed SA. Delayed SA was reported by almost half of first-time mothers, and those with GDM more likely to be affected. Additional support for these mothers may help improve breastfeeding rates.