Jacki L. McEachran

Background: Sleep in early infancy supports neurodevelopment, yet the influence of breast milk composition on sleep duration remains unclear. Objective: To determine whether breast milk energy intake is associated with the duration and timing of subsequent infant sleep episodes. Methods: Thirty-four healthy, fully breastfeeding mother–infant dyads (infant age: 3.7 ± 1.3 months) recorded 24-h infant feeding and sleep data, with feed volumes measured by pre- and post-feed test-weighing. Milk samples were collected and analysed for macronutrient concentrations to calculate energy intake per feed. Linear mixed-effects models were used to examine whether energy intake from the preceding feed was associated with subsequent sleep duration. Additional models evaluated lagged and cumulative energy intake, and mixed-effects modelling was used for associations between feed energy and time until the next feed. Results: Intake for 24-h infant breast milk was 851.8 ± 194.2 mL and sleep duration was 15.5 ± 3.4 h. The mean energy density of the feeds was 674.7 ± 140.7 kcal/L. Energy intake for the breastfeed preceding a sleep episode was not associated with sleep duration (β = 4.13 min; 95% CI −0.89 to 9.15; p = 0.106). Energy intake from lagged feeds and cumulative energy intake across the three preceding breastfeeds were also not associated with sleep duration (p = 0.171 and p = 0.290 respectively) nor the time until the next breastfeed (β = −0.025; 95% CI −6.2 to 1.4; p = 0.212). Conclusions: In healthy breastfed infants, the energetic content of breast milk feeds was not associated with subsequent sleep duration or the time until the next feed. These findings suggest that infant sleep–wake behaviour and feeding patterns were not associated with short-term variation in breast milk energy intake. Other factors, including circadian and developmental processes, are likely to contribute to infant sleep behaviour.

Background/Objectives: Women who exclusively pump (EP) expend more time and effort on pumping and feeding infants their expressed breast milk (EBM) than those who directly breastfeed. However, little is known about their 24 h milk production (MP) or pumping and feeding dynamics. Methods: An online survey of 195 EP women explored the experiences, characteristics, MP and pumping and feeding dynamics of EP women. Quantitative data were compared by prematurity/neonatal unit admission, milk supply and parity, and self-reported MP was compared with MP in a predominantly breastfeeding reference group. Results: The 24 h pumping frequency was 6.0 [5.0, 8.0] with a pumping session duration of 25 [20, 30] min and a total pumping time of 2.3 [1.8, 3.0] h/24 h. The self-reported MP was 900 [600, 1100] mL/24 h, which was higher than that of the reference group (p = 0.012). Infant cues (58%), as well as advice from the child health nurse (39%), lactation consultant (34%) and pediatrician (34%) informed EBM feed volumes. Fifty-six percent of the infants were fed on demand, with 37% using a feeding schedule. Infants were fed 7.0 [6.0, 8.0] times/24 h; the average individual EBM feed and total 24 h volume were 120 [100, 150] and 750 [600, 900] mL, respectively. Conclusions: This study confirms it is possible to sustain lactation with EP and provide sufficient EBM volumes for the infant. However, the time commitment of EP and infant feeding represents a serious burden. These families would benefit from enhanced professional support and accessible evidence-based pumping and feeding guidelines.

Background/Objectives: Breast pumps are essential tools when breastfeeding dyads are separated or there are breastfeeding challenges that prevent or reduce effective milk removal. Hospital-grade and personal-use pumps offer different features and performance characteristics. Direct comparative studies evaluating pump efficacy and maternal satisfaction are limited in this area, hampering healthcare professionals in their support of lactating women. We compared the efficacy and maternal perceptions of a hospital-grade breast pump (Symphony; Medela AG) and an electric personal-use pump (Pump in Style Pro; Medela AG). Methods: In total, 28 lactating mothers with healthy-term infants participated in an unblinded randomised crossover trial. Participants attended two pumping sessions using either the hospital-grade pump or personal-use pump. Effectiveness of milk removal and maternal perception were measured. Participants completed a 24 h milk profile to enable calculation of the percentage of available milk removed from the breast. Results: There were no significant differences for milk removal efficacy parameters after accounting for pre-expression degree of fullness of the breast between pumps. Similarly, there was no difference in comfort ratings. However, mothers perceived the hospital-grade breast pump vacuum as smoother than the personal-use pump (p = 0.003) and rated the hospital-grade breast pump as having a more pleasant sound (p < 0.001). Both findings remained significant after adjustment for pre-expression degree of fullness (p < 0.001 and p = 0.030, respectively). Conclusions: The hospital-grade pump and the personal-use pump did not differ with respect to milk removal efficacy and comfort. However, participants did perceive differences in vacuum application.

Background/Objectives: The prevalence of women who exclusively pump (EP) their breast milk to feed their infants is increasing; however, this group is underrepresented in research. This study aimed to examine maternal and infant characteristics and the experiences of EP women. Methods: An online survey explored the experiences and characteristics of EP women with p < 0.001) and lactation/breastfeeding challenges (p < 0.001). Themes developed from the qualitative data relating to how health professionals/support people could better assist EP women were: ‘Respect for the EP Journey’, ‘EP Information and Logistical Needs’ and ‘Mental and Physical Load’. Conclusions: Most EP women had originally intended to breastfeed but utilised EP because of latching issues, breast refusal and/or neonatal unit admission. They face unique challenges associated with EP, yet current professional acceptance and support are lacking. Targeted education for health professionals on EP is needed so that they can better support women with tailored, evidence-based guidelines aimed at extending lactation and improving maternal well-being.

Background: Whilst maternal body mass index (BMI) is linked to suboptimal breastfeeding outcomes, maternal body composition has not been assessed with respect to milk production (MP). Methods: Lactating mothers 1–6 months postpartum (n = 281) completed a demographic questionnaire and a 24 h MP measurement using the test-weigh method, enabling the calculation of 24 h MP parameters, breast storage capacity (BSC) and the percentage of available milk removed (PAMR). Body composition was measured with bioimpedance spectroscopy. Linear regression models were used to determine maternal and infant factors associated with MP parameters; structural equation modelling was used to assess the mediating role of BSC. Results: Higher maternal adiposity was associated with lower BSC (p ≤ 0.028), MP (p ≤ 0.003), infant breast milk intake (p ≤ 0.003) and total milk intake (p ≤ 0.026). Higher BSC was associated with higher MP (p < 0.001), with BSC confirmed as a mediator of the relationship between adiposity and MP (67.5%). Mean PAMR was negatively associated with BSC and milk removal frequency (both p < 0.001), and was lower in occasionally pumping compared to breastfeeding only (p = 0.037) and exclusively pumping mothers (p = 0.012). Conclusions: Our findings confirm maternal adiposity as a major contributor to low MP and reveal BSC, which is a measure of glandular tissue volume or breast development, as a mediator between adiposity and MP. This provides a rationale for antenatal lactation assessment of mothers and timely intervention in high-risk mothers to ensure they reach their full lactation potential.

Background/Objectives: Human milk oligosaccharides (HMOs) are bioactive carbohydrates abundant in human milk that shape the infant gut microbiome, yet their influence on the oral microbiome remains poorly understood. This study investigated associations between HMO concentrations and infant HMO intakes and the composition of the oral microbiome in predominantly (n = 2) and exclusively (n = 54) breastfed infants. Methods: We profiled infant oral samples collected at 2 months of age using full-length 16S rRNA gene sequencing, alongside paired milk HMO analyses from 56 mother–infant dyads from the Western Australian BLOSOM cohort. Daily HMO intakes were calculated using 24 h milk intake data. Results: Concentrations of human milk 3FL and LNFPIII were negatively associated with infant oral Shannon diversity (p = 0.027) and richness (p = 0.037), respectively. LNFPII concentration and daily intake were linked to increased abundance of Neisseria subflava (both p = 0.025), while daily intakes of DFLNT and DFLNH were positively associated with Streptococcus parasanguinis (p = 0.028 and p = 0.040). Notably, the associations observed for daily HMO intakes were modest in effect size. Conclusions: These findings demonstrate a statistically significant but biologically limited effect of HMOs on the development of the infant oral microbiome. By clarifying how specific components of human milk shape early microbial development, this work provides mechanistic insights relevant to nutritional and supportive interventions that promote breastfeeding success.

Background: Current low milk supply (LMS) definitions use subjective maternal perceptions or arbitrary thresholds for 24 h milk production (MP), potentially misclassifying cases. This study aimed to re-evaluate the definition of LMS using data-driven approaches and investigate associated maternal risk factors. Methods: Lactating mothers 4–26 weeks postpartum (n = 460) provided demographic, obstetric, and infant data and measured 24 h MP and infant milk intake using the test-weighing method. Infant growth was calculated as their weight-for-age z-score. Latent profile analysis, receiver operating characteristic curve analysis, and multinomial logistic regression were used for classification, diagnostic evaluation, and risk factor assessment for LMS. Results: Four milk supply classes emerged: Class 1 with adequate MP, infant intake and infant growth (n = 254); Class 2 with high MP exceeding infant demand and adequate growth (n = 30); Class 3 with slow infant growth despite moderate MP (n = 120); and Class 4 with extremely low MP and high formula intake (n = 56). Classes 1 and 2 were grouped as the normal milk supply group (61.7%), while Classes 3 and 4 formed the LMS group (38.3%). New thresholds were identified for 24 h MP (708 mL/24 h, area under the curve (AUC) = 0.92) and infant breast milk intake (694 mL/24 h, AUC = 0.94) with high diagnostic accuracy. Moreover, practical alternative thresholds for infant average daily weight gain (26 g, AUC = 0.89), formula intake (122 mL/24 h, AUC = 0.89) and formula-to-growth ratio (4 mL/g, AUC = 0.94) were established for the identification of LMS. Minimal breast growth during pregnancy (Odds ratio (OR) = 4.6, 95% confidence interval (CI): 2.3–9.6), advanced maternal age (OR = 2.1, 95% CI: 1.0–4.5), and gestational diabetes mellitus (OR = 2.1, 95% CI: 1.1–4.0) were significant risk factors related to the LMS subgroups. Co-existence of maternal advanced age and overweight showed greatly amplified risk of LMS (OR = 3.7, 95% CI: 1.3–10.5), and a more pronounced risk was observed for the combination of minimal breast growth and advanced maternal age (OR = 9.2, 95% CI: 3.0–28.3). Conclusions: This data-driven classification of LMS and identified risk factors may enhance the precision of LMS diagnosis and guide targeted interventions for lactating mothers.

Obesity is linked to suboptimal breastfeeding outcomes, yet the relationships between maternal adiposity, breast anatomy, and milk production (MP) have not been investigated. We conducted ultrasound imaging to assess the breast anatomy of 34 lactating women. The amount of glandular tissue (glandular tissue representation (GTR)) was classified as low, moderate, or high. Number and diameters of main milk ducts and mammary blood flow (resistive index) were measured. Women completed a 24 h MP measurement and an obstetric/lactation history questionnaire. Body composition was measured with bioimpedance spectroscopy. Statistical analysis employed correlation networks. Multiple relationships were revealed, with later menarche correlating with minimal pubertal and pregnancy breast growth. A minimal breast growth was further correlated with lower mammary blood flow during lactation and lower numbers and smaller diameters of main milk ducts, which in turn correlated with a lower MP. Importantly, higher adiposity also correlated with minimal breast growth during pregnancy and low GTR and MP. Several modifiable and non-modifiable maternal factors may be associated with breast development and MP. Antenatal lactation assessment and intervention in high-risk women may ensure they reach their full lactation potential and inform future interventions, such as maintaining healthy adiposity.

Background/Objectives: Breastfeeding multiple birth infants (MBIs) poses unique challenges that require tailored support; however, research on these mothers’ experiences is limited. This study explored the breastfeeding journeys of Australian mothers of MBIs, highlighting barriers, facilitators, and support needs. Methods: Data were collected via an online survey (May–August 2024) and included quantitative data on breastfeeding initiation, duration, and challenges, as well as qualitative insights into mothers’ experiences. Thematic analysis was used to identify key themes, and statistical analyses were used to compare breastfeeding outcomes by parity. Results: While most mothers (87%) had an antenatal intention to breastfeed, they faced barriers such as latching difficulties (56%), inadequate milk supply (49%), and sore nipples (47%). Preterm births (58%) and neonatal unit admissions delayed the breastfeeding initiation. Most mothers (99%) used electric breast pumps to boost milk supply (68%) and enable expressed breast milk feeding by other caregivers (65% of mothers). While 72% were satisfied with hospital breastfeeding support and some mothers received excellent hands-on support, others felt neglected due to busy staff or conflicting advice. Mothers frequently reported that breastfeeding guidance was geared toward singletons, leaving them unprepared for the challenges of feeding multiples. Mothers’ suggestions for improving care included specialised guidance, better access to lactation support, and in-home practical support to alleviate the burden of feeding and expressing. Additionally, mothers reported that healthcare professionals should be trained to offer practical, non-judgemental support to help mothers navigate the elaborate challenges of breastfeeding MBIs. Conclusions: This study underscores the need for early postpartum support and tailored guidelines to enhance MBI breastfeeding outcomes and maternal-infant well-being.

Background/Objectives: Optimal infant growth is reliant on the sufficient intake of human milk. Studies in animal models speculate that multiparous mothers produce a higher milk yield compared to primiparous mothers. We aimed to examine if there are relationships between consecutive lactations and infant demographics and both maternal 24 h milk production (MP) and infant milk intake (MI). Methods: Lactating mothers 1–6 months postpartum (n = 36; 25 fully breastfeeding (FBF), 11 supplementing with commercial milk formula (partly breastfeeding (PBF)) test-weighed their infants for 24 h during two consecutive lactations and provided demographic information. Twenty-four-hour MP by breast, infant MI (including mothers’ own expressed milk and formula), breastfeeding and expressing frequencies were measured. The statistical analysis used linear mixed modelling accounting for infant birth weight (FBF) or time postpartum (PBF) and for the random effect of the participant. Results: In the FBF group, there were no differences between lactations in terms of MP (p = 0.31) or the infant mother’s own MI (p = 0.14). The birth weight was higher for consecutive lactation infants (p = 0.008). Infant sex was not associated with MP (p = 0.12) or the infant mother’s own MI (p = 0.090). In the PBF group, the breastfeeding frequency (p = 0.042), MP (p = 0.025) and infant mother’s own MI (p = 0.019) were higher in consecutive lactations whilst formula intake was lower (p = 0.004). Conclusions: This study suggests that in fully breastfeeding women, there is no significant effect of consecutive lactation or infant sex on MP or infant MI during established lactation.