Associations of secretory activation breast milk biomarkers with breastfeeding outcome measures

Anita L. Esquerra-Zwiers, Carly Mulder, Lauren Czmer, Anastasia Perecki, Emilie Dykstra Goris, Ching Tat Lai, Donna Geddes

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objective: The objective of this study was to explore associations between day 10 postpartum (D10) secretory activation biomarkers and the breastfeeding outcome measures. Study design: This prospective longitudinal descriptive study collected antepartum, D10, and day 60 postpartum (D60) questionnaire data and D10 milk samples. Protein, lactose, and citrate were analyzed with enzymatic spectrophotometric assays. Sodium and potassium were analyzed with inductively coupled plasma optical emission spectrophotometry. Group comparison data were analyzed using χ2, Fisher exact, and independent sample t tests, as appropriate, using SPSS for Mac (version 28). Results: Participants (n = 92) provided a D10 breastmilk sample and completed D10 questionnaires, and 83 completed D60 questionnaires. Participants with D10 impaired secretory activation sodium (>23.0 mM) were more likely to report D10 perceived insufficient milk supply, χ2 = 7.002, P <.05; and less D10 feeding/pumping frequency a day, P <.05; and partial breastfeeding at D60, P <.05. Additionally, participants with D10 impaired secretory activation sodium-to-potassium ratio (sodium: potassium) > 0.8 were more likely to partially breastfeed at D60, P <.05. Conclusion: Elevated milk sodium and sodium: potassium are biomarkers related to variables indicative of low milk supply. Therefore, immediate milk testing can be useful in identifying lactation compromise and improving breastfeeding duration. Because breastfeeding affords maternal and infant health benefits, clinicians should identify ways to measure lactation compromise in conjunction with an examination and clinical history to provide early interventions to increase breastfeeding duration and exclusivity.

Original languageEnglish
Pages (from-to)259-265.e2
JournalJournal of Pediatrics
Early online date2022
Publication statusPublished - Feb 2023


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