Abstract

Background: Delayed secretory activation can negatively impact maternal and child health through increasing the risk of early cessation of breastfeeding. Early cessation of breastfeeding is known to be associated with increased health risks. Aim: To determine the occurrence of, and risk factors associated with, delayed secretory activation in nulliparous women in Western Australia. Methods: This analysis used a subset of participants (n = 183) enrolled in a multicentre trial. Nulliparous low-risk pregnant women were enrolled between 28–32 weeks’ gestation and followed until 1 week after birth. The association between self-reported delayed secretory activation status (onset 4 days or more postpartum) and potential risk factors across the following five dimensions was examined: maternal demographics and health behaviours during pregnancy; maternal anthropometry; obstetric and birth outcomes; newborn characteristics; and infant feeding. Any variables that demonstrated significance (p ≤ 0.10) were entered into binary logistic regression models to quantify their association with delayed secretory activation and adjusted for known confounders. Results: The rate of delayed secretory activation was 43.2% (n = 79) and was significantly associated with body mass index (BMI) category 25 kg to <30 kg/m2: OR 2.83 (95% CI 1.39, 5.77), BMI ≥30 kg/m2: OR 2.51 (95% CI 1.13, 5.55), and gestational diabetes mellitus (GDM): OR (5.06; 95% CI 1.28, 20.08) in bivariate analysis and in the adjusted multivariable model. Among mothers with GDM, 78.6% experienced delayed secretory activation, compared to 21.4% of mothers who did not have GDM. Conclusion: Nulliparous women, particularly those with GDM, should be supported to initiate early, frequent, and optimal breast stimulation to exclusively breastfeed.

Keywords

Breastfeeding, delayed secretory activation, gestational diabetes mellitus (GDM), lactation, pregnancy, prepregnancy body mass index (BMI)

Document Type

Journal Article

Date of Publication

1-1-2026

Publication Title

Journal of Human Lactation

Publisher

Sage

School

Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences / School of Nursing and Midwifery

Funders

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The ACE Study has received funding from the Department of Health Western Australia and The Stan Perron Charitable Foundation. The first author, CC, is the recipient of a Research Excellence Fellowship Scholarship at Edith Cowan University (ECU) where she is a PhD candidate. The salary of JRL is supported by a National Heart Foundation Future Leader Fellowship (ID: 102817).

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Comments

Cuffe, C., Giglia, R., Hill, J., Cooper, M. N., Moorhead, A. M., Lewis, J. R., Ireson, D., & O’Sullivan, T. A. (2026). Risk factors associated with delayed secretory activation in a cohort of nulliparous women in western Australia. Journal of Human Lactation. Advance online publication. https://doi.org/10.1177/08903344261435721

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Link to publisher version (DOI)

10.1177/08903344261435721