345 - Disparities in Donor Breast Milk Intake in Preterm Infants

Publication Number: 3332.345

Leslie C. Cabrera Toribio, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ting Ting Fu, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Laura P. Ward, Cincinnati Children's Hospital Medical C, Cincinnati, OH, United States; John Feister, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Emily Miller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Donor breast milk (DBM) is recommended when maternal breast milk (MBM) is unavailable for preterm infants (PTI). Socioeconomic and racial disparities in lactation and healthcare can lead to an increase in formula use; however, little is known about how these factors relate to DBM utilization, now established as standard of care to supplement MBM in PTI.

Objective: To evaluate maternal sociodemographic factors associated with higher DBM and lower MBM intake among PTI.

Design/Methods: Retrospective cohort study of infants < 33 weeks' gestation age (GA) admitted to a level III NICU (2019-2024) who were fed enterally and had available maternal data. Per unit policy, infants < 33 weeks GA were eligible for DBM supplementation during this period. Maternal characteristics (education; insurance; participation in Women, Infants, and Children program [WIC]; race; ethnicity; and language) were recorded. Enteral volumes up to 30 days of age and up to 34 weeks postmenstrual age (PMA) (or discharge, whichever came first) were used to determine DBM, MBM, and formula intake proportions. Due to non-normal distributions, DBM and MBM intake were categorized as binary (majority intake >50% or not), and formula intake was log transformed. Logistic and linear regressions adjusting for GA and delivery mode assessed associations with enteral intake types.

Results: 938 PTI were included (median [IQR] GA 30 [27.6-31.6] weeks). Most were born by cesarean delivery and to mothers with education level associate degree or less, public insurance, and no WIC participation (Table 1). MBM and DBM intake had bimodal distribution, and formula intake was skewed right (Figure 1). Infants of mothers with ≤ associate-degree education or public insurance had markedly higher odds of receiving majority DBM and lower odds of receiving majority MBM at 30 days and 34 weeks PMA (Table 2). Black race was also linked to slightly greater DBM and less MBM intake at 34 weeks PMA and 30 days. WIC participation was associated with reduced odds of majority MBM at 30 days (aOR 0.65 [95% CI: 0.49-0.87]). Formula use was 87% higher among publicly insured families, compared to private, at 30 days (exponentiated β = 1.87 [95% CI: 1.24-2.8]).

Conclusion(s): Lower maternal education and public insurance were strongly associated with greater DBM and lower MBM intake, reflecting persistent socioeconomic disparities in early nutrition. Targeted, equitable lactation support and system-level interventions are needed to ensure optimal MBM availability and improve preterm infant outcomes.

Table 1. Demographic and socioeconomic characteristics of cohort
WIC: Women, Infants, and Children Program

Figure 1
Density plot of enteral intake proportion by (a) 30 days and (b) 34 weeks PMA. DBM, donor breast milk; MBM, maternal breast milk; PMA, postmenstrual age.

Table 2. Adjusted associations of maternal characteristics with higher intake of donor or maternal milk
Adjusted for gestational age and mode of delivery. * p<0.0001, † p<0.01, ‡ p<0.05.
DBM, donor breast milk; MBM, maternal breast milk; PMA, postmenstrual age; WIC, Women, Infants, and Children Program; combined insurance, both private and public.