{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:20:06Z","timestamp":1777944006234,"version":"3.51.4"},"reference-count":52,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hum Lact"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To determine the occurrence of, and risk factors associated with, delayed secretory activation in nulliparous women in Western Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This analysis used a subset of participants (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009183) enrolled in a multicentre trial. Nulliparous low-risk pregnant women were enrolled between 28\u201332\u2009weeks\u2019 gestation and followed until 1 week after birth. The association between self-reported delayed secretory activation status (onset 4\u2009days 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 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009\u2264\u20090.10) were entered into binary logistic regression models to quantify their association with delayed secretory activation and adjusted for known confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The rate of delayed secretory activation was 43.2% (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200979) and was significantly associated with body mass index (BMI) category 25\u2009kg to &lt;30\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      : OR 2.83 (95% CI 1.39, 5.77), BMI \u226530 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      : 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Nulliparous women, particularly those with GDM, should be supported to initiate early, frequent, and optimal breast stimulation to exclusively breastfeed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08903344261435721","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T06:53:42Z","timestamp":1777359222000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors Associated With Delayed Secretory Activation in a Cohort of Nulliparous Women in Western Australia"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0645-3089","authenticated-orcid":false,"given":"Cassandra","family":"Cuffe","sequence":"first","affiliation":[{"name":"Nutrition &amp; Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roslyn","family":"Giglia","sequence":"additional","affiliation":[{"name":"Nutrition &amp; Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Hill","sequence":"additional","affiliation":[{"name":"Nutrition &amp; Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1139-3682","authenticated-orcid":false,"given":"Matthew N.","family":"Cooper","sequence":"additional","affiliation":[{"name":"The Kids Research Institute Australia, Nedlands, WA, Australia"},{"name":"UWA Centre for Child Health Research, The University of Western Australia, Nedlands, WA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita M.","family":"Moorhead","sequence":"additional","affiliation":[{"name":"Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia"},{"name":"Royal Women\u2019s Hospital, Parkville, VIC, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua R.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Nutrition &amp; Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia"},{"name":"Medical School, The University of Western Australia, Perth, WA, Australia"},{"name":"Centre for Kidney Research, Children\u2019s Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Ireson","sequence":"additional","affiliation":[{"name":"Midwifery Lecturer, Faculty of Health, Charles Darwin University, Ellengowan Drive, Casuarina, Northern Territory, Australia"},{"name":"Adjunct position, School of Nursing and Midwifery, Edith Cowan University, Southwest Campus, Bunbury, WA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Therese A.","family":"O\u2019Sullivan","sequence":"additional","affiliation":[{"name":"Nutrition &amp; Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"Australian Bureau of Statistics. 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