{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T07:04:23Z","timestamp":1792047863202,"version":"4.4.0"},"reference-count":50,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013407","name":"Medela AG","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013407","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001801","name":"University of Western Australia","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001801","id-type":"DOI","asserted-by":"crossref"}]},{"name":"UWA-China Scholarship Council"},{"name":"UWA-CSC Higher Degree by Research Top-Up Scholarship"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>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\u201326 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\u20139.6), advanced maternal age (OR = 2.1, 95% CI: 1.0\u20134.5), and gestational diabetes mellitus (OR = 2.1, 95% CI: 1.1\u20134.0) 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\u201310.5), 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\u201328.3). 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.<\/jats:p>","DOI":"10.3390\/nu17223524","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T10:56:27Z","timestamp":1762858587000},"page":"3524","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Defining Low Milk Supply: A Data-Driven Diagnostic Framework and Risk Factor Analysis for Breastfeeding Women"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2273-8941","authenticated-orcid":false,"given":"Xuehua","family":"Jin","sequence":"first","affiliation":[{"name":"School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia"},{"name":"UWA Centre for Human Lactation Research and Translation, Crawley, WA 6009, Australia"},{"name":"ABREAST Network, Perth, WA 6000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9025-4922","authenticated-orcid":false,"given":"Ching Tat","family":"Lai","sequence":"additional","affiliation":[{"name":"School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia"},{"name":"UWA Centre for Human Lactation Research and Translation, Crawley, WA 6009, Australia"},{"name":"ABREAST Network, Perth, WA 6000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7727-7767","authenticated-orcid":false,"given":"Sharon L.","family":"Perrella","sequence":"additional","affiliation":[{"name":"School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia"},{"name":"UWA Centre for Human Lactation Research and Translation, Crawley, WA 6009, Australia"},{"name":"ABREAST Network, Perth, WA 6000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6841-2958","authenticated-orcid":false,"given":"Zoya","family":"Gridneva","sequence":"additional","affiliation":[{"name":"School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia"},{"name":"UWA Centre for Human Lactation Research and Translation, Crawley, WA 6009, Australia"},{"name":"ABREAST Network, Perth, WA 6000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6648-1316","authenticated-orcid":false,"given":"Jacki L.","family":"McEachran","sequence":"additional","affiliation":[{"name":"School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia"},{"name":"UWA Centre for Human Lactation Research and Translation, Crawley, WA 6009, Australia"},{"name":"ABREAST Network, Perth, WA 6000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6636-8807","authenticated-orcid":false,"given":"Ghulam Mubashar","family":"Hassan","sequence":"additional","affiliation":[{"name":"School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2004-5217","authenticated-orcid":false,"given":"Nicolas L.","family":"Taylor","sequence":"additional","affiliation":[{"name":"School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia"},{"name":"ARC Training Centre for Next-Gen Technologies in Biomedical Analysis, The University of Western Australia, Crawley, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0431-7078","authenticated-orcid":false,"given":"Donna T.","family":"Geddes","sequence":"additional","affiliation":[{"name":"School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia"},{"name":"UWA Centre for Human Lactation Research and Translation, Crawley, WA 6009, Australia"},{"name":"ABREAST Network, Perth, WA 6000, Australia"},{"name":"ARC Training Centre for Next-Gen Technologies in Biomedical Analysis, The University of Western Australia, Crawley, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/MOP.0000000000000468","article-title":"Low milk supply and the pediatrician","volume":"29","author":"Riddle","year":"2017","journal-title":"Curr. 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