A brief history of antenatal colostrum expression, and where to from here.

The practice of antenatal colostrum expression (ACE), or the extraction of colostrum from the breasts during pregnancy, has an interesting history and continues to evolve. This narrative review aims to describe how perception and practices of ACE have changed over time, summarise the evidence on ACE in maternal and infant care, and highlight areas for future research. The literature demonstrates that ACE is safe for low-risk women when done from around 36 weeks' gestation. Women should be reassured that the skill of hand expressing is a valuable tool post-birth, regardless of whether they are able to collect colostrum antenatally or not. The collection and storage of colostrum in pregnancy can help avoid formula use in hospital, which may have follow on effects immune function and other areas. Ideally, colostrum collected during pregnancy would be kept safely frozen during the hospital stay and only defrosted and used during the stay if medically indicated, with parents supported through that process. Although ACE does not appear to improve long-term breastfeeding rates at present, it can increase confidence around breastfeeding. Further research in more diverse population groups, long-term breastfeeding and long-term health outcomes of using frozen antenatally expressed colostrum for babies (as compared to formula or fresh colostrum) would be valuable to gain a better understanding of the importance of ACE in maternity care.