The Association of Metabolic Dysfunction with Breastfeeding Outcomes in Gestational DiabetesFunding This study was partially funded by the National Institutes of Health: The National Institute of Diabetes and Digestive and Kidney Disease, 1R21DK092750–01A1.
07 September 2017
28 December 2017
02 February 2018 (online)
Objective To evaluate the relationship between prenatal metabolic markers and breastfeeding outcomes in women with gestational diabetes mellitus (GDM).
Study Design Secondary analysis of a cluster-randomized trial of a lifestyle intervention to improve metabolic health among women with GDM. Women were enrolled between 22 and 36 weeks' gestation and followed through 10 months postpartum. Metabolic markers were measured at enrollment. Women reported when they stopped breastfeeding, whether they breastfed as long as desired, and when they introduced formula. We evaluated the association of tertiles of metabolic markers with undesired weaning and time to breastfeeding cessation using Cox proportional hazards models and Mantel–Haenszel chi-square tests, respectively.
Results Eighty-two women were eligible for analysis. There was a statistically significant difference in time to breastfeeding cessation among tertiles of fasting glucose, hemoglobin A1c (A1c), body mass index (BMI), and skinfolds (all p < 0.05). Women with higher fasting glucose, BMI, or skinfolds were also more likely to report undesired weaning; women with higher fasting glucose introduced formula earlier.
Conclusion Higher fasting glucose, A1c, BMI, and subscapular skinfolds were associated with earlier breastfeeding cessation in women with GDM. These markers may identify mothers in need of enhanced postpartum support to achieve their breastfeeding goals.
Higher fasting glucose, glycated hemoglobin, and greater adiposity are associated with early breastfeeding cessation in mother–infant dyads affected by gestational diabetes.
This study was presented as a poster at the 37th Annual Pregnancy Meeting, Society for Maternal-Fetal Medicine, January 23–28, 2017, Las Vegas, NV.
- 1 Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep 2016; 16 (01) 7
- 2 DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis 2014; 11: E104
- 3 Committee on Practice Bulletins--Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2 Pt 1): 406-416
- 4 Schaefer-Graf UM, Hartmann R, Pawliczak J. , et al. Association of breast-feeding and early childhood overweight in children from mothers with gestational diabetes mellitus. Diabetes Care 2006; 29 (05) 1105-1107
- 5 Bentley-Lewis R, Levkoff S, Stuebe A, Seely EW. Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab 2008; 4 (10) 552-558
- 6 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677): 1773-1779
- 7 Gunderson EP, Hurston SR, Ning X. , et al; Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy Investigators. Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus: a prospective cohort study. Ann Intern Med 2015; 163 (12) 889-898
- 8 Kim C. Maternal outcomes and follow-up after gestational diabetes mellitus. Diabet Med 2014; 31 (03) 292-301
- 9 Chouinard-Castonguay S, Weisnagel SJ, Tchernof A, Robitaille J. Relationship between lactation duration and insulin and glucose response among women with prior gestational diabetes. Eur J Endocrinol 2013; 168 (04) 515-523
- 10 Gunderson EP. Impact of breastfeeding on maternal metabolism: implications for women with gestational diabetes. Curr Diab Rep 2014; 14 (02) 460
- 11 Kjos SL, Henry O, Lee RM, Buchanan TA, Mishell Jr DR. The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes. Obstet Gynecol 1993; 82 (03) 451-455
- 12 Much D, Beyerlein A, Kindt A. , et al. Lactation is associated with altered metabolomic signatures in women with gestational diabetes. Diabetologia 2016; 59 (10) 2193-2202
- 13 Nagahori W, Takenoshita H, Yuki K, Kimachi M. Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus. Ann Intern Med 2016; 165 (04) 299
- 14 O'Reilly M, Avalos G, Dennedy MC, O'Sullivan EP, Dunne FP. Breast-feeding is associated with reduced postpartum maternal glucose intolerance after gestational diabetes. Ir Med J 2012; 105 (5, Suppl): 31-36
- 15 Stuebe AM. Does breastfeeding prevent the metabolic syndrome, or does the metabolic syndrome prevent breastfeeding?. Semin Perinatol 2015; 39 (04) 290-295
- 16 Chapman DJ. Risk factors for delayed lactogenesis among women with gestational diabetes mellitus. J Hum Lact 2014; 30 (02) 134-135
- 17 Fenger-Grøn J, Fenger-Grøn M, Blunck CH, Schønemann-Rigel H, Wielandt HB. Low breastfeeding rates and body mass index in Danish children of women with gestational diabetes mellitus. Int Breastfeed J 2015; 10: 26
- 18 McManus RM, Cunningham I, Watson A, Harker L, Finegood DT. Beta-cell function and visceral fat in lactating women with a history of gestational diabetes. Metabolism 2001; 50 (06) 715-719
- 19 Shearrer GE, Whaley SE, Miller SJ, House BT, Held T, Davis JN. Association of gestational diabetes and breastfeeding on obesity prevalence in predominately Hispanic low-income youth. Pediatr Obes 2015; 10 (03) 165-171
- 20 Stuebe AM, Bonuck K, Adatorwovor R, Schwartz TA, Berry DC. A cluster randomized trial of tailored breastfeeding support for women with gestational diabetes. Breastfeed Med 2016; 11: 504-513
- 21 Wojcicki JM. Maternal prepregnancy body mass index and initiation and duration of breastfeeding: a review of the literature. J Womens Health (Larchmt) 2011; 20 (03) 341-347
- 22 Berry DC, Neal M, Hall EG. , et al. Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study. BMC Pregnancy Childbirth 2013; 13: 184
- 23 Nommsen-Rivers LA, Dewey KG. Development and validation of the infant feeding intentions scale. Matern Child Health J 2009; 13 (03) 334-342
- 24 Nommsen-Rivers LA. Does insulin explain the relation between maternal obesity and poor lactation outcomes? An overview of the literature. Adv Nutr 2016; 7 (02) 407-414
- 25 Matias SL, Dewey KG, Quesenberry Jr CP, Gunderson EP. Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. Am J Clin Nutr 2014; 99 (01) 115-121
- 26 Nommsen-Rivers LA, Dolan LM, Huang B. Timing of stage II lactogenesis is predicted by antenatal metabolic health in a cohort of primiparas. Breastfeed Med 2012; 7 (01) 43-49
- 27 Morrison MK, Collins CE, Lowe JM, Giglia RC. Factors associated with early cessation of breastfeeding in women with gestational diabetes mellitus. Women Birth 2015; 28 (02) 143-147