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Breastfeeding After Gestational Diabetes Mellitus

Longer duration of breastfeeding showed correlation with reduction of type 2 risk.

Gestational diabetes are pregnant women who have never had diabetes before but have high blood glucose levels during pregnancy. According to the 2014 analysis by the Centers for Disease Control and Prevention, the prevalence of gestational diabetes is as high as 9.2%. A large retrospective cohort study, following 5,470 women with gestational diabetes and 783 control subjects from 1971 to 2003, found that the cumulative risk of developing type 2 diabetes in patients with gestational diabetes was 25.8% at 15 years post diagnosis.

A recent study published by Kaiser Permanente looked at women with gestational diabetes and their progression to diabetes after childbirth with association with breastfeeding. Women with gestational diabetes are up to seven times more likely to develop type 2 diabetes within years of pregnancy. While breastfeeding is recommended for mothers with gestational diabetes, previous studies had inconsistent findings on the impact of breastfeeding and progression to diabetes.

The Kaiser prospective cohort study looked at 1,010 women who breastfed for at least two months after giving birth versus those who continued to breastfeed for several months. The women were screened for diabetes six to nine weeks after delivery, again in one year, and again two years post-delivery.

After evaluating the women for 2 years, 11.8% of the women developed diabetes. Women who exclusively breastfed their children for several months were half as likely to develop diabetes as women who exclusively formula-fed their baby at six to nine weeks. The study showed a graded 35% to 57% reduction in the two-year diabetes incidence associated with greater lactation intensity from less than two months to more than 10 months of breastfeeding.

The study also controlled for numerous other factors that could contribute to diabetes such as maternal obesity before pregnancy, gestational weight gain, prenatal metabolism, treatment for gestational diabetes, C-section delivery, infant size and birth outcomes, race/ethnicity, and lifestyle behaviors such as diet, physical activity and weight change. Even after accounting for these factors, the results showed greater risk reduction of diabetes in mothers who breastfed their child longer.

While the Kaiser study clearly shows that women with gestational diabetes should exclusively breastfeed their child, another recent study showed that women with gestational diabetes are less likely to breastfeed their child. In a cross-sectional analysis of 2,038 women between May 2005 and June 2007, the study showed that only 62.2% of women with gestational diabetes exclusively breastfeed their child after discharge as compared to 75.4% of women without gestational diabetes. After adjusting for sociodemographic, behavioral, and anthropometric factors between the two groups, the results still showed lower odds of exclusively breastfeeding in women with gestational diabetes. These results emphasize the need for healthcare providers to provide additional education on exclusive breastfeeding and to support these women’s breastfeeding efforts in the early postpartum period to increase the chances of longer term breastfeeding success.

There is also research looking at women’s experiences with early breastfeeding after gestational diabetes. A research study looked at 27 women who had been diagnosed with gestational diabetes and who had started breastfeeding postpartum. The women were asked questions to initiate conversation and to provide structure for focus group discussions and interviews. Their answers were then analyzed independently. From the results, three themes emerged as barriers to breastfeeding: Breastfeeding challenges and support, milk supply challenges, and concern for infant health. The women expressed a need for consistent breastfeeding education as well as strategies for addressing breastfeeding challenges and milk supply issues.

 

The results of these studies not only showed that breastfeeding reduces the risk of diabetes, but also support the importance of breastfeeding education for women with gestational diabetes. Healthcare providers can play a major role in breastfeeding adherence by providing education and support to mothers to increase their likelihood of breastfeeding.

Practice Pearls:

  • Women with gestational diabetes are up to seven times more likely to develop type two diabetes.
  • In mothers with gestational diabetes, longer duration of breastfeeding showed a correlation with reduction in risk of developing type 2 diabetes.
  • Breastfeeding education for women with gestational diabetes should be a part of early diabetes prevention efforts.

Lee, Anna J., et al. “Gestational diabetes mellitus: Clinical predictors and long-term risk of developing type 2 diabetes a retrospective cohort study using survival analysis.” Diabetes care 30.4 (2007): 878-883.

Gunderson, Erica P., et al. “Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study.”Annals of Internal Medicine: 889-898.

Haile, Zelalem T., et al. “Association between History of Gestational Diabetes and Exclusive Breastfeeding at Hospital Discharge.” Journal of Human Lactation (2015): 0890334415618936.

Jagiello, Karen P., and Ilana R. Azulay Chertok. “Women’s Experiences With Early Breastfeeding After Gestational Diabetes.” Journal of Obstetric, Gynecologic, & Neonatal Nursing (2015).