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Breastfeeding and Gestational Diabetes

Apr 23, 2019
 
Editor: Steve Freed, R.PH., CDE

Author: Dahlia Elimairi, Pharm D Student, UC Denver Skaggs School of Pharmacy

Breastfeeding (BF) may protect against obesity and type 2 diabetes mellitus in children exposed to maternal diabetes in utero.

A few studies have shown that women with gestational diabetes throughout pregnancy, compared with those without gestational diabetes, are less likely to exclusively breastfeed in the first hour postpartum, are more likely to formula feed their children, and have delayed onset of lactation mainly due to diabetes, insulin treatment, and obesity.

Children born to mothers with gestational diabetes are more likely to develop prediabetes, metabolic syndrome, and increased adiposity later in life. Exposure to gestational diabetes is associated with excess fetal growth and overnutrition in utero, possibly due to hormonal perturbations and alterations in expression of genes that direct the accumulation of body fat or related metabolism in fetus.

An article by A. Stuebe states that, for infants, not being breastfed is associated with an increased incidence of infectious morbidity, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome. The article concluded that obstetricians are uniquely positioned to counsel mothers about the health impact of breastfeeding and to ensure that mothers and infants receive appropriate, evidence-based care, starting at birth.

A prospective cohort study by Gunderson et al evaluated breastfeeding intensity and duration in relation to infant growth from birth through 12 months among offspring of mothers with gestational diabetes mellitus. The study found that greater breastfeeding intensity and duration throughout the first 12 months of life was protective against ponderal growth and weight gain among children of mothers with gestational diabetes.

A new study published on February 8th, 2019 in Pediatric Obesity assessed the effects of breastfeeding and gestational diabetes mellitus in relation to the prevalence of prediabetes and metabolic syndrome in Hispanic children and adolescents.

This was a longitudinal study with 229 Hispanic children (8‐13 y) with overweight/obesity, family history of diabetes, and an average of four annual visits. Participants were categorized as follows: never (negative for prediabetes/metabolic syndrome at all annual visits), ever (positive for prediabetes/metabolic syndrome at any visit), intermittent (positive for prediabetes/metabolic syndrome at 1‐2 annual visits), and persistent (positive for prediabetes/metabolic syndrome at greater than or equal to 3 annual visits).

Compared with gestational diabetes offspring who were not breastfed, gestational diabetes offspring who were breastfed had lower odds of persistent prediabetes and metabolic syndrome. Compared with gestational diabetes offspring who were not breastfed, non-gestational diabetes offspring who were breastfed had lower odds of persistent prediabetes and metabolic syndrome.

The study concluded that breastfeeding is protective against prediabetes and metabolic syndrome in offspring regardless of gestational diabetes status. Their findings highlight the need to encourage mothers diagnosed with gestational diabetes during pregnancy to breastfeed for at least 1 month. Breastfeeding is one of the vital modifiable approaches that can have a profound effect on reducing the persistence of the metabolic syndrome and prediabetes during adulthood.

Practice Pearls:

  • Breastfeeding is protective against prediabetes and metabolic syndrome in offspring regardless of gestational diabetes status.
  • Providers can play an important role to counsel mothers about the benefits of breastfeeding for at least 1 month.
  • Continued longitudinal analyses using more precise and valid measures such as exclusivity of breastfeeding in relation to metabolic syndrome and prediabetes are warranted, especially in high‐risk populations.

References:

Vandyousefi S, Goran MI, Gunderson EP, Khazaee E, Landry MJ, Ghaddar R, Asigbee FM, Davis JN. Association of breastfeeding and gestational diabetes mellitus with the prevalence of prediabetes and the metabolic syndrome in offspring of Hispanic mothers. Pediatr Obes. 2019 Feb 8:e12515.

Stuebe A. The risks of not breastfeeding for mothers and infants. Rev Obstet Gynecol. 2009 Fall;2(4):222-31.

Gunderson EP, Greenspan LC, Faith MS, Hurston SR, Quesenberry CP Jr; SWIFT Offspring Study Investigators. Breastfeeding and growth during infancy among offspring of mothers with gestational diabetes mellitus: a prospective cohort study. Pediatr Obes. 2018 Aug;13(8):492-504.

Dahlia Elimairi, Pharm D Student, Skaggs School of Pharmacy UC Denver