Associations Among Lactation, Maternal Carbohydrate Metabolism, and Cardiovascular Health

Stuebe, Alison M.

doi:10.1097/grf.0000000000000155

Cited by 35 publications

(27 citation statements)

References 82 publications

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“…several mechanisms have been postulated to underpin the association between breastfeeding and CVD risk in later life. 19 Pregnancy is characterized by major changes in the maternal metabolic system to support fetal growth and in anticipation of breastfeeding, including accumulation of visceral fat, increased insulin resistance, and higher circulating lipid levels. 1,2 The "reset hypothesis" posits that breastfeeding plays a central role in mobilizing these accumulated fat stores and in resetting the maternal metabolism after birth.…”

Section: Discussionmentioning

confidence: 99%

Breastfeeding and the Risk of Maternal Cardiovascular Disease: A Prospective Study of 300 000 Chinese Women

Peters

Yang

Guo

et al. 2017

JAHA

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BackgroundBreastfeeding confers substantial benefits to child health and has also been associated with lower risk of maternal cardiovascular diseases (CVDs) in later life. However, the evidence on the effects of CVD is still inconsistent, especially in East Asians, in whom the frequency and duration of breastfeeding significantly differ from those in the West.Methods and ResultsIn 2004–2008, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30 to 79 years from 10 diverse regions across China. During 8 years of follow‐up, 16 671 incident cases of coronary heart disease and 23 983 cases of stroke were recorded among 289 573 women without prior CVD at baseline. Cox regression yielded adjusted hazard ratios (HRs) and 95% CIs for incident CVD by breastfeeding. Overall, ≈99% of women had given birth, among whom 97% reported a history of breastfeeding, with a median duration of 12 months per child. Compared with parous women who had never breastfed, ever breastfeeding was associated with a significantly lower risk of CVD, with adjusted HRs of 0.91 (95% CI, 0.84–0.99) for coronary heart disease and 0.92 (95% CI, 0.85–0.99) for stroke. Women who had breastfed for ≥24 months had an 18% (HR, 0.82; 0.77–0.87) lower risk of coronary heart disease and a 17% (HR, 0.83; 0.79–0.87) lower risk of stroke compared with women who had never breastfed. Among women who ever breastfed, each additional 6 months of breastfeeding per child was associated with an adjusted HR of 0.96 (95% CI, 0.94–0.98) for coronary heart disease and 0.97 (95% CI, 0.96–0.98) for stroke.ConclusionsAmong Chinese women, a history of breastfeeding was associated with an ≈10% lower risk of CVD in later life and the magnitude of the inverse association was stronger among those with a longer duration of breastfeeding.

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Section: Discussionmentioning

confidence: 99%

Breastfeeding and the Risk of Maternal Cardiovascular Disease: A Prospective Study of 300 000 Chinese Women

Peters

Yang

Guo

et al. 2017

JAHA

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“…Similarly, higher parity and younger age at first birth have been associated with greater body mass index (BMI) in adulthood [11]. Breastfeeding has been shown to release oxytocin, which reduces cardiovascular and sympathetic reactivity to stress [12]. Preeclampsia is associated with an increased mean arterial pressure, hyperlipidemia, and insulin resistance during pregnancy and postpartum [13], whereas a more extreme insulin resistance and adiposity is associated with gestational diabetes [14].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

et al. 2019

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We identified sex-specific factors associated with subclinical CVD measures in late midlife women. • Hypertension in pregnancy was related to midlife subclinical atherosclerosis. • History of gestational diabetes was associated with arterial stiffness in midlife. • Need to assess benefit of a composite subclinical CVD index for risk modification. A R T I C L E I N F O Keywords: Cardiovascular disease Midlife Reproductive history Subclinical atherosclerosis Women's health A B S T R A C TBackground and aims: Reproductive factors are associated with later life CVD in women (e.g., age at first birth, preeclampsia, gestational diabetes), but studies have focused largely on premenopausal women. We examined the relationship of reproductive factors with subclinical CVD burden in late midlife women. Methods: We included 964 parous women from the Study of Women's Health Across the Nation (SWAN), who completed a reproductive history questionnaire at the 13th SWAN visit (2011)(2012), and a carotid ultrasound and brachial-ankle pulse wave velocity (baPWV) assessment. The primary outcomes were carotid intima-media thickness, plaque, and baPWV; our secondary outcome was a composite subclinical CVD index created using these measures. Linear and logistic regression was performed to examine associations with individual subclinical CVD measures, and multinomial logistic regression was used in analyses of the composite index. Models adjusted for socio-demographics and cardiovascular risk factors. Results: Mean age at subclinical CVD assessment was 60.2 years (SD ± 2.7). History of gestational hypertension/preeclampsia was associated with greater carotid IMT (β: 0.038, p = 0.004). Earlier age at first birth was associated with subclinical CVD, but not when accounting for CVD risk factors. History of gestational diabetes was associated with greater baPWV, but not related to our composite index. Conclusions: Pregnancy history is an important marker of subclinical CVD in late midlife and may impact the vasculature through distinct pathways. Future studies are necessary to evaluate racial/ethnic differences in the observed associations and to assess the benefit of a composite subclinical CVD index for earlier CVD risk modification in midlife women.

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“…As leptin slowly returns to baseline, adiponectin levels are suppressed to below pre‐pregnancy levels among lactating women by the action of prolactin, the primary hormone involved in both mammary development and lactation maintenance (Gunderson et al, ; Stuebe et al, ). Maternal triglyceride levels likewise return to pre‐pregnancy levels earlier among lactating women, as has also been shown for glucose tolerance and insulin sensitivity (Darmady & Postle, ; Stuebe, ).…”

Section: Introductionmentioning

confidence: 54%

“…Changes in maternal metabolism during pregnancy coordinate changes in the storage and mobilization of energy substrates. Maternal glucose and insulin production increase in early pregnancy to facilitate energy storage in adipose tissue, which prepares the mother's body for higher energy demands in later gestation and lactation (Stuebe, ). Although glucose production increases at this time, fasting levels of both glucose and insulin are lower than in the pre‐pregnancy state due to more rapid maternal glucose uptake into peripheral tissues and the diluting effects of steadily increasing plasma volume (Catalano & De Mouzon, ; Ogato, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…After parturition, lactation imposes a significant metabolic burden marked by a 15%‐25% increase in energy expenditure, and is characterized by a shift in maternal metabolism that mobilizes fat stores accumulated during pregnancy to sustain these extra costs (see Stuebe, , for review). Most pregnancy‐supporting hormones return to pre‐pregnancy levels within a few weeks after birth, regardless of breastfeeding status.…”

Section: Introductionmentioning

confidence: 99%

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Maternal metabolic adaptations to pregnancy among young women in Cebu, Philippines

Fried

Mayol

McDade³

et al. 2017

American J Hum Biol

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Associations Among Lactation, Maternal Carbohydrate Metabolism, and Cardiovascular Health

Cited by 35 publications

References 82 publications

Breastfeeding and the Risk of Maternal Cardiovascular Disease: A Prospective Study of 300 000 Chinese Women

Breastfeeding and the Risk of Maternal Cardiovascular Disease: A Prospective Study of 300 000 Chinese Women

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

Maternal metabolic adaptations to pregnancy among young women in Cebu, Philippines

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