Exclusive breastfeeding among women with type 1 and type 2 diabetes mellitus

Abstract

Objective To compare exclusive breastfeeding (BF) and BF initiation among 185 women with Type 1 and 212 women with Type 2 pregestational diabetes who intended exclusive or partial BF and delivered at ≥34 weeks of gestation. Methods Retrospective cohort study. At discharge, exclusive BF is direct BF or BF complemented with expressed breast milk. BF initiation is defined by exclusive or partial BF. Results Type 1 and Type 2 groups were similar in prior BF experience (69 vs 67%) but were different in intention to BF exclusively (92 vs 78%) and partially (8 vs 22%). Women in the Type 1 group were younger (median age 30 vs 33y), likely to be primiparous (47 vs 25%), have a lower median BMI (32 vs 36 kg/m2) and deliver by primary cesarean (37 vs 26%). Infants born to Type 1 women were more likely to be admitted to the NICU (44 vs 18%) and to have hypoglycemia (59 vs 41%). At discharge, exclusive BF among Type 1 was higher (34 vs 23%), partial BF was similar (47 vs 46%) while FF (formula feeding) was lower (19 vs 31%) than in the Type 2 group. BF initiation occurred in 81% of Type 1 and 69% of Type 2 women. Conclusion Intention to BF exclusively was higher in Type 1 women compared to Type 2. At discharge, exclusive BF and BF initiation were lower and FF higher in the Type 2 group highlighting the need for different strategies if lactation in this special population is to be improved.

Impact of excessive gestational weight gain on exclusive breastfeeding among women with Type 1 and Type 2 diabetes and obesity

“…In a recent study of maternity care practices and policies in 1,305 hospitals in the United States, the mean in-hospital EBF rate for infants in the general population was 51.4% [ 6 ]. Recently, we reported EBF rates in women with mild CHTN (47%) and with severe CHTN (50%) [ 25 ], with preeclampsia (39%) and with severe preeclampsia (37%) [ 26 ], with preeclampsia superimposed on pregestational diabetes (18%) [ 27 ], with CHTN superimposed on pregestational diabetes (19%) [ 28 ], and with pregestational diabetes with prior BF experience (33%) and without prior BF experience (11%) [ 9 ]. In line with the above, the low EBF rates associated with e xcessive GWG for Type 1 and Type 2 (27%), prior BF experience (33%), Grade 1 obesity (28%), Grade 2 (33%) and Grade 3 (22%) reported here are similar to those of women with pregestational diabetes and superimposed comorbidities described above [ 9 , 25 – 28 ].…”

“…Our data also showed that women with excessive GWG and no prior BF experience had the lowest EBF at discharge. A positive BF experience improves attitude, confidence, self-efficacy, motivation and intention to BF [ 9 , 34 ]. Negative BF experiences are related to maternal or neonatal morbidities, to difficulties inherent to lactation such as perception of low milk supply, suck or latch problems, mastitis or nipple fissures [ 9 , 35 , 36 ].…”

“…Electronic maternal and neonatal records (2013–20) were reviewed. Some information obtained from women who delivered between 2013 and 2018 was used in previous investigations [ 7 – 9 ]. Type 1 and Type 2 pregestational diabetes, chronic hypertension (CHTN) and preeclampsia were diagnosed and treated in accordance with established guidelines [ 19 – 21 ].…”

“…Upon arrival to labor and delivery, each woman described her past BF experience and her intention to exclusively or partially BF. In our institution, maternity practices include BF within 1 hour of delivery, no formula supplementation unless indicated, rooming in, on demand BF, full-time lactation consultants and post discharge BF support [ 8 , 9 ]. Furthermore, our institution reports BF data to the Joint Commission as required for hospital accreditation [ 5 ].…”

“…Following delivery, if the condition of the mother and her infant allowed, maternal-infant interactions such as holding, skin-to-skin contact, and BF were encouraged. Asymptomatic infants able to feed were transferred to the Newborn Nursery for routine care and glucose monitoring [ 7 – 9 ]. According to standard intrauterine growth charts, all infants were categorized as appropriate for gestational age (AGA), small for gestational age (SGA), large for gestational age (LGA) or macrosomic (birthweight ≥ 4000g) [ 23 ].…”