Lactation intensity and fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: The SWIFT cohort

Abstract

Objectives Lactation may influence future progression to type 2 diabetes after gestational diabetes mellitus (GDM). However, biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM. This study investigates whether higher lactation intensity is related to more favorable blood lipids, lipoproteins and adipokines after GDM pregnancy independent of obesity, socio-demographics and insulin resistance. Methods The Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT) is a prospective cohort study that recruited 1,035 women diagnosed with GDM by the 3-hour 100 g oral glucose tolerance tests (OGTTs) after delivery of a live birth in 2008–2011. Research staff conducted 2-hour 75 gram OGTTs, and assessed lactation intensity, anthropometry, lifestyle behaviors and socio-demographics at 6–9 weeks postpartum (baseline). We assayed fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin from stored samples obtained at 6–9 weeks postpartum for in 1,007 of the SWIFT participants who were free of diabetes at baseline. Mean biomarker concentrations were compared among lactation intensity groups using multivariable linear regression models. Results Increasing lactation intensity showed graded monotonic associations with fully adjusted mean biomarkers: 5–8% higher high-density lipoprotein cholesterol (HDL-cholesterol), 20–28% lower fasting triglycerides, 15–21% lower leptin (all trend P-values<0.01), and with 6% lower adiponectin, but only after adjustment for insulin resistance (trend P-value=0.04). Conclusion Higher lactation intensity was associated with more favorable biomarkers for type 2 diabetes, except for lower plasma adiponectin, after GDM delivery. Long-term follow-up studies are needed to assess whether these effects of lactation persist to predict progression to glucose intolerance.

Associations Among Lactation, Maternal Carbohydrate Metabolism, and Cardiovascular Health

“…In women who continue breastfeeding for 1 year, higher levels of HDL appear to persist until weaning 15 . In the Kaiser SWIFT cohort, greater breastfeeding intensity was associated with higher HDL and lower LDL 16 at 6 to 9 weeks postpartum.…”

Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus

“…In postpartum women with recent GDM, lactation enhances β-cell compensation for insulin resistance, resulting in better insulin sensitivity, glucose effectiveness, and first-phase insulin response to glucose according to the Bergman Minimal Model (9). In SWIFT, we previously reported an inverse association for lactation intensity and fasting blood lipids, glucose, and insulin resistance as well as the prevalence of prediabetes at study baseline independent of body mass index, race, or other risk factors (5, 6). …”

Metabolic effects of breastfeed in women with prior gestational diabetes mellitus: A systematic review and meta‐analysis

“…Characteristics of included studies are shown in Table 1. All the included women had a history of GDM, while the diagnostic criteria were various, involving the International Association of Diabetes and Pregnancy Study Group criteria, 20,21,27,31 the American Diabetes Association criteria, 28,41 the World Health Organization criteria, 25 Carpenter-Coustan criteria, 26,[29][30][31]33,37 the National Diabetes Data Group criteria, 43,45 and some local criteria. 24,35,44,46 Two kinds of BF measure (status, intensity) were used to describe and group the exposure in each study, with different distinction points, ranged from BF initiation to 12 months.…”

“…Quality assessments using RoBANS are summarized in Table S2. A total of 12 studies 23,26,27,[30][31][32]34,35,37,[43][44][45] with diabetes-free at baseline had a low risk of selection bias caused by selection of participants. Meanwhile, seven studies 20,[23][24][25]35,40,43 had a low risk of confounding bias caused by confounding variables, due to the adequate adjustment for covariates.…”