Lifetime duration of lactation and chronic inflammation among middle-aged women with a history of gestational diabetes

Abstract

IntroductionLonger duration of lactation is associated with lower cardiometabolic disease risk, but pathogenic pathways involved in the disease progression are unclear, especially among high-risk women. We aimed to examine the associations of lifetime lactation duration with cardiometabolic biomarkers among middle-aged women with a history of gestational diabetes (GDM).Research design and methodsWomen with a history of GDM participating in the Nurses’ Health Study II, a prospective cohort study, were identified and followed through biennial questionnaires beginning in 1991. Lactation history was asked in three follow-up questionnaires to calculate lifetime duration. In 2012–2014, fasting blood samples were collected through the Diabetes & Women’s Health Study to measure inflammatory (C-reactive protein (CRP), interleukin (IL) 6), liver enzyme (alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase), and lipid biomarkers (total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol).ResultsAt follow-up blood collection, women were at median age 58.2 (95% CI 51 to 65) years and 26.3 (95% CI 15.7 to 34.1) years since GDM index pregnancy. After multiple adjustment including prepregnancy body mass index (BMI), longer duration of lactation was significantly associated with lower CRP (least squares (LS) mean 1.90 mg/L (95% CI 1.47 to 2.45) for 0-month lactation, 1.98 mg/L (95% CI 1.68 to 2.32) for up to 12-month lactation, 1.67 mg/L (95% CI 1.42 to 1.97) for 12–24 month lactation, and 1.39 mg/L (95% CI 1.19 to 1.62) for >24-month lactation; p trend=0.003) and IL-6 (1.25 pg/L (95% CI 0.94 to 1.68), 1.19 pg/L (95% CI 0.99 to 1.42), 1.04 pg/L (95% CI 0.87 to 1.25), and 0.93 pg/L (95% CI 0.78 to 1.11); p trend=0.04). Longer duration of lactation was associated with lower risk for chronic inflammation using CRP 3 mg/L cut-off in middle-aged women (OR 0.81 (95% CI 0.69 to 0.940 per 1-year increase) with multiple adjustment.ConclusionsLonger lifetime duration of lactation was associated with favorable inflammatory biomarker concentrations in middle-aged women with a history of GDM. Chronic inflammatory pathways may be responsible for previously reported associations between lactation and long-term risk for cardiometabolic diseases.

Prospective associations between breast feeding, metabolic health, inflammation and bone density in women with prior gestational diabetes mellitus

“… 20 23 25 26 One study found a significant association between breastfeeding duration and lower CRP in middle-aged women with a history of GDM. 26 It is worthy to point out that in our cohort, breastfeeding was not associated with TNF-α or IL-6 at 1 year postpartum. Different mechanisms might be involved in the long-term and short-term regulation and expression of these inflammatory markers in the blood in women with GDM, suggesting that the impact of breastfeeding might not be the same.…”

“…6 Measures Breastfeeding duration served as the predictor, and we assessed metabolic, inflammatory, and bone density measures at 1 year postpartum. Sociodemographic, descriptive health, and lifestyle characteristics Sociodemographic variables including age, educational level, and ethnicity were assessed during the first GDM visit (24)(25)(26)(27)(28)(29)(30)(31)(32). Data on medical characteristics including pre-pregnancy weight, parity, gravida, GDM Clinical care/Education/Nutrition in previous pregnancy, family history of diabetes, and medical treatment were extracted from the patients' medical chart or assessed during a structured face-to-face interview.…”