Long-Term Protective Effect of Lactation on the Development of Type 2 Diabetes in Women With Recent Gestational Diabetes Mellitus

Abstract

Women with gestational diabetes mellitus (GDM) have a high risk of developing postpartum type 2 diabetes. Strategies to prevent postpartum type 2 diabetes are important to reduce the epidemic of diabetes and its societal impact. Breastfeeding was reported to improve early postpartum glucose tolerance and reduce the subsequent risk of type 2 diabetes. To investigate whether breastfeeding influences short- and long-term postpartum diabetes outcomes, women with GDM (n = 304) participating in the prospective German GDM study were followed from delivery for up to 19 years postpartum for diabetes development. All participants were recruited between 1989 and 1999. Postpartum diabetes developed in 147 women and was dependent on the treatment received during pregnancy (insulin vs. diet), BMI, and presence/absence of islet autoantibodies. Among islet autoantibody-negative women, breastfeeding was associated with median time to diabetes of 12.3 years compared with 2.3 years in women who did not breastfeed. The lowest postpartum diabetes risk was observed in women who breastfed for >3 months. On the basis of these results, we recommend that breastfeeding should be encouraged among these women because it offers a safe and feasible low-cost intervention to reduce the risk of subsequent diabetes in this high-risk population.

Differences in breast-feeding initiation and continuation by maternal diabetes status

“…Early breastfeeding has been associated with improved glycaemic outcomes in infants born to women with diabetes in pregnancy (18,19) . On the maternal side, lack of breast-feeding is associated with developing type 2 diabetes (20) , with a dosedependent effect for longer duration and higher intensity associated with lower risk of postpartum diabetes among women with GDM history (21)(22)(23)(24)(25)(26) .…”

Lactation is associated with altered metabolomic signatures in women with gestational diabetes

“…Consequently, it was hypothesised that the association between duration of lactation and maternal type 2 diabetes risk may be confounded by maternal BMI [7,8]. However, in our previous analysis [3] and in studies of healthy women [9,10], adjusting for BMI had no impact or a very small impact on the association between lactation and type 2 diabetes risk. Moreover, a recent population-based study demonstrated that healthy lifestyle behaviours, which may be more prevalent in lactating mothers, did not confound the association between lactation and type 2 diabetes risk [10].…”

“…However, there is increasing evidence to suggest that lactation also has longterm health benefits for the mother. We recently reported that lactation in women with gestational diabetes was associated with a considerable long-term reduction in the risk of developing type 2 diabetes postpartum [3]. This risk reduction was most pronounced in women who lactated for >3 months, and the beneficial effect of lactation on the risk of diabetes was apparent for up to 15 years postpartum [3].…”

“…We recently reported that lactation in women with gestational diabetes was associated with a considerable long-term reduction in the risk of developing type 2 diabetes postpartum [3]. This risk reduction was most pronounced in women who lactated for >3 months, and the beneficial effect of lactation on the risk of diabetes was apparent for up to 15 years postpartum [3]. However, the mechanisms that may explain this protective association are unclear [4].…”

The maternal diabetes mellitus and consequences for newborn

“…Wydłużenie czasu trwania laktacji do 24 tygodni czyni te różnice znamiennymi statystycznie. Najlepsze efekty prewencji cukrzycy typu 2 i otyłości uzyskiwano przy utrzymywaniu karmienia z piersi przez co najmniej rok [16]. Mechanizm tego korzystnego oddziaływania laktacji nie został jeszcze ostatecznie określony.…”