Relationship between lactation duration and insulin and glucose response among women with prior gestational diabetes

Abstract

Background: Few studies have investigated whether favorable effects of lactation persist after weaning and protect women with prior gestational diabetes mellitus (GDM) against later development of insulin resistance and insulin secretion defects. Objective: To investigate the impact of lactation duration on insulin and glucose response among women with prior GDM. Design/methods: The study group comprised 144 women with a history of GDM between 2003 and 2010. Plasma insulin and glucose concentrations were obtained from a 75 g oral glucose tolerance test (OGTT). Total lactation duration (exclusive breastfeeding and breast and bottle-feeding) for all infants was self-reported in months. Results: Mean age was 36.5G5.0 years. Time between delivery and metabolic testing was 4.0G1.9 years. Women breastfed for an average of 13.9G16.8 months. Most women (80.6%) reported a history of lactation. Women who lactated had higher homeostasis model assessment for insulin sensitivity (HOMA-IS) and Matsuda indices and lower fasting and 2-h post-OGTT insulin concentrations as well as area under the curve (AUC) for insulin (P%0.01 for all). Compared with women who lactated for !10 months, women who lactated for R10 months had improved insulin sensitivity-secretion index, higher HOMA-IS and Matsuda indices, lower fasting and 2-h post-OGTT insulin concentrations as well as AUC for insulin, and lower incidence of impaired glucose intolerance (P%0.05 for all). In multiple linear regression analyses, lactation duration emerged as an independent predictor of fasting insulin concentrations (bZK0.02) and insulin sensitivity indices (bZ0.02) (P%0.05 for all). Conclusions: These results suggest that longer duration of lactation is associated with improved insulin and glucose response among women with prior GDM.

Women with rigorously managed overt diabetes during pregnancy do not experience adverse infant outcomes but do remain at serious risk of postpartum diabetes

“…Exclusive or mostly (≤ 6 oz formula/24 h) breastfeeding was associated with lowering the prevalence of diabetes or prediabetes at 6-8 week postpartum in women who had GDM. Chouinard-Castonguay et al [25] observed that longer duration of lactation (≥ 10 months) is associated with improved insulin and glucose homeostasis in women with prior GDM at about 4 years after delivery. Ziegler et al [26] observed that the postpartum diabetes risk was lowest in women who breastfed for ≥ 3 months.…”

Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative

“…Women who report more than 9 cumulative months of breastfeeding over their reproductive lifetime are less likely to develop hypertension, hyperlipidemia, and metabolic syndrome 32, 33, 34, 35, 36, 37. Further, evidence suggests that a longer duration of breastfeeding is associated with a lower risk of developing type 2 diabetes mellitus,38, 39, 40, 41, 42, 43 and reduced maternal postpartum weight 44, 45, 46, 47…”

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

“…(3;4) Lactation duration has been associated with higher plasma HDL-cholesterol up to 2 years postpartum,(5;6) but others found no association with adipokines (leptin and adiponectin) at 3 years postpartum. (7;8) In women with recent gestational diabetes mellitus (GDM), lactation also has been associated with more favorable metabolic parameters during the postpartum period,(9–13) including lower plasma glucose (fasting and 2-hour), improved glucose tolerance, improved pancreatic β-cell function and higher HDL-cholesterol. Evidence is limited and conflicting about whether lactation exerts persistent effects on metabolism that may reduce future risk of type 2 diabetes.…”