The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production

Abstract

Background Previous studies focusing on the association between gestational diabetes and breastfeeding duration have been inconclusive. Objectives We aimed to determine whether maternal gestational hyperglycemia is associated with the duration of breastfeeding and the concentrations of markers linked to breastmilk production. Methods Data from the prospective, multiethnic Growing Up in Singapore Towards Healthy Outcomes study were used to assess the association of fasting plasma glucose (FPG) and 2-h postglucose challenge (2hPG) measured at 26–28 wk of gestation with duration of breastfeeding and concentrations of protein, lactose, citrate, sodium, potassium, and zinc in breastmilk 3 wk postpartum. Results Of the 1035 participants, 5.2% and 9.5% had elevated FPG and 2hPG, respectively, consistent with a diagnosis of gestational diabetes mellitus based on International Association of Diabetes and Pregnancy Study Groups criteria. FPG ≥5.1 mmol/L was associated with a crude reduction in median breastfeeding duration of 2.3 mo. In a model adjusted for maternal prepregnancy BMI and intention to breastfeed, FPG ≥5.1 mmol/L predicted earlier termination of any breastfeeding (adjusted HR: 1.47; 95% CI: 1.04, 2.08) but not full breastfeeding (adjusted HR: 1.08; 0.76, 1.55). 2hPG ≥8.5 mmol/L was not significantly associated with the durations of any (adjusted HR: 0.86; 95% CI: 0.62, 1.19) or full (adjusted HR: 0.85; 95% CI: 0.62, 1.18) breastfeeding. Maternal FPG was significantly and positively associated with breastmilk sodium (adjusted coefficient: 1.28; 95% CI: 1.08, 1.51) and sodium-to-potassium ratio (adjusted coefficient: 1.29; 95% CI: 1.08, 1.54) but not with other measured breastmilk components. Conclusions Women with FPG ≥5.1 mmol/L during pregnancy breastfeed for a shorter duration. Future work involving measurement of milk production is needed to determine whether low milk production predicts breastfeeding duration among women with elevated FPG. This trial was registered at www.clinicaltrials.gov as NCT01174875.

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“…However, the additional analyses found rather positive correlations between the body mass index at about 20 years of age and each measurement of breastfeeding history. Fifth, although evidence is insufficient [ 60 ], several observational studies showed that women with gestational diabetes are also less likely to initiate and maintain breastfeeding [ 60 , 61 ], which is another potential cause of reverse causality. Sixth, multiple comparisons of cardiovascular risk factors should have produced false-positive results, and thus, these analyses should be regarded as exploratory rather than confirmatory.…”

25 Years of Research in Human Lactation: From Discovery to Translation

“…These procedures often sever milk ducts, thus disrupting milk removal and, over time, potentially isolating glandular tissue, causing milk stasis and ultimately apoptosis and regression of the tissue. Alternatively, in some instances breast implants may have been inserted into breasts that were already hypoplastic [73][74][75][76].…”

Explaining the experience of breastfeeding in women with gestational diabetes and designing and implementing an educational program based on planned behavior theory: a combined exploratory study protocol

“…The result of Herbert et al study (2021) showed that gestational diabetes was more common in American Indian, Alaska Natives, and Hispanic women than in black and non-Hispanic women (12% vs. 9%), and those with gestational diabetes had the lowest rates of exclusive breastfeeding (51% vs. 57–69%) compared to other women without gestational diabetes [ 4 ]. The results of many studies showed that stopping breastfeeding early was associated with many complications for the mother and the baby [ 6 – 18 ]. The results of Chertok et al study (2016) showed that there is a relationship between breastfeeding self-efficacy and the breastfeeding behavior of mothers.…”