The Effects of Mild Gestational Hyperglycemia on Exclusive Breastfeeding Cessation

Abstract

Gestational diabetes increases the risk of a range of adverse perinatal outcomes, including breastfeeding failure, but the best cut-off point for gestational diabetes is unknown. The purpose of this study was to evaluate the association between mild gestational glucose tolerance impairment and the early cessation of exclusive breastfeeding (EBF). This is an observational study of 768 women with full term pregnancies that were screened for gestational diabetes at 24–28 weeks gestation. Subjects were divided into two groups: those with a normal 1-h glucose challenge test and those with an elevated 1-h glucose challenge test but still did not qualify for gestational diabetes. We constructed multivariable logistic regression models using data from 616 women with normal gestational glucose tolerance and 152 women with an isolated positive 1-h glucose challenge test. The risk of early exclusive breastfeeding cessation was found to increase in women with mildly impaired glucose tolerance during pregnancy (adjusted OR, 1.65; 95% CI: 1.11, 2.45). Risks of early EBF cessation were also independently associated with the amount of neonatal weight loss and admission to the neonatal ward. Instead, parity was associated with a decreased risk for shorter EBF duration. Insulin resistance—even in the absence of gestational diabetes mellitus—may be an impeding factor for EBF.

Recent gestational diabetes was associated with mothers stopping predominant breastfeeding earlier in a multi‐ethnic population

“…In line with previous studies, we observed lower rates of predominant breastfeeding in the first two weeks after delivery in mothers with recent GDM . Our finding of an earlier cessation of predominant breastfeeding after GDM supports the findings of studies from Denmark and Spain . However, in the TEDDY study, country‐specific differences were observed, with a strong association between maternal GDM and an earlier end to exclusive breastfeeding in Sweden and the USA, but not Finland and Germany .…”

“…Gestational diabetes mellitus (GDM) is a common complication of pregnancy . Although hyperglycaemia is usually resolved after delivery, a meta‐analysis has shown that women with previous gestational diabetes had a sevenfold increased risk of developing type 2 diabetes in the following 5–10 years, compared to those with normal glucose levels during pregnancy .…”

“…Being breastfed has been associated with reductions in overweight or obesity and type 2 diabetes in children , although findings from studies on the children of mothers with GDM were inconsistent . Whereas studies have found lower rates of initiation of exclusive breastfeeding after GDM , country‐specific differences have been observed for the continuation of exclusive and predominant breastfeeding .…”

Cohort profile: maternal lifestyle and diet in relation to pregnancy, postpartum and infant health outcomes in Vietnam: A multicentre prospective cohort study

“…The sample size calculation was based on testing the hypothesis that mothers with gestational hyperglycaemia (primary exposure) have a lower rate of exclusive breastfeeding at 3 months post partum (primary outcome). Assuming that 20% of participants would have gestational hyperglycaemia diagnosed at 24–28 weeks of gestation, 21 and that the rates of exclusive breastfeeding at 3 months post partum among mothers with prior gestational hyperglycaemia and those without are 42% and 52%, respectively, 14 a minimum sample size of 1662 is required to attain 90% power to detect an expected OR of 0.7 14 between the two groups 22 at 5% level of significance. We assumed a further 20% attrition, owing to withdrawal or subsequent loss to follow-up, and thus 2000 pregnant women were targeted for recruitment.…”

“… 13 Notably, mothers with hyperglycaemia during pregnancy tend to have a high rate of exclusive breastfeeding cessation. 14 …”