Gestational diabetes and obesity tied to breastfeeding delay

According to a new study in The American Journal of Clinical Nutrition, pre-pregnancy obesity and gestational diabetes mellitus (GDM) can lead to a delay in lactation, which can lead to women supplementing more frequently with formula or even abandoning breastfeeding.

The Kaiser Permanente study used data from the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy (SWIFT), a cohort of women who were diagnosed with GDM from 2008 to 2011 and delivered in a northern California Kaiser Permanente hospital. Data on prenatal course and postdelivery infant feeding practices were collected from electronic medical records and in-person surveys.

Investigators included 883 SWIFT participants who did not have diabetes at 6 to 9 weeks postpartum and had initiated breastfeeding. A delay in the onset of stage II lactogenesis (OL) was seen in 33% of the women. Delayed OL was found to be associated with prepregnancy obesity (odds ratio [OR]: 1.56; 95% confidence interval [CI] 1.07, 2.29), older maternal age (OR: 1.05, 95% CI: 1.01, 1.08), insulin GDM treatment (OR: 3.11; 95% CI: 1.37, 7.05), and suboptimal in-hospital breastfeeding (OR: 1.65; 95% CI 1.20, 2.26). Decreased odds of delayed OL were associated with a higher gestational age, but only in mothers who were multiparous (OR: 0.79; 95% CI: 0.67, 0.94).

Earlier Kaiser Permanente studies showed women who breastfeed exclusively or with very little formula supplementation have lower fasting blood glucose and insulin levels at 6 to 9 weeks postpartum than those who breastfeed very little or not at all. Exclusive or nearly exclusive breastfeeding has also been found to reduce the prevalence of pre-diabetes, even among obese women.

Given that nearly 50% of women with GDM are eventually diagnosed with Type 2 diabetes within 5 to 8 years, providing enhanced breastfeeding skilled support to older, obese, or insulin-treated mothers with GDM is an important part of post-delivery care.

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