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Kortsmit K, Boone KI, Warner L, Horan J, Bower JK, Gallo MF. Prepregnancy and Gestational Diabetes and Cessation of Breastfeeding <1 Week Postpartum, United States, 2016-2018. Public Health Rep 2023; 138:475-482. [PMID: 35674289 PMCID: PMC10240902 DOI: 10.1177/00333549221099082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Diabetes may delay milk letdown, and perceiving milk production as insufficient can lead to breastfeeding cessation. We evaluated whether prepregnancy or gestational diabetes is associated with cessation of breastfeeding by 1 week postpartum. METHODS We analyzed 2016-2018 data from 42 sites in the Pregnancy Risk Assessment Monitoring System, a population-based survey of women with a recent live birth. Participants were surveyed 2-6 months after childbirth. We used logistic regression models to evaluate the relationship between prepregnancy or gestational diabetes only and breastfeeding <1 week postpartum among women who had initiated breastfeeding. RESULTS Among 82 050 women who initiated breastfeeding, 4.5% reported breastfeeding <1 week postpartum. Overall, 11.7% of women reported any history of diabetes in the 3 months before becoming pregnant; 3.3% reported prepregnancy diabetes, and 8.4% reported gestational diabetes only. In both unadjusted and adjusted models, the prevalence of breastfeeding <1 week postpartum did not differ significantly among women with prepregnancy diabetes or gestational diabetes only compared with women without any history of diabetes. The prevalence of breastfeeding <1 week postpartum was 4.4% among women without any history of diabetes, 5.6% among women with prepregnancy diabetes (adjusted prevalence ratio [aPR] = 1.15; 95% CI, 0.91-1.46), and 4.5% among women with gestational diabetes only (aPR = 1.01; 95% CI, 0.84-1.20). CONCLUSIONS We found no association between a history of diabetes prepregnancy or gestational diabetes only and breastfeeding <1 week postpartum in a large, population-based survey of postpartum women who initiated breastfeeding. Regardless of their diabetes status, women who want to breastfeed might benefit from interventions that support their ability to continue breastfeeding.
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Affiliation(s)
- Katherine Kortsmit
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kirsten I. Boone
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lee Warner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Horan
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Julie K. Bower
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Maria F. Gallo
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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2
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Stampe S, Leth-Møller M, Greibe E, Hoffmann-Lücke E, Pedersen M, Ovesen P. Artificial Sweeteners in Breast Milk: A Clinical Investigation with a Kinetic Perspective. Nutrients 2022; 14:nu14132635. [PMID: 35807817 PMCID: PMC9268461 DOI: 10.3390/nu14132635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023] Open
Abstract
Artificial sweeteners (ASs) are calorie-free chemical substances used instead of sugar to sweeten foods and drinks. Pregnant women with obesity or diabetes are often recommended to substitute sugary products with ASs to prevent an increase in body weight. However, some recent controversy surrounding ASs relates to concerns about the risk of obesity caused by a variety of metabolic changes, both in the mother and the offspring. This study addressed these concerns and investigated the biodistribution of ASs in plasma and breast milk of lactating women to clarify whether ASs can transfer from mother to offspring through breast milk. We recruited 49 lactating women who were provided with a beverage containing four different ASs (acesulfame-potassium, saccharin, cyclamate, and sucralose). Blood and breast milk samples were collected before and up to six hours after consumption. The women were categorized: BMI < 25 (n = 20), BMI > 27 (n = 21) and type 1 diabetes (n = 8). We found that all four ASs were present in maternal plasma and breast milk. The time-to-peak was 30−120 min in plasma and 240−300 min in breast milk. Area under the curve (AUC) ratios in breast milk were 88.9% for acesulfame-potassium, 38.9% for saccharin, and 1.9% for cyclamate. We observed no differences in ASs distributions between the groups.
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Affiliation(s)
- Sofie Stampe
- Department of Gynaecology and Obstetrics, Aarhus University Hospital and Steno Diabetes Centre Aarhus, 8200 Aarhus N, Denmark;
- Comparative Medicine Laboratory, Aarhus University, 8000 Aarhus, Denmark;
- Institute for Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; (E.G.); (E.H.-L.)
- Correspondence: (S.S.); (P.O.); Tel.: +45-31714417 (S.S.); +45-30714824 (P.O.)
| | - Magnus Leth-Møller
- Department of Gynaecology and Obstetrics, Aarhus University Hospital and Steno Diabetes Centre Aarhus, 8200 Aarhus N, Denmark;
- Comparative Medicine Laboratory, Aarhus University, 8000 Aarhus, Denmark;
- Institute for Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; (E.G.); (E.H.-L.)
| | - Eva Greibe
- Institute for Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; (E.G.); (E.H.-L.)
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Elke Hoffmann-Lücke
- Institute for Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; (E.G.); (E.H.-L.)
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Michael Pedersen
- Comparative Medicine Laboratory, Aarhus University, 8000 Aarhus, Denmark;
| | - Per Ovesen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital and Steno Diabetes Centre Aarhus, 8200 Aarhus N, Denmark;
- Institute for Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; (E.G.); (E.H.-L.)
- Correspondence: (S.S.); (P.O.); Tel.: +45-31714417 (S.S.); +45-30714824 (P.O.)
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3
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Scime NV, Lee S, Jain M, Metcalfe A, Chaput KH. A Scoping Review of Breastfeeding in Women with Chronic Diseases. Breastfeed Med 2021; 16:851-862. [PMID: 34319788 DOI: 10.1089/bfm.2021.0129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Approximately 10-20% of mothers have a chronic disease. Studies on breastfeeding in women with chronic disease span multiple disciplines, and these have not been collated to synthesize knowledge and identify gaps. The objective of this review was to summarize published literature on breastfeeding in women with chronic disease. Methods: We conducted a scoping review of original research and systematic reviews identified in Medline, EMBASE, and CINAHL (1990-2019) and by hand searching on women with chronic diseases reporting on at least one breastfeeding-related topic. Conference abstracts, case-studies, and studies on pregnancy-induced conditions or lactation pharmacology were excluded. Content analysis and narrative synthesis were used to analyze findings. Results: We identified 128 articles that were predominantly quantitative (80.5%), conducted in Europe or North America (65.6%), analyzed sample sizes of <200 (57.0%), and published from 2010 onward (68.8%). Diabetes (42.2%), multiple sclerosis (MS; 19.5%), and epilepsy (13.3%) were the most common diseases studied. Breastfeeding was a primary focus in approximately half (53.1%) of the articles, though definitions were infrequently reported (32.8%). The most-studied topics were breastfeeding duration/exclusivity (55.7%), reasons for feeding behavior (19.1%), and knowledge and attitudes about breastfeeding (18.3%). Less studied topics (<10% of articles each) included milk expression behaviors, breastfeeding difficulties, and feeding supports. Conclusions: Existing literature focuses primarily on diabetes or MS, and breastfeeding behaviors and outcomes. Further research examining a broader range of chronic diseases, with large sample sizes, and sufficient breastfeeding measurement detail can improve our understanding of breastfeeding disparities in this population.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sangmin Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mandakini Jain
- Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kathleen H Chaput
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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4
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Azulay Chertok IR, Haile ZT, Shuisong N, Kennedy M. Differences in Human Milk Lactose and Citrate Concentrations Based on Gestational Diabetes Status. Breastfeed Med 2020; 15:798-802. [PMID: 33074745 DOI: 10.1089/bfm.2020.0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Exclusive breastfeeding is the optimal manner of early infant nutrition but women with gestational diabetes mellitus (GDM) often experience challenges with lactation in the early postpartum period. Increases in the colostral metabolites of lactose and citrate have been found to indicate increased milk production. Materials and Methods: A follow-up study of 133 postpartum women with and without GDM was conducted to examine differences in specific colostral metabolite levels using enzymatic methods to determine transition to lactogenesis II during the first week postpartum. We used linear mixed models for repeated measures over time to examine the effect of GDM on colostral metabolite levels at baseline and follow-up with fixed effects of GDM status, time, covariates, and interactions between time and GDM, between time and time, and between time, time and GDM into the model allowing quadratic trends over time. Results: Over time, lactose and citrate levels increased for all mothers (p < 0.001 and p < 0.001, respectively), although mothers with GDM had consistently lower lactose and citrate levels compared with nondiabetic mothers (p = 0.004 and p = 0.014, respectively). Age, prepregnancy body mass index, mode of birth, and parity did not independently influence colostral concentrations of lactose and citrate. Conclusions: Findings suggest that the rate of change overtime in lactose and citrate concentrations differ by GDM status. Further research examining the trajectory of colostral metabolite levels by GDM status is warranted.
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Affiliation(s)
| | - Zelalem T Haile
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Dublin, Ohio, USA
| | - Ni Shuisong
- Department of Chemistry and Biochemistry, Miami University, Oxford, Mississippi, USA
| | - Michael Kennedy
- Department of Chemistry and Biochemistry, Miami University, Oxford, Mississippi, USA
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5
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Walker M. Is Exclusive Breastfeeding Dangerous? CLINICAL LACTATION 2018. [DOI: 10.1891/2158-0782.9.4.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Social media has been alight with descriptions of exclusive breastfeeding being dangerous, resulting in significant and severe negative outcomes in infants whose mothers wished to breastfeed. This backlash has been led by a campaign that uses inflammatory anecdotes and misleading and inaccurate interpretation of research to bolster its assault on breastfeeding. However, poor breastfeeding outcomes can and do happen. The narratives identify areas where clinicians can improve their delivery of care. A closer look at risk factors and interventions may help reduce the risk of poor outcomes and increase the likelihood of mothers meeting their breastfeeding goals.
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6
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Nucci AM, Virtanen SM, Sorkio S, Bärlund S, Cuthbertson D, Uusitalo U, Lawson ML, Salonen M, Berseth CL, Ormisson A, Lehtonen E, Savilahti E, Becker DJ, Dupré J, Krischer JP, Knip M, Åkerblom HK. Regional differences in milk and complementary feeding patterns in infants participating in an international nutritional type 1 diabetes prevention trial. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27714970 DOI: 10.1111/mcn.12354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 01/24/2023]
Abstract
Differences in breastfeeding, other milk feeding and complementary feeding patterns were evaluated in infants at increased genetic risk with and without maternal type 1 diabetes (T1D). The Trial to Reduce IDDM in the Genetically at Risk is an international nutritional primary prevention double-blinded randomized trial to test whether weaning to extensively hydrolyzed vs. intact cow's milk protein formula will decrease the development of T1D-associated autoantibodies and T1D. Infant diet was prospectively assessed at two visits and seven telephone interviews between birth and 8 months. Countries were grouped into seven regions: Australia, Canada, Northern Europe, Southern Europe, Central Europe I, Central Europe II and the United States. Newborn infants with a first-degree relative with T1D and increased human leukocyte antigen-conferred susceptibility to T1D were recruited. A lower proportion of infants born to mothers with than without T1D were breastfed until 6 months of age in all regions (range, 51% to 60% vs. 70% to 80%). Complementary feeding patterns differed more by region than by maternal T1D. In Northern Europe, a higher proportion of infants consumed vegetables and fruits daily compared with other regions. Consumption of meat was more frequent in all European regions, whereas cereal consumption was most frequent in Southern Europe, Canada and the United States. Maternal T1D status was associated with breastfeeding and other milk feeding patterns similarly across regions but was unrelated to the introduction of complementary foods. Infant feeding patterns differed significantly among regions and were largely inconsistent with current recommended guidelines.
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Affiliation(s)
- Anita M Nucci
- Department of Nutrition, Georgia State University, Atlanta, Georgia, USA
| | - Suvi M Virtanen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland.,Center for Child Health Research, Tampere University Hospital, University of Tampere, Tampere, Finland.,The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Susa Sorkio
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Sonja Bärlund
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - David Cuthbertson
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Ulla Uusitalo
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Marja Salonen
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Anne Ormisson
- Department of Paediatrics, University of Tartu, Tartu, Estonia
| | - Eveliina Lehtonen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Savilahti
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Dorothy J Becker
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, Pittsburgh, PA
| | - John Dupré
- Robarts Research Institute, London, Ontario, Canada
| | - Jeffrey P Krischer
- Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida, USA
| | - Mikael Knip
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Hans K Åkerblom
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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7
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De Bortoli J, Amir LH. Is onset of lactation delayed in women with diabetes in pregnancy? A systematic review. Diabet Med 2016; 33:17-24. [PMID: 26113051 DOI: 10.1111/dme.12846] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 01/20/2023]
Abstract
AIM To determine if women with diabetes in pregnancy have a delayed onset of lactation through a systematic review of the literature. METHODS We searched databases including MEDLINE, Web of Science, PubMed, CINAHL Plus and PsychINFO for articles assessing diabetes in pregnancy and lactogenesis. Thirty-one articles were screened and 10 articles were included in the systematic review. We extracted data on diabetes in pregnancy and onset of lactation (secretory activation or lactogenesis II). RESULTS The 10 studies examining the association between women with diabetes in pregnancy and delayed onset of lactation reported a significant delay in women with diabetes compared with women without diabetes. Two studies assessed the impact of metabolic control on lactogenesis, and found an association between poorer metabolic control and delayed onset of lactation. CONCLUSIONS Although this review has found evidence of an association between women experiencing diabetes during pregnancy and delayed onset of lactation, the presence of many potential confounding factors need to be acknowledged.
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Affiliation(s)
- J De Bortoli
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - L H Amir
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
- Breastfeeding Service, Royal Women's Hospital, Melbourne, Australia
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8
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Abstract
Type 1 diabetes (T1D) is an autoimmune disease that results from the destruction of the β cells of the pancreas in genetically at-risk individuals. The autoimmune process that precedes the development of T1D is believed to be triggered by environmental factors, including nutrition. Early introduction of complementary foods has been implicated in the etiology of T1D as a possible explanation of the increasing incidence of the disease, particularly in children younger than 5 years of age. Infant feeding recommendations have been designed to promote adequate growth, provide essential nutrients, and reduce the risk of developing chronic illnesses. The World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding to 6 months of age followed by continued breastfeeding as complementary foods are introduced. A lack of compliance with these recommendations has been observed in the general population as well as in infants at high risk for T1D. Dietary factors such as the provision of breast milk and duration of breastfeeding, the age at introduction of cow's milk and gluten-containing foods, as well as other complementary feeding have been investigated. However, the evidence that early infant feeding patterns are linked with T1D currently remains inconclusive.
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Affiliation(s)
- Anita M. Nucci
- Department of Nutrition, Georgia State University, P.O. Box 3995, Atlanta, GA 30303-3995, USA
| | - Suvi M. Virtanen
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
- Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Dorothy J. Becker
- Division of Endocrinology and Diabetes, University of Pittsburgh and Children's Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Pittsburgh, PA 15224, USA
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9
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Forster DA, Jacobs S, Amir LH, Davis P, Walker SP, McEgan K, Opie G, Donath SM, Moorhead AM, Ford R, McNamara C, Aylward A, Gold L. Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial. BMJ Open 2014; 4:e006571. [PMID: 25358679 PMCID: PMC4216858 DOI: 10.1136/bmjopen-2014-006571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/02/2014] [Accepted: 10/06/2014] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant's risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact. METHODS AND ANALYSIS Women will be recruited from 34 weeks gestation to a multicentre, two arm, unblinded randomised controlled trial. The intervention starts at 36 weeks. Randomisation will be stratified by site, parity and diabetes type. Women allocated to the intervention will be taught expressing and encouraged to hand express twice daily for 10 min and keep an expressing diary. The sample size of 658 (329 per group) will detect a 10% difference in proportion of babies admitted to SCN/NICU (85% power, α 0.05). Data are collected at recruitment (structured questionnaire), after birth (abstracted from medical record blinded to group), and 2 and 12 weeks postpartum (telephone interview). DATA ANALYSIS the intervention group will be compared with the standard care group by intention to treat analysis, and the primary outcome compared using χ(2) and ORs. ETHICS AND DISSEMINATION Research ethics approval will be obtained from participating sites. Results will be published in peer-reviewed journals and presented to clinicians, policymakers and study participants. TRIAL REGISTRATION NUMBER Australian Controlled Trials Register ACTRN12611000217909.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan Jacobs
- Royal Women's Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
| | - Peter Davis
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Kerri McEgan
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Gillian Opie
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anita M Moorhead
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Rachael Ford
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | | | | | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
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10
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Sorkio S, Cuthbertson D, Bärlund S, Reunanen A, Nucci AM, Berseth CL, Koski K, Ormisson A, Savilahti E, Uusitalo U, Ludvigsson J, Becker DJ, Dupré J, Krischer JP, Knip M, Akerblom HK, Virtanen SM. Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial. Diabetes Metab Res Rev 2010; 26:206-11. [PMID: 20474068 PMCID: PMC4225619 DOI: 10.1002/dmrr.1074] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both the initiation and maintenance of breastfeeding have been reported to be negatively affected by maternal type 1 diabetes (T1D). The aim of this study was to prospectively examine the breastfeeding patterns among mothers with and without T1D participating in a large international randomized infant feeding trial (TRIGR). METHODS Families with a member affected by T1D and with a newborn infant were invited into the study. Those who had HLA-conferred genetic susceptibility for T1D tested at birth with gestation > 35 weeks and were healthy were eligible to continue in the trial. Among the 2160 participating children, 1096 were born to women with T1D and 1064 to unaffected women. Information on infant feeding was acquired from the family by frequent prospective dietary interviews. RESULTS Most (>90%) of the infants of mothers with and without T1D were initially breastfed. Breastfeeding rates declined more steeply among mothers with than without T1D being 50 and 72% at 6 months, respectively. Mothers with T1D were younger, less educated and delivered earlier and more often by caesarean section than other mothers (p < 0.01). After adjusting for all these factors associated with the termination of breastfeeding, there was no difference in the duration of breastfeeding among mothers with and without T1D. CONCLUSIONS Maternal diabetes status per se was not associated with shorter breastfeeding. The lower duration of breastfeeding in mothers with T1D is largely explained by their more frequent caesarean sections, earlier delivery and lower age and education.
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Affiliation(s)
- Susa Sorkio
- Nutrition Unit, National Institute for Health and Welfare, Helsinki, Finland
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11
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Forster DA, McEgan K, Ford R, Moorhead A, Opie G, Walker S, McNamara C. Diabetes and antenatal milk expressing: a pilot project to inform the development of a randomised controlled trial. Midwifery 2009; 27:209-14. [PMID: 19615797 DOI: 10.1016/j.midw.2009.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 04/30/2009] [Accepted: 05/20/2009] [Indexed: 12/17/2022]
Abstract
OBJECTIVE infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia. If the infant's blood glucose is low and the mother is unable to breast feed/provide sufficient expressed breast milk, infants are often given formula. Some hospitals encourage women with diabetes to express breast milk before birth. However, there is limited evidence for this practice, including its impact on labour and birth, e.g. causing premature birth may be a concern. A pilot study was undertaken to establish the feasibility of conducting an adequately powered randomised controlled trial to evaluate this practice. DESIGN consecutive eligible women with pre-existing or gestational diabetes (requiring insulin), planning to breast feed and attending the study hospital were offered participation. INCLUSION CRITERIA 34-36 weeks of gestation; singleton pregnancy; cephalic presentation; and able to speak, read and write in English. EXCLUSION CRITERIA history of spontaneous preterm birth, antepartum haemorrhage, placenta praevia and suspected fetal compromise. Women were encouraged to express colostrum twice a day from 36 weeks of gestation, and advised how to store the colostrum, which was frozen for their infant's use after birth. They were asked to keep a diary documenting their expressing. DATA demographic questionnaire, telephone interview at six and 12 weeks postpartum and medical record data. SETTING a public, tertiary, women's hospital in Melbourne, Australia. PARTICIPANTS 43 women with diabetes in pregnancy (requiring insulin). FINDINGS cardiotocographs were undertaken after the first expressing episode and none of the infants showed any sign of fetal compromise. Forty per cent of infants received formula in the 24 hours postpartum. The proportion of infants receiving any breast milk at six weeks was 90%, and this decreased to 75% at 12 weeks. No women showed evidence of hypoglycaemia post expressing. The intervention was positively received by most women; 95% said that they would express antenatally again if the practice proved to be beneficial. The amount of colostrum varied according to the number of expressions, the length of time in the study and the time spent expressing, with a median of 14 days expressing and 39.6 ml of colostrum obtained. KEY CONCLUSIONS the small number of women in this pilot was not an adequate number to examine safety or efficacy, but this study does provide evidence that it would be feasible and desirable to conduct a randomised controlled trial of antenatal milk expressing for women with diabetes requiring insulin in pregnancy. IMPLICATIONS FOR PRACTICE it is important that this widespread practice undergoes rigorous evaluation to assess both efficacy and safety. Until such evidence is available, the authors suggest that the routine encouragement of antenatal milk expressing in women with diabetes in pregnancy should cease.
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Affiliation(s)
- Della A Forster
- Mother and Child Health Research, La Trobe University, 324–328 Little Lonsdale Street, Melbourne, Australia.
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12
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Pepino MY, Mennella JA. Effects of breast pumping on the pharmacokinetics and pharmacodynamics of ethanol during lactation. Clin Pharmacol Ther 2008; 84:710-4. [PMID: 18596681 PMCID: PMC2720548 DOI: 10.1038/clpt.2008.119] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study tested two hypotheses. First, that breast pumping contributes to the previously observed decrease in ethanol bioavailability in lactating women. Second, that the effects of breast pumping are more pronounced when ethanol is consumed after a meal. The within-subject factor was test condition (fed or fasted) and the between-subject factor was experimental group (pumped before, PB; pumped after, PA). Those randomly assigned to the PB group (N = 8) breast pumped 1 h before drinking, whereas those assigned to the PA group (N = 8) breast pumped 0.6 h after drinking. Pumping before drinking significantly decreased blood ethanol concentration (P < 0.05) and ethanol bioavailability (P = 0.05). Pumping after drinking sped up elimination (P = 0.008), attenuated ethanol-induced hypothermia (P = 0.002), and increased feelings of stimulation (P = 0.03). The effects were more pronounced when ethanol was consumed after a meal. Common neural/hormonal responses to food and suckling may contribute additive effects in altering the pharmacokinetics/pharmacodynamics of ethanol, and perhaps of other drugs, during lactation.
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Affiliation(s)
- MY Pepino
- Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA
| | - JA Mennella
- Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA
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Bentley-Lewis R, Goldfine AB, Green DE, Seely EW. Lactation after normal pregnancy is not associated with blood glucose fluctuations. Diabetes Care 2007; 30:2792-3. [PMID: 17698611 PMCID: PMC4428539 DOI: 10.2337/dc07-1243] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Rhonda Bentley-Lewis
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Dina E. Green
- Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Mount Sinai Medical Center, New York, New York
| | - Ellen W. Seely
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Hummel S, Winkler C, Schoen S, Knopff A, Marienfeld S, Bonifacio E, Ziegler AG. Breastfeeding habits in families with Type 1 diabetes. Diabet Med 2007; 24:671-6. [PMID: 17403118 DOI: 10.1111/j.1464-5491.2007.02148.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS Breastfeeding is acknowledged to be beneficial for child development. Women with diabetes may be more likely not to breastfeed their children because of neonatal morbidity and instability in diabetes control. The aim of this study was to assess the effect of maternal Type 1 diabetes on breastfeeding habits. METHODS Full breastfeeding and any breastfeeding were reported in the first year of life in 1560 children born in Germany between 1989 and 2004. Of those, 997 children had a mother with Type 1 diabetes, and the remaining 563 children had a father or sibling with Type 1 diabetes. RESULTS Fewer children of mothers with Type 1 diabetes were breastfed than children of non-diabetic mothers (77 vs. 86%; P < 0.0001) and, amongst breastfed children, there was a shorter duration of full breastfeeding (12 vs. 17 weeks; P < 0.0001) and any breastfeeding (20 vs. 26 weeks, P < 0.0001) in children of mothers with Type 1 diabetes compared with children of non-diabetic mothers. Other factors associated with reduced frequency and duration of breastfeeding were pre-term delivery (P < 0.0001), young maternal age (P < 0.0001), and firstborn children (P < 0.0001). After stratification for each of these factors, breastfeeding remained significantly less frequent and of less duration in children of mothers with Type 1 diabetes as compared with children of non-diabetic mothers. CONCLUSIONS Mothers with Type 1 diabetes breastfeed their children less than international recommendations. Counselling to increase frequency and duration of breastfeeding may be warranted in this population.
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Affiliation(s)
- S Hummel
- Diabetes Research Institute and Academic Hospital Schwabing, Munich, Germany
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Abstract
OBJECTIVE Breast-feeding may be more difficult in women with diabetes because of neonatal morbidity and fluctuating maternal blood glucose values. The frequency of long-term breast-feeding and the possible predictors for successful breast-feeding were investigated. RESEARCH DESIGN AND METHODS One hundred two consecutive women with type 1 diabetes were interviewed about breast-feeding using a semistructured questionnaire 5 days and 4 months after delivery. Clinical data were collected from the medical records. RESULTS Five days after delivery, 86% of the women were breast-feeding. Four months after delivery, 55 (54%) women were exclusively, 14 (14%) were partly, and 33 (32%) were not breast-feeding compared with 50, 26, and 24% in the background population (NS). Mothers exclusively breast-feeding at 4 months were characterized by previous experience with breast-feeding, a higher educational level, and vaginal delivery and included a high proportion of nonsmokers, whereas there were no associations with diabetes-related parameters such as white classes, duration of diabetes, HbA(1c), and insulin dose at conception. Breast-fed offspring had a significantly higher birth weight and gestational age and were less often receiving glucose intravenously compared with the remaining offspring. Independent predictors of exclusive breast-feeding at 4 months were previous experience with breast-feeding (odds ratio 6.3 [95% CI 2.4-17]) and higher educational level (7.1 [2.4-21]). Cessation of breast-feeding was mainly due to common nursing problems, such as perceived milk supply, and not related to maternal diabetes status. CONCLUSIONS The majority of the women with type 1 diabetes initiated breast-feeding, and the prevalence of breast-feeding at 4 months was comparable to that in the background population. Independent predictors of exclusive breast-feeding at 4 months were previous experience with breast-feeding and higher educational level.
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Affiliation(s)
- Edna Stage
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Abstract
Human milk is recommended for infants throughout at least the first year of life. Breastfeeding is also recommended for infants of women with preexisting diabetes or gestational diabetes. Dietary Reference Intakes (DRIs) 2002 provides recommendations for energy and macronutrients for all ages and for pregnancy and lactation. During the first 6 months, infants receive an average of 500 kcal/d from human milk, and during the second 6 months 400 kcal/d. To cover this need for the first 6 months of lactation, women need an additional energy intake of 330 kcal/d plus the approximately 170 kcal/d that is supplied by the women's tissue stores, and for the second 6 months 400 kcal/d. The DRIs also set recommended levels for both the infant and mother for carbohydrate, protein, and fats. Women with type 1 diabetes may have problems initiating breastfeeding, and with hypo- and hyperglycemia during lactation. Breastfeeding may have long-term beneficial effects on glycemia in women with gestational diabetes. More research is needed on all aspects of lactation in women with diabetes.
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Affiliation(s)
- Diane Reader
- Nutrition Concepts by Franz, Inc., 6635 Limerick Drive, Minneapolis, MN 55439, USA
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Saez-de-Ibarra L, Gaspar R, Obesso A, Herranz L. Glycaemic behaviour during lactation: postpartum practical guidelines for women with type 1 diabetes. ACTA ACUST UNITED AC 2003. [DOI: 10.1002/pdi.529] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chiasson JL, Garg A, Holzmeister LA, Hoogwerf B, Mayer-Davis E, Mooradian AD, Purnell JQ, Wheeler M. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002; 25:148-98. [PMID: 11772915 DOI: 10.2337/diacare.25.1.148] [Citation(s) in RCA: 375] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Marion J Franz
- Nutrition Concepts by Franz, Inc., Minneapolis, Minnesota 55439, USA.
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Affenito SG, Kerstetter J. Position of the American Dietetic Association and Dietitians of Canada: women's health and nutrition. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1999; 99:738-51. [PMID: 10361541 DOI: 10.1016/s0002-8223(99)00178-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Within the past 10 years women's health has evolved to a much broader paradigm, beyond reproductive issues. From a physiological perspective, women's health now refers to the prevention, diagnosis, and management of conditions or diseases that may be unique to women, be more prevalent in women, or manifest differently in women than men. Women's health encompasses emotional, social, cultural, spiritual, and physical well-being. It is determined by the social, political, and economic context of women's lives. Nutrition is involved in the etiology or treatment of half of the 10 leading causes of death in women. The incidence of osteoporosis and extremes in body weight are approaching epidemic proportions in women. This position reviews the following health problems: cardiovascular disease, cancer, osteoporosis, weight, and diabetes mellitus. Dietetics professionals are in the perfect position to understand the issues surrounding women's health in order to deliver a message to women that will allow them to make wise decisions regarding their health. Nutrition is a critical component of risk reduction and treatment, and must be included in clinical and preventive services for women. Dietetics professionals must work to increase their knowledge about women's health issues, to promote health and education programs, to influence policy makers, to deliver the highest-quality medical nutrition therapy, and to be proactive in documenting the effectiveness of outcomes-based research.
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