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Huang Y, Zhang L, Ainiwan D, Alifu X, Cheng H, Qiu Y, Zhou H, Liu H, Yu Y. Breastfeeding, Gestational Diabetes Mellitus, Size at Birth and Overweight/Obesity in Early Childhood. Nutrients 2024; 16:1351. [PMID: 38732598 PMCID: PMC11085597 DOI: 10.3390/nu16091351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Breastfeeding appears to reduce the risk of childhood overweight/obesity. However, it remains unclear whether this protective effect persists among high-risk populations. This study aims to investigate the association of breastfeeding with the risk of overweight/obesity in early childhood and whether this association is altered by gestational diabetes mellitus (GDM) or size at birth. Methods: Feeding practices during the first 12 months of age and weight and length at 12-36 months of age were collected. Full breastfeeding includes exclusive and predominant breastfeeding. Children with body mass index (BMI) values greater than 1 standard deviation from the mean of sex- and age-specific BMI were classified as overweight/obese. Multiple generalized estimating equations models were applied to analyze the associations of full breastfeeding duration with overweight/obesity risk. Results: Among all participants (n = 9329), infants with a longer full-breastfeeding duration had a reduced risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Infants exposed to GDM and those born large for gestational age (LGA) had a higher risk of overweight/obesity in early childhood. Among infants of mothers with GDM (n = 1748), infants with full breastfeeding for greater than 6 months (aOR: 0.58; 95% CI: 0.44, 0.78) showed a decreased risk of overweight/obesity in early childhood compared with those breastfed for less than one month. Among LGA infants (n = 1279), infants with full breastfeeding for 3-5 months (aOR: 0.66; 95% CI: 0.57, 0.76) and greater than 6 months (aOR: 0.70; 95% CI: 0.56, 0.88) showed a decreased risk of overweight/obesity in early childhood. Similar results were observed among LGA infants of mothers with GDM. Conclusions: Initiating and prolonging breastfeeding would reduce the risk of overweight/obesity in early childhood, and LGA infants and infants born to mothers with GDM would experience greater benefits.
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Affiliation(s)
- Ye Huang
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Libi Zhang
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Diliyaer Ainiwan
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Xialidan Alifu
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Haoyue Cheng
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yiwen Qiu
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Haibo Zhou
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Hui Liu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China;
| | - Yunxian Yu
- Department of Public Health and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China; (Y.H.); (L.Z.); (D.A.); (X.A.); (H.C.); (Y.Q.); (H.Z.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
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Otter G, Davis D, Kurz E, Hooper ME, Shield A, Samarawickrema I, Spiller S, Atchan M. Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative review. Int Breastfeed J 2024; 19:4. [PMID: 38233823 PMCID: PMC10795405 DOI: 10.1186/s13006-023-00603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/25/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy. METHODS A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework. RESULTS From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis - the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group. CONCLUSION Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence.
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Affiliation(s)
- Georgia Otter
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia
| | - Deborah Davis
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia
| | - Ella Kurz
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia
| | - Mary-Ellen Hooper
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia
| | - Alison Shield
- School of Health Science, University of Canberra, Bruce, Australia
| | | | - Sarah Spiller
- Health Care Consumer Association, Canberra, Australia
| | - Marjorie Atchan
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia.
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3
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Doughty KN, Abeyaratne D, Merriam AA, Taylor SN. Self-Efficacy and Outcomes in Women with Diabetes: A Prospective Comparative Study. Breastfeed Med 2023; 18:307-314. [PMID: 36999939 PMCID: PMC10124167 DOI: 10.1089/bfm.2022.0298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Background: Breastfeeding is especially beneficial to women with diabetes and their infants, yet diabetic mothers frequently experience less favorable breastfeeding outcomes. Objectives: To identify facilitators and barriers to breastfeeding for women with diabetes by comparing cognitive and social factors, health and hospital-related factors, and breastfeeding outcomes between women with and without diabetes. Design/Methods: Women with any type of diabetes (n = 28) and without diabetes (n = 29) were recruited during pregnancy. Data were collected from the electronic medical record and maternal surveys at 24-37 weeks' gestation, birth hospitalization, and 4 weeks' postbirth. We compared differences in mother's regard for breastfeeding, breastfeeding intention, and birth hospital experience by diabetes status, and estimated odds ratios for exclusive breastfeeding (EBF) and unmet intention to breastfeed. Results: Women with and without diabetes had similar breastfeeding intentions, attitudes, and self-efficacy. Women with diabetes were less likely to EBF, and more likely to have unmet intentions to EBF at hospital discharge, compared to women without diabetes. At 4 weeks' postpartum, there was no difference in breastfeeding by diabetes status, although EBF at hospital discharge was strongly associated with EBF at 4 weeks. Infant neonatal intensive care unit (NICU) admission and hypoglycemia were significantly associated with diabetes status, reduced EBF rates, and unmet breastfeeding intentions. Conclusions: Despite having a strong intent to breastfeed, women with diabetes experienced less favorable early breastfeeding outcomes and were less likely to meet their own breastfeeding goals. These differences may be driven by neonatal complications, such as infant hypoglycemia and NICU admissions, rather than maternal cognitive and social factors.
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Affiliation(s)
- Kimberly N Doughty
- Egan School of Nursing and Health Studies, Public Health Fairfield University, Fairfield, Connecticut, USA
| | - Dhatri Abeyaratne
- Yale School of Medicine, Department of Pediatrics, Division of Neonatology, New Haven, Connecticut, USA
| | - Audrey A Merriam
- Yale School of Medicine, Department of Pediatrics, Division of Neonatology, New Haven, Connecticut, USA
| | - Sarah N Taylor
- Yale School of Medicine, Department of Pediatrics, Division of Neonatology, New Haven, Connecticut, USA
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4
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Ikonen R, Kaunonen M, Hakulinen T. In-hospital supplementation and subsequent breastfeeding practices in Finland: A cross-sectional population-level study. Birth 2023; 50:171-181. [PMID: 36537472 DOI: 10.1111/birt.12696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/07/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Baby-Friendly Hospital Initiative suggests that in-hospital supplementation should be avoided unless medically indicated. The supporting evidence is contradictory, as nonexperimental studies have shown an association between supplementation and decreased breastfeeding rates, whereas trials have failed to do so. The aim of this study was to investigate whether in-hospital supplementation is associated with exclusive breastfeeding to the age of 5 months and any breastfeeding to the age of 12 months in full-term, normal-weight singleton infants. METHODS This is a secondary analysis of national-level, cross-sectional survey data. The data were collected in child health clinics in Finland. Families attending a regular health examination with a child aged 2 weeks to 12 months were eligible to participate. Full-term, normal-weight, singleton infants (n = 3025) were included in this study. Multivariate logistic regression was performed using in-hospital supplementation and socioeconomic characteristics as covariates and exclusive and any breastfeeding as outcomes. RESULTS In total, 55.3% (n = 1631) of the infants received in-hospital supplementation. After controlling for socioeconomic factors, in-hospital supplementation was associated with decreased exclusive breastfeeding to the age of 5 months and with a decrease in any breastfeeding to the age of 7 months. CONCLUSIONS Our findings suggest that noncontrolled supplementation, without a trial's rigorous procedures of care, is associated with decreased breastfeeding postdischarge. Both donor milk and infant formula use were associated with lower breastfeeding rates, although the association was stronger with formula use. In clinical settings, liberal, nonmedically indicated supplementation should be avoided.
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Affiliation(s)
- Riikka Ikonen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.,Pirkanmaa Hospital District, Tampere, Finland
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Pérez‐Escamilla R, Hromi‐Fiedler A, Rhodes EC, Neves PAR, Vaz J, Vilar‐Compte M, Segura‐Pérez S, Nyhan K. Impact of prelacteal feeds and neonatal introduction of breast milk substitutes on breastfeeding outcomes: A systematic review and meta‐analysis. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13368. [PMID: 35489107 PMCID: PMC9113480 DOI: 10.1111/mcn.13368] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rafael Pérez‐Escamilla
- Department of Social and Behavioral Sciences Yale School of Public Health New Haven Connecticut USA
| | - Amber Hromi‐Fiedler
- Department of Social and Behavioral Sciences Yale School of Public Health New Haven Connecticut USA
| | - Elizabeth C. Rhodes
- Department of Social and Behavioral Sciences Yale School of Public Health New Haven Connecticut USA
| | - Paulo A. R. Neves
- International Center for Equity in Health Universidade Federal de Pelotas Pelotas Rio Grande do Sul Brazil
| | - Juliana Vaz
- Faculty of Nutrition Universidade Federal de Pelotas Pelotas Rio Grande do Sul Brazil
| | - Mireya Vilar‐Compte
- Department of Public Health Montclair State University Montclair New Jersey USA
| | | | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library Yale University New Haven Connecticut USA
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Cherubini KA, Schmidt MI, Vigo Á, Drehmer M. Breastfeeding rates and related factors at one year postpartum in women with gestational diabetes initially recruited for a diabetes prevention program. Can J Diabetes 2022; 46:441-448. [DOI: 10.1016/j.jcjd.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/02/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Pillay J, Donovan L, Guitard S, Zakher B, Gates M, Gates A, Vandermeer B, Bougatsos C, Chou R, Hartling L. Screening for Gestational Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 326:539-562. [PMID: 34374717 DOI: 10.1001/jama.2021.10404] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Gestational diabetes is associated with several poor health outcomes. OBJECTIVE To update the 2012 review on screening for gestational diabetes to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, EMBASE, and CINAHL (2010 to May 2020), ClinicalTrials.gov, reference lists; surveillance through June 2021. STUDY SELECTION English-language intervention studies for screening and treatment; observational studies on screening; prospective studies on screening test accuracy. DATA EXTRACTION AND SYNTHESIS Dual review of titles/abstracts, full-text articles, and study quality. Single-reviewer data abstraction with verification. Random-effects meta-analysis or bivariate analysis (accuracy). MAIN OUTCOMES AND MEASURES Pregnancy, fetal/neonatal, and long-term health outcomes; harms of screening; accuracy. RESULTS A total of 76 studies were included (18 randomized clinical trials [RCTs] [n = 31 241], 2 nonrandomized intervention studies [n = 190], 56 observational studies [n = 261 678]). Direct evidence on benefits of screening vs no screening was limited to 4 observational studies with inconsistent findings and methodological limitations. Screening was not significantly associated with serious or long-term harm. In 5 RCTs (n = 25 772), 1-step (International Association of Diabetes and Pregnancy Study Group) vs 2-step (Carpenter and Coustan) screening was significantly associated with increased likelihood of gestational diabetes (11.5% vs 4.9%) but no improved health outcomes. At or after 24 weeks of gestation, oral glucose challenge tests with 140- and 135-mg/dL cutoffs had sensitivities of 82% and 93%, respectively, and specificities of 82% and 79%, respectively, against Carpenter and Coustan criteria, and a test with a 140-mg/dL cutoff had sensitivity of 85% and specificity of 81% against the National Diabetes Group Data criteria. Fasting plasma glucose tests with cutoffs of 85 and 90 mg/dL had sensitivities of 88% and 81% and specificities of 73% and 82%, respectively, against Carpenter and Coustan criteria. Based on 8 RCTs and 1 nonrandomized study (n = 3982), treatment was significantly associated with decreased risk of primary cesarean deliveries (relative risk [RR], 0.70 [95% CI, 0.54-0.91]; absolute risk difference [ARD], 5.3%), shoulder dystocia (RR, 0.42 [95% CI, 0.23-0.77]; ARD, 1.3%), macrosomia (RR, 0.53 [95% CI, 0.41-0.68]; ARD, 8.9%), large for gestational age (RR, 0.56 [95% CI, 0.47-0.66]; ARD, 8.4%), birth injuries (odds ratio, 0.33 [95% CI, 0.11-0.99]; ARD, 0.2%), and neonatal intensive care unit admissions (RR, 0.73 [95% CI, 0.53-0.99]; ARD, 2.0%). The association with reduction in preterm deliveries was not significant (RR, 0.75 [95% CI, 0.56-1.01]). CONCLUSIONS AND RELEVANCE Direct evidence on screening vs no screening remains limited. One- vs 2-step screening was not significantly associated with improved health outcomes. At or after 24 weeks of gestation, treatment of gestational diabetes was significantly associated with improved health outcomes.
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Affiliation(s)
- Jennifer Pillay
- University of Alberta Evidence-based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lois Donovan
- Faculty of Medicine, Departments of Obstetrics & Gynecology and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samantha Guitard
- University of Alberta Evidence-based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Bernadette Zakher
- University of Alberta Evidence-based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Gates
- University of Alberta Evidence-based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Gates
- University of Alberta Evidence-based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ben Vandermeer
- University of Alberta Evidence-based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Bougatsos
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Lisa Hartling
- University of Alberta Evidence-based Practice Center, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Cummins L, Meedya S, Wilson V. Factors that positively influence in-hospital exclusive breastfeeding among women with gestational diabetes: An integrative review. Women Birth 2021; 35:3-10. [PMID: 33745821 DOI: 10.1016/j.wombi.2021.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 01/03/2023]
Abstract
PROBLEM Women with gestational diabetes have higher rates of introducing infant formula before leaving hospital. BACKGROUND Despite health professional support, less women with gestational diabetes exclusively breastfeed in hospital. AIM To find factors that positively influence in-hospital exclusive breastfeeding practices among women with gestational diabetes. METHODS An online search was performed in Medline, Scopus, Pubmed, CINAHL and Cochrane databases. Studies containing the keywords gestational diabetes and breastfeeding were retrieved. FINDINGS Authors identified 1935 papers from search criteria. Twenty-six papers with no restrictions on research design met inclusion criteria and were included in the review. Factors were divided into personal, antenatal, intrapartum and postnatal factors. The main modifiable factors that were associated with improved in-hospital exclusive breastfeeding rates were having a strong intention to breastfeed, being confident, feeling supported and having continuity of education and support. Women's main reasons to introduce formula were related to baby's hypoglycaemia, delayed lactogenesis II and perceived low milk supply. Skin-to-skin contact after birth combined with frequent breastfeeds were effective ways to improve in-hospital exclusive breastfeeding rates. CONCLUSION Influencing factors such as women's breastfeeding intention, confidence and ongoing support are no different to the general population of women. However, promoting skin-to-skin contact after birth combined with frequent feeds are crucial for women with gestational diabetes who are more likely to introduce formula due to delayed lactogenesis II and fear of neonatal hypoglycaemia. There is a need for developing educational and supportive interventions that are tailored specifically for women who have gestational diabetes.
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Affiliation(s)
- Leanne Cummins
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus St, Wollongong, NSW, 2500, Australia.
| | - Shahla Meedya
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Valerie Wilson
- School of Nursing, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus St, Wollongong, NSW, 2500, Australia
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9
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Abstract
Gestational diabetes mellitus (GDM) is a disease of glucose intolerance during pregnancy and is associated with infant macrosomia, infant hypoglycemia, and increased risk of type 2 diabetes development for both mother and infant. Although breastfeeding potentially mitigates metabolic sequelae for both mother and her offspring, women with GDM are more likely to introduce formula and, therefore, are less likely to exclusively breastfeed, and some studies show less initiation and shorter breastfeeding duration as well. Therefore, women with GDM and their infants warrant investigation of methods by which to increase breastfeeding exclusivity and duration. Exploration of the barriers to breastfeeding for women with GDM demonstrate not only biologic complications such as maternal obesity, increased prevalence of cesarean section, and infant hypoglycemia, but also maternal report of less provider support of breastfeeding and reduced breastfeeding self-efficacy. Consequently, interventions designed to optimize breastfeeding outcomes in this high-risk population should not only focus on the biology but also on provider behavior and maternal social factors.
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Laine MK, Kautiainen H, Gissler M, Pennanen P, Eriksson JG. Impact of gestational diabetes mellitus on the duration of breastfeeding in primiparous women: an observational cohort study. Int Breastfeed J 2021; 16:19. [PMID: 33593367 PMCID: PMC7885226 DOI: 10.1186/s13006-021-00369-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background The impact of gestational diabetes mellitus (GDM) on the duration of breastfeeding varies between shortening and no impact. Breastfeeding seems to reduce both maternal and offspring risk for type 2 diabetes and offspring risk for overweight or obesity later in life. The aim of our study was to evaluate in primiparous women whether GDM had an influence on the duration of breastfeeding, and further, to evaluate the factors that influenced on the duration of breastfeeding. Methods The study cohort (N = 1089) consisted of all primiparous women with a Finnish background excluding women with pre-existing diabetes mellitus who lived in the city of Vantaa, Finland, gave birth to a singleton living child between 2009 and 2015, and with valid data on breastfeeding available. The diagnosis of GDM was based on a standard 75 g 2-h oral glucose tolerance test. Data were obtained from Finnish national registers and from the medical records of the city of Vantaa. Results No differences were observed in the duration of breastfeeding between women diagnosed with GDM and without GDM, 7.5 (Standard Deviation [SD] 3.7) months versus 7.9 (SD 3.5) months (p = 0.17). Women diagnosed with GDM breastfed boys for a longer duration than girls (maternal age, pre-pregnancy body mass index, marital status, educational attainment, duration of pregnancy, and smoking habits adjusted p = 0.042). Women who breastfed < 6 months were younger, were more likely smokers, had shorter education, and higher pre-pregnancy body mass index than women who breastfed over 6 months (p < 0.001 for linearity). Conclusions In primiparous women GDM did not influence breastfeeding duration. The positive health effects of breastfeeding should be emphasized especially in young, overweight and less educated women in order to minimize the risk of obesity and type 2 diabetes for themselves and their offspring.
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Affiliation(s)
- Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. .,Folkhälsan Research Center, Helsinki, Finland.
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Mika Gissler
- Information Services Department Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | | | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,National University Singapore, Yong Loo Lin School of Medicine, Human Potential Translational Research programme and Department of Obstetrics and Gynecology, Singapore, Singapore.,Singapore Institute for Clinical Sciences (SCIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
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11
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Reinheimer SM, Schmidt MI, Duncan BB, Drehmer M. Factors Associated With Breastfeeding Among Women With Gestational Diabetes. J Hum Lact 2020; 36:126-135. [PMID: 31071277 DOI: 10.1177/0890334419845871] [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: 11/15/2022]
Abstract
BACKGROUND Breastfeeding offers benefits to mother and child but is frequently not practiced among women whose pregnancy is complicated by gestational diabetes mellitus. Factors associated with not initiating or not maintaining breastfeeding among these women have been little investigated. RESEARCH AIMS (1) To evaluate the frequency of breastfeeding for 30 days among women with a recent pregnancy complicated by gestational diabetes and (2) to determine factors associated with not initiating or not maintaining breastfeeding. METHODS Between January 2014 and July 2017 we enrolled women with gestational diabetes at high-risk prenatal services in three Brazilian cities. We collected baseline sociodemographic and health data and followed up with participants by telephone. Using Kaplan-Meier curves, we calculated the proportions of participants not initiating breastfeeding or not maintaining it for at least 30 days. We used Poisson regression with robust variance to identify factors related to this outcome. RESULTS Of the 2328 participants with complete information, 2236 (96.1%) initiated breastfeeding, and 2166 (93.1%) maintained breastfeeding for 30 days. Not having breastfed the previous infant (relative risk [RR] = 5.02, 95% CI [3.39, 7.45]), smoking during pregnancy (RR = 2.37, 95% CI [1.48, 3.80]), infant with health problems (RR = 2.25, 95% CI [1.27, 3.99]), early preterm birth (RR = 2.49, 95% CI [1.07, 5.77]), and not intending to breastfeed (RR = 3.73, 95% CI [1.89, 7.33]) were related to not maintaining breastfeeding for at least 30 days. CONCLUSIONS Breastfeeding initiation was nearly universal among participants, and most maintained breastfeeding for 30 days. Factors relating to not breastfeeding at 30 days were easily identifiable.
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Affiliation(s)
- Shaline Modena Reinheimer
- Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce Bartholow Duncan
- Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Michele Drehmer
- Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Studies Program in Food, Nutrition and Health, Department of Nutrition, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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12
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Maternal gestational diabetes and infant feeding, nutrition and growth: a systematic review and meta-analysis. Br J Nutr 2020; 123:1201-1215. [PMID: 31964432 DOI: 10.1017/s0007114520000264] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gestational diabetes mellitus (GDM) is a major health problem, with increased risks of obesity and diabetes in offspring. However, little is known about the effect of GDM on infant feeding, nutrition and growth, and whether these factors play a role in mediating these risks. We systematically reviewed evidence for the effect of GDM on infant feeding, nutrition and growth. We searched MEDLINE, Web-of-Science, Embase, CINAHL and CENTRAL for studies that reported outcomes in infants <2 years who were and were not exposed to GDM. Studies of pre-gestational diabetes were excluded. Meta-analysis was performed for three epochs (1–6, 7–12, 13–24 months), using inverse-variance, fixed-effects methods. Primary outcomes were energy intake (kJ) and BMI (kg/m2). Twenty-five studies and 308 455 infants were included. Infants exposed to GDM, compared with those not exposed, had similar BMI at age 1–6 months (standardised mean difference (SMD) = 0·01, 95 % CI −0·04, 0·06; P = 0·69) and 7–12 months (SMD = 0·04, 95 % CI −0·01, 0·10; P = 0·09), reduced length at 1–6 and 7–12 months, increased whole-body fat at 1–6 months, higher rates of formula supplementation in hospital, shorter duration of breast-feeding and decreased rates of continued breast-feeding at 12 months. Breast milk of women with GDM had lower protein content. There was no association between GDM and infant weight and skinfold thickness. No data were available for nutritional intake and outcomes at 13–24 months. Low- or very low-quality evidence suggests GDM is not associated with altered BMI in infancy, but is associated with increased fat mass, high rates of formula use and decreased duration of breast-feeding.
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13
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Stevens DR, Taylor SN, Roberts JR, Neelon B, Newman RB, Vena JE, Hunt KJ. Breastfeeding Initiation as Related to the Interaction of Race/Ethnicity and Maternal Diabetes. Breastfeed Med 2019; 14:630-639. [PMID: 31364862 PMCID: PMC6857546 DOI: 10.1089/bfm.2019.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction: The health benefits of breastfeeding for both the mother and her offspring are well established, and breastfeeding may be especially important for mitigating negative health effects of pregnancy complicated by diabetes. Objective: This study sought to examine the association between race/ethnicity, maternal diabetes, and breastfeeding initiation in South Carolina (SC). Materials and Methods: Our study population is comprised of all live, singleton, full-term births in SC delivered January 2004 to December 2016 (292,468 non-Hispanic Whites, 173,158 non-Hispanic Blacks, and 52,174 Hispanics). Generalized estimating equations and an interaction term between race/ethnicity and maternal diabetes status were used to estimate the race/ethnic-specific odds ratio (OR) and 95% confidence intervals (CIs) that a mother with diabetes versus without diabetes initiated breastfeeding. Models were adjusted for maternal and infant sociodemographics (Model 1), additionally for clinical variables and birth outcomes (Model 2), and also for maternal prepregnancy body mass index (BMI) (Model 3). Results: We found statistically significant differences in breastfeeding initiation by race/ethnicity and diabetes status in Model 1. These associations were attenuated and lost significance upon additional adjustment. Non-Hispanic Black mothers with gestational diabetes were significantly more likely to initiate breastfeeding than nondiabetic non-Hispanic Black mothers, even after adjustment for prepregnancy BMI (OR: 1.07 [95% CI 1.02-1.12]). Conclusion: This large, population-based study of all live, singleton, full-term births in SC improves our understanding of how race/ethnicity and maternal metabolic disorders impact breastfeeding initiation, and may inform future hospital-based breastfeeding interventions in populations with the most need.
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Affiliation(s)
- Danielle R. Stevens
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah N. Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - James R. Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Roger B. Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
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14
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Jirakittidul P, Panichyawat N, Chotrungrote B, Mala A. Prevalence and associated factors of breastfeeding in women with gestational diabetes in a University Hospital in Thailand. Int Breastfeed J 2019; 14:34. [PMID: 31384287 PMCID: PMC6668133 DOI: 10.1186/s13006-019-0227-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM), which is a medical complication that develops during pregnancy, is associated with several long-term health problems. Despite several benefits of exclusive breastfeeding (EBF), including reduction in long-term health problems in mothers with GDM, few studies have investigated breastfeeding in women with GDM and information in the Thai population is lacking. The aim of the study was to determine the prevalence of breastfeeding and the factors associated with breastfeeding during the first six months postpartum in women with GDM. Methods A questionnaire-based prospective study was conducted during November 2014 to June 2017. Study participants were first interviewed on the second day post-delivery, and then by telephone at 6 weeks, 3 months and 6 months postpartum. Breastfeeding assessment based on infant feeding practice in the last 24-h period was classified according to World Health Organization definitions. Results A total 229 women were enrolled in this study. Prevalence of any breastfeeding at 24 h, 6 weeks, 3 months, and 6 months postpartum was 28.8% (n = 66), 94.3% (n = 214), 71% (n = 154), and 49.8% (n = 104), respectively. Prevalence of EBF was 35.9% (n = 78) at 3 months, and 23% (n = 48) at 6 months after delivery. Maternal intention to breastfeed for 6 months was an independent predictor for both 6 months EBF (RR 16.38; 95% CI 2.29, 116.99) and any breastfeeding (RR 2.65; 95% CI 1.65, 4.25). Breastfeeding initiation within 24 h postpartum (RR 1.38; 95% CI 1.08, 1.76) and being a government officer or private business owner (RR 1.66; 95% CI 1.03, 2.68) were independent predictors of any breastfeeding and EBF for 6 months, respectively. Conclusion The prevalence of breastfeeding in Thai women with GDM was lower than the national and global target goal. Maternal intention to breastfeed for at least 6 months and breastfeeding initiation were important factors associated with 6 months' breastfeeding. In order to improve the breastfeeding rate and duration, health care providers should support women's feeding decision, emphasize the benefits of breastfeeding to enhance breastfeeding intention, seek to remove or minimize barriers to the initiation of breastfeeding and reduce mother-infant separation time.
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Affiliation(s)
- Preeyaporn Jirakittidul
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nalinee Panichyawat
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Benjaphorn Chotrungrote
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Athitaya Mala
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Nguyen PTH, Pham NM, Chu KT, Van Duong D, Van Do D. Gestational Diabetes and Breastfeeding Outcomes: A Systematic Review. Asia Pac J Public Health 2019; 31:183-198. [DOI: 10.1177/1010539519833497] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Studies of gestational diabetes mellitus in relation to breastfeeding are limited, while their findings are inconsistent. This systematic review was conducted to assess the associations between gestational diabetes and breastfeeding outcomes. An initial search of PubMed, Web of Science, and ProQuest identified 518 studies, and after applying the inclusion criteria, 16 studies were finally included in the review. Four studies reported that “exclusive/predominant/full breastfeeding” rates at discharge were lower in mothers with gestational diabetes than in those without gestational diabetes, and 2 studies showed a shorter duration of “exclusive/predominant breastfeeding” in the former than in the latter. However, most studies found no apparent difference in the rate of “breastfeeding initiation”, “any breastfeeding” duration, or “any breastfeeding” in hospital and at discharge between mothers with and without gestational diabetes. In summary, mothers with gestational diabetes were less likely to exclusively breastfeed their infants and may have a shorter breastfeeding duration than other mothers.
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Affiliation(s)
| | - Ngoc Minh Pham
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Khac Tan Chu
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Dung Van Do
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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16
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Cordero L, Stenger MR, Landon MB, Nankervis CA. In-hospital formula supplementation and breastfeeding initiation in infants born to women with pregestational diabetes mellitus. J Neonatal Perinatal Med 2019; 12:285-293. [PMID: 30932901 DOI: 10.3233/npm-180140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To ascertain the rate of in-hospital supplementation as it relates to early breastfeeding (BF) and early formula feeding (FF) and its effects on BF (exclusive and partial) at the time of discharge for infants born to women with pregestational diabetes mellitus (PGDM). METHODS Retrospective cohort investigation of 282 women with PGDM who intended to BF and their asymptomatic infants admitted to the newborn nursery for blood glucose monitoring and routine care. Early feeding was defined by the initial feeding if given within four hours of birth. RESULTS Of the 282 mother-infant dyads, for 134 (48%) early feeding was BF and for 148 (52%) early feeding was FF. Times from birth to BF and FF (median 1 hr, 0.3-6) were similar, while the time to first BF for those who FF and supplemented was longer (median 6 hr., 1-24). Ninety-seven infants (72%) who first BF also supplemented. Of these, 22 (23%) BF exclusively, 67 (69%) BF partially and 8 (8%) FF at discharge. One hundred seventeen (79%) who first FF also supplemented. Of these, 21 (18%) BF exclusively, 76 (65%) BF partially and 20 (17%) FF at discharge. CONCLUSION Regardless of the type of first feeding, the majority of infants born to women with PGDM require supplementation. Even when medically indicated, in-hospital supplementation is an obstacle, albeit not absolute, to exclusive BF at discharge. Parents should be reminded that occasional supplementation should not deter resumption and continuation of BF.
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Affiliation(s)
- L Cordero
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - M R Stenger
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - M B Landon
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - C A Nankervis
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
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17
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Nguyen PTH, Binns CW, Nguyen CL, Ha AVV, Chu TK, Duong DV, Do DV, Lee AH. Gestational Diabetes Mellitus Reduces Breastfeeding Duration: A Prospective Cohort Study. Breastfeed Med 2019; 14:39-45. [PMID: 30383402 DOI: 10.1089/bfm.2018.0112] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) and its complications are major concerns because of the negative effects of GDM during antenatal period and on the future health of mothers and infants. Breastfeeding is beneficial for GDM mothers and their babies to reduce future health risks. Little is known about the link between GDM and the duration of "any" breastfeeding. Therefore, the aim of this study was to investigate the relationship between GDM and the duration for which Vietnamese women breastfeed their babies postpartum. MATERIALS AND METHODS A prospective cohort of 2,030 pregnant women between 24 and 28 weeks of gestation was recruited. GDM status was determined using a 75 g oral glucose tolerance test. Included mothers were then followed up from discharge after childbirth until 12 months postpartum to determine their breastfeeding duration. Kaplan-Meier estimates, log-rank tests, logistic and Cox regression models were used to examine the association between GDM and breastfeeding outcomes. RESULTS In our cohort, 94.4% of all women reported "any" breastfeeding at discharge and 72.9% of women were still breastfeeding at 12 months postpartum. The risk of early breastfeeding cessation was higher in GDM women than their non-GDM counterparts after adjustment for demographic factors (hazard ratios [HR] = 1.39, 95% confidence intervals [CI] = 1.13-1.71, p = 0.002), and all potential confounding factors (HR = 1.38, 95% CI = 1.12-1.70, p = 0.002). There were no significant differences in breastfeeding outcomes at discharge (early initiation, prelacteal feeding, and "any" breastfeeding rate) between GDM and non-GDM mothers. CONCLUSIONS GDM was associated with shorter breastfeeding duration. Women with GDM require ongoing support after hospital discharge to maintain long-term breastfeeding.
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Affiliation(s)
- Phung Thi Hoang Nguyen
- 1 Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,2 School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Colin W Binns
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Cong Luat Nguyen
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia.,3 National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Anh Vo Van Ha
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia.,4 Department of Environmental and Occupational Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Tan Khac Chu
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia.,5 Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Dat Van Duong
- 6 Department of Sexual and Reproductive Health, United Nations Population Fund, Hanoi, Vietnam
| | - Dung Van Do
- 1 Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Andy H Lee
- 2 School of Public Health, Curtin University, Perth, Western Australia, Australia
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18
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Barriers to Exclusive Breastfeeding Among Women With Gestational Diabetes Mellitus in the United States. J Obstet Gynecol Neonatal Nurs 2018; 47:301-315. [DOI: 10.1016/j.jogn.2018.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/24/2022] Open
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