Hospital Supplementation Differentially Impacts the Association Between Breastfeeding Intention and Duration Among Women With and Without Gestational Diabetes Mellitus History

Breastfeeding, Gestational Diabetes Mellitus, Size at Birth and Overweight/Obesity in Early Childhood

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.

Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative review

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.

Self-Efficacy and Outcomes in Women with Diabetes: A Prospective Comparative Study

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.

In-hospital supplementation and subsequent breastfeeding practices in Finland: A cross-sectional population-level study

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.

Screening for Gestational Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

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.

Factors that positively influence in-hospital exclusive breastfeeding among women with gestational diabetes: An integrative review

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.

Barriers and benefits to breastfeeding with gestational diabetes

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.

Impact of gestational diabetes mellitus on the duration of breastfeeding in primiparous women: an observational cohort study

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.

Factors Associated With Breastfeeding Among Women With Gestational Diabetes

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.

Maternal gestational diabetes and infant feeding, nutrition and growth: a systematic review and meta-analysis

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.

Breastfeeding Initiation as Related to the Interaction of Race/Ethnicity and Maternal Diabetes

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.

Prevalence and associated factors of breastfeeding in women with gestational diabetes in a University Hospital in Thailand

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.

Gestational Diabetes and Breastfeeding Outcomes: A Systematic Review

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.

In-hospital formula supplementation and breastfeeding initiation in infants born to women with pregestational diabetes mellitus

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.

Gestational Diabetes Mellitus Reduces Breastfeeding Duration: A Prospective Cohort Study

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.