1
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Acheampong AK, Ganga-Limando M, Aziato L. Qualitative exploration of perceived barriers of exclusive breastfeeding among pregnant teenagers in the Greater Accra Region of Ghana. BMC Public Health 2022; 22:1885. [PMID: 36217132 PMCID: PMC9552491 DOI: 10.1186/s12889-022-14277-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/02/2022] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background The World Health Organization endorses exclusive breastfeeding for the first six months of every child’s life since exclusive breastfeeding has the potential of saving thousands of infants’ lives. The global exclusive breastfeeding rate among mothers is sub-optimal. This predisposes infants born to teenage mothers to all types of ailments. Therefore, this study explored the factors that inhibit the practice of exclusive breastfeeding as perceived by pregnant teenagers in the Greater Accra Region of Ghana which is an urban area. Methods The study used techniques in qualitative descriptive exploration to collect data from 30 pregnant teenagers through focus group discussions. Six focus group discussions were conducted and each group was made up of five participants. Informed consent was obtained from participants who were 18 years and above as well as parents of participants below 18 years while informed assent was obtained from participants below 18 years after purposive sampling. Interviews were audiotaped, transcribed and data were analysed through content analysis. Results Two major themes and eight sub themes emerged from the data after analysis. Personal related barriers (negative emotional feelings, irrational thinking, perceived health risks to the baby and perceived self-inefficacy) and social related barriers (provider-client interaction, disapproval of exclusive breastfeeding by close relatives, unfriendly workplace policies and social myths) were the perceived factors that discouraged exclusive breastfeeding among teenage mothers. Conclusion Health professionals should be trained to provide culturally sensitive care to teenage mothers in order to promote exclusive breastfeeding. The media, religious leaders and politicians should help debunk misconceptions about breastfeeding expressed by participants in the study.
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Affiliation(s)
| | | | - Lydia Aziato
- University of Health and Allied Sciences, Ho, Ghana
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2
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Cheshmeh S, Nachvak SM, Hojati N, Elahi N, Heidarzadeh‐Esfahani N, Saber A. The effects of breastfeeding and formula feeding on the metabolic factors and the expression level of obesity and diabetes-predisposing genes in healthy infants. Physiol Rep 2022; 10:e15469. [PMID: 36200185 PMCID: PMC9535349 DOI: 10.14814/phy2.15469] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Diabetes mellitus (DM) and obesity are common illnesses characterized by glucose metabolism issues and excessive weight gain. Breastfeeding is the best way to feed a newborn up to 6 months old and it has been shown to reduce the risk of diabetes and obesity later in life due to its nutritional properties. The purpose of this study was to investigate the effects of breastfeeding, formula feeding, and formula-plus breastfeeding (mix-feeding) on the anthropometric indices, metabolic variables, and the expression level of obesity and diabetes-predisposing genes of healthy infants. A total of 150 healthy infants were enrolled in this cross-sectional study. All infants (aged 24 months) were divided into three groups based on the type of feeding, breastfeeding, formula feeding, and mix-feeding. The anthropometric indices, glycemic indexes, lipid profile, and the expression levels of acetyl-coenzyme A carboxylase beta (ACACB), brain-derived neurotrophic factor (BDNF), liver X receptor α (LXR-α), peroxisome proliferator-activated receptor γ (PPAR-γ), and phosphatase and tensin homolog (PTEN) genes were measured in all infants using reverse transcription-polymerase chain reaction (RT-PCR) method. The anthropometric indices including weight, height, head circumference, insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were lower in the breastfeeding infants in comparison to other groups. As well, the expression level of the ACACB gene was significantly downregulated in breastfeeding infants, while the PPAR-γ gene was significantly upregulated, but the expression levels of LXR- α, PTEN and BDNF did not change significantly across groups. Breastfeeding compared to formula feeding had positive effects on anthropometric indices, metabolic variables, and diabetes-predisposing genes.
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Affiliation(s)
- Sahar Cheshmeh
- Department of Nutritional Sciences, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
- Student Research Committee, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
| | - Seyed Mostafa Nachvak
- Department of Nutritional Sciences, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
| | - Niloofar Hojati
- Department of Nutritional Sciences, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
- Student Research Committee, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
| | - Negin Elahi
- Department of Nutritional Sciences, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
- Student Research Committee, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
| | - Neda Heidarzadeh‐Esfahani
- Department of Nutritional Sciences, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
- Student Research Committee, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
| | - Amir Saber
- Department of Nutritional Sciences, School of Nutritional Sciences and Food TechnologyKermanshah University of Medical SciencesKermanshahIran
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3
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Reichental ZL, O'Brien VM, O'Reilly SL. Interventions to support women with overweight or obesity or gestational diabetes mellitus to initiate and continue breastfeeding: Systematic review and meta-analysis. Obes Rev 2022; 23:e13371. [PMID: 34617394 DOI: 10.1111/obr.13371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 12/19/2022]
Abstract
Exclusive breastfeeding is recommended for the first 6 months of life and benefits both mother and child. Women with overweight/obesity or gestational diabetes are at risk for poor breastfeeding outcomes. This review evaluates the efficacy of breastfeeding interventions in these at-risk populations. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Five databases were searched for interventions from inception to May 2020. Nineteen trials including 2,740 participants, 226 of which were dyads, were included. Intervention increased any breastfeeding at ≥6 months (OR 1.43, 95% CI [1.05-1.95]), and women in the intervention group were 90% more likely to exclusively breastfeed at 1-2 weeks (OR 1.9, 95% CI [1.17-3.09]) and more than twice as likely to exclusively breastfeed at 4-6 weeks (OR 2.23, 95% CI [1.27-3.90]) within the sensitivity analysis. These findings support breastfeeding interventions improving exclusive early postpartum breastfeeding and any breastfeeding from 6 months in women with gestational diabetes or obesity/overweight. Further randomized controlled trials with harmonized breastfeeding outcome reporting are needed to confirm efficacy.
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Affiliation(s)
- Zoe L Reichental
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Victoria M O'Brien
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
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4
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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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5
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Standish KR, Parker MG. Social Determinants of Breastfeeding in the United States. Clin Ther 2021; 44:186-192. [PMID: 34906370 DOI: 10.1016/j.clinthera.2021.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022]
Abstract
Despite overall improvement in breastfeeding in the past 3 decades in the United States, significant and alarming social disparities persist. Adverse social determinants of health are increasingly recognized as root causes of social disparities in health outcomes, including breastfeeding initiation and continuation. We provide an overview of the evidence and mechanisms by which social determinants of health, including education, employment, food, neighborhood, and housing contribute to ongoing social disparities in breastfeeding in the United States, including current research gaps. We also review the intersection of social determinants of health with income, racism, and theory of planned behavior, a commonly used decision-making framework for breastfeeding promotion. Future interventions to address social determinants of breastfeeding should occur at the policy, community, organization, and individual levels.
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Affiliation(s)
- Katherine R Standish
- Department of Family Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
| | - Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
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6
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Misita D, Yamamoto JM, Yuan Y, Donovan LE, Bell RC, Jarman M. An exploration of differences in infant feeding practices among women with and without diabetes in pregnancy: A mixed-methods study. Diabet Med 2021; 38:e14635. [PMID: 34265117 DOI: 10.1111/dme.14635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
AIMS (1) To determine the likelihood of full breastfeeding at 3 months postpartum in women with and without diabetes in pregnancy (DiP); (2) to explore the associations between diabetes management practices and infant feeding practices in those who had DiP and (3) to examine women's experiences of feeding their infants after having DiP. METHODS The quantitative study used data from Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study. Participants who had DiP (n = 62) were matched 1:3 to participants without DiP for pre-pregnancy BMI, parity, mode of delivery and pre-term birth. Infant feeding questionnaires, prospective breastfeeding diaries and medical chart data were analysed to determine likelihood of fully breastfeeding at 3 months postpartum. For the qualitative study, interviews were conducted with postpartum women who had DiP to explore the experiences of infant feeding. Interviews were thematically analysed, and the results were compared between women who were categorized as 'full breast feeders' or 'mixed feeders'. RESULTS The odds of fully breastfeeding were 50% lower in women with DiP than women without DiP (OR: 0.50, 95% CI 0.25-0.99, p = 0.04). Qualitative interviews identified that although all women showed resilience in the face of infant feeding challenges, those who were fully breastfeeding reported seeking out external infant feeding supports, for example, classes or Doula's. Mixed Feeders perceived there was a lack of infant feeding information and support given to them prior to giving birth. CONCLUSION Women with DiP may require additional prenatal and postnatal infant feeding support to be better prepared to overcome feeding challenges they may face.
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Affiliation(s)
- Dragana Misita
- Department of Agricultural, Food and Nutritional Sciences, Division of Human Nutrition, University of Alberta, Edmonton, AB, Canada
| | - Jennifer M Yamamoto
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Medicine, Division of Endocrinology and Metabolism, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lois E Donovan
- Department of Medicine, Division of Endocrinology and Metabolism, Department of Obstetrics and Gynecology, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Sciences, Division of Human Nutrition, University of Alberta, Edmonton, AB, Canada
| | - Megan Jarman
- Department of Agricultural, Food and Nutritional Sciences, Division of Human Nutrition, University of Alberta, Edmonton, AB, Canada
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7
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The Effect of a Structured Individualized Educational Intervention on Breastfeeding Rates in Greek Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111359. [PMID: 34769876 PMCID: PMC8582789 DOI: 10.3390/ijerph182111359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Breastfeeding rates remain extremely low in Greece and women with gestational diabetes mellitus and hypothyroidism may experience additional difficulties. The aim of the study was to investigate the effect of a structured individualized lactation educational intervention by a midwife on increasing breastfeeding rates in women with endocrine disorders and low-risk women compared to women receiving standard care, 24 months after delivery. Two-hundred women made up the study population. Half of them were experiencing endocrine pregnancy disorders and 100 women constituted the low-risk pregnancy standard care control group. Women who were breastfeeding exclusively were significantly higher in the midwifery intervention group with endocrine disorders, namely breastfeeding continued at four months (breastfeeding: 20% vs. 12%, exclusive breastfeeding: 50% vs. 26%, p = 0.0228), and at six months after childbirth (breastfeeding: 54% vs. 28%, exclusive breastfeeding: 32% vs. 12%, p = 0.0011), compared to the standard care control group with endocrine disorder. The low-risk midwifery intervention group breastfed at four months (22% vs. 14%, p = 0.0428) and at six months (52% vs. 26%, p = 0.0018) at higher rates compared to the standard care control group. In addition, exclusive breastfeeding was significantly higher in the low-risk midwifery intervention group at four months (46% vs. 20%, p = 0.0102) and six months (38% vs. 4%, p < 0.0001) compared to the standard care control group. This study was the first attempt of a structured midwifery breastfeeding education in Greece and its major contribution reflects a significant positive impact on breastfeeding rates in terms of duration and exclusivity in women with gestational endocrine disorders as well as in low-risk women, and could possibly be applied and instituted in everyday clinical practice to increase the low breastfeeding rates in Greece.
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8
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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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9
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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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10
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Rudland VL, Price SAL, Hughes R, Barrett HL, Lagstrom J, Porter C, Britten FL, Glastras S, Fulcher I, Wein P, Simmons D, McIntyre HD, Callaway L. ADIPS 2020 guideline for pre-existing diabetes and pregnancy. Aust N Z J Obstet Gynaecol 2020; 60:E18-E52. [PMID: 33200400 DOI: 10.1111/ajo.13265] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
This is the full version of the Australasian Diabetes in Pregnancy Society (ADIPS) 2020 guideline for pre-existing diabetes and pregnancy. The guideline encompasses the management of women with pre-existing type 1 diabetes and type 2 diabetes in relation to pregnancy, including preconception, antepartum, intrapartum and postpartum care. The management of women with monogenic diabetes or cystic fibrosis-related diabetes in relation to pregnancy is also discussed.
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Affiliation(s)
- Victoria L Rudland
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah A L Price
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Diabetes, Royal Women's Hospital, Melbourne, Victoria, Australia.,Mercy Hospital for Women, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth Hughes
- Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
| | - Helen L Barrett
- Department of Endocrinology, Mater Health, Brisbane, Queensland, Australia.,Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Janet Lagstrom
- Green St Specialists Wangaratta, Wangaratta, Victoria, Australia.,Denis Medical Yarrawonga, Yarrawonga, Victoria, Australia.,Corowa Medical Clinic, Corowa, New South Wales, Australia.,NCN Health, Numurkah, Victoria, Australia
| | - Cynthia Porter
- Geraldton Diabetes Clinic, Geraldton, Western Australia, Australia
| | - Fiona L Britten
- Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Mater Private Hospital and Mater Mother's Private Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Glastras
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ian Fulcher
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Peter Wein
- Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Simmons
- Western Sydney University, Sydney, New South Wales, Australia.,Campbelltown Hospital, Sydney, New South Wales, Australia
| | - H David McIntyre
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Mater Health, Brisbane, Queensland, Australia
| | - Leonie Callaway
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Women's and Children's Services, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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11
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Gestational Diabetes Mellitus Is Associated with Age-Specific Alterations in Markers of Adiposity in Offspring: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093187. [PMID: 32375312 PMCID: PMC7246521 DOI: 10.3390/ijerph17093187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022]
Abstract
Maternal hyperglycemia alters an offspring’s metabolic health outcomes, as demonstrated by the increased risk for obesity, impaired glucose handling and diabetes from early childhood onwards. Infant growth patterns are associated with childhood adiposity and metabolic health outcomes and, as such, can be used as potential markers to detect suboptimal metabolic development at an early age. Hence, we aimed to assess whether gestational diabetes mellitus (GDM) has an impact on offspring growth trajectories. Outcomes included weight gain (WG), body mass index (BMI), and skin fold thickness (SFT) measured at least at two time points from birth to later childhood. In addition, we explored the role of early life pre- and post-natal nutritional modifiable factors on longitudinal growth in infants of mother with GDM (GDM–F1). Despite the large heterogeneity of the studies, we can still conclude that GDM seems to be associated with altered growth outcomes in the offspring. More specifically, these alterations in growth outcomes seem to be rather time-specific. Increased SFT were reported particularly at birth, with limited information on reporting SFT between 2–5 y, and increased adiposity, measured via SFT and BMI, appeared mainly in later childhood (5–10 y). Studies evaluating longitudinal growth outcomes suggested a potential role of early life nutritional modifiable factors including maternal nutrition and breastfeeding. These may impact the cycle of adverse metabolic health by attenuating growth outcome alterations among GDM–F1. Conclusions: Timely diagnoses of growth deviations in infancy are crucial for early identification of GDM–F1 who are at risk for childhood overweight and metabolic disease development.
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Neonatal Vitamin D Status and Risk of Asthma in Childhood: Results from the D-Tect Study. Nutrients 2020; 12:nu12030842. [PMID: 32245170 PMCID: PMC7146263 DOI: 10.3390/nu12030842] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/06/2023] Open
Abstract
Background: low vitamin D status in pregnancy can influence the offspring’s lung function and contribute to childhood asthma development. The objective of this study was to examine the influence of neonatal vitamin D status on the development of asthma among children age 3–9 years in a large population sample. Method: in a case-cohort study utilizing a Danish biobank and register data we examined the association between neonatal 25-hydroxyvitamin D3 (25(OH)D3) concentrations and incidence of asthma among children aged 3–9 years. Cases of asthma (n = 911) were randomly selected among all cases of asthma in the Danish National Patient Register from children born between 1992 and 2002. The sub-cohort (n = 1423) was randomly selected among all children born in the same period. We used a weighted Cox proportional hazard model assessing the hazard of first asthma diagnoses by quintiles of 25(OH)D3. Results: the median 25(OH)D3 (interquartile range) for asthma cases was 23 nmol/L (14–35) and the sub-cohort 25 nmol/L (14–40). The hazard ratio for developing asthma between ages 3 and 9 years was lower for children in the fifth quintile of neonatal 25(OH)D3 compared to children in the first quintile, both in the unadjusted (0.61 95% CI: 0.46–0.80) and adjusted (0.55 95% CI: 0.39–0.77) analyses. Conclusion: the results from our study suggest that higher neonatal vitamin D concentration may reduce the risk of developing childhood asthma at ages 3–9 years, indicating that neonatal vitamin D status as a proxy of vitamin D status during the prenatal period is important for normal immune- and lung development.
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13
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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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14
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Sauder KA, Bekelman TA, Harrall KK, Glueck DH, Dabelea D. Gestational diabetes exposure and adiposity outcomes in childhood and adolescence: An analysis of effect modification by breastfeeding, diet quality, and physical activity in the EPOCH study. Pediatr Obes 2019; 14:e12562. [PMID: 31274243 PMCID: PMC6844624 DOI: 10.1111/ijpo.12562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intrauterine exposure to gestational diabetes (GDM) is associated with increased adiposity; however, not all offspring exposed to GDM exhibit excess adiposity. OBJECTIVES Examine whether optimal diet and activity behaviours in infancy, childhood, and adolescence modify the association between GDM exposure and adiposity. METHODS In 564 offspring (84 exposed to GDM), we assessed breastfeeding (maternal recall), dietary intake (food frequency questionnaire), physical activity (3-day recall), and adiposity (BMI, waist-to-height ratio, visceral and subcutaneous adipose tissue, and subscapular-to-triceps skinfold ratio) at 10.4 (SD, 1.5) and 16.7 (SD, 1.2) years. Optimal behaviours were defined as >6 breastmilk months, Healthy Eating Index score >60, and daily vigorous activity >1 hour. Linear mixed models assessed the association between GDM exposure and adiposity among those with optimal versus suboptimal health behaviours, adjusting for sex, race/ethnicity, age, and pubertal status. RESULTS GDM exposure was associated with increased skinfold ratio, visceral and subcutaneous adipose tissue among those with <6 breastmilk months (all Ps < .05), but only associated with increased skinfold ratio among those with >6 breastmilk months (P = .01). GDM exposure was associated with increases in all adiposity measures among those with Healthy Eating Index scores <60 (P < .01), but not those with scores >60 (P > .10). GDM exposure was associated with increased BMI and subcutaneous adipose tissue among those with >1 hour of vigorous activity (P < .05) but not among those with <1 hour of vigorous activity (P > .30). CONCLUSIONS The association of GDM exposure with excess adiposity is attenuated in offspring with more optimal diet and activity behaviours in infancy, childhood, and adolescence.
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Affiliation(s)
- Katherine A Sauder
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Traci A Bekelman
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Kylie K Harrall
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Deborah H Glueck
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO, USA
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15
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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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16
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Dalsgaard BT, Rodrigo-Domingo M, Kronborg H, Haslund H. Breastfeeding and skin-to-skin contact as non-pharmacological prevention of neonatal hypoglycemia in infants born to women with gestational diabetes; a Danish quasi-experimental study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 19:1-8. [PMID: 30928129 DOI: 10.1016/j.srhc.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 10/10/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the effect on infant blood glucose levels of an intervention consisting of early, frequent breastfeeding and two hours of immediate uninterrupted skin-to-skin contact following birth of term infants born to mothers with diet-treated gestational diabetes (GDM). STUDY DESIGN Quasi-experimental study design with a historical control group (n = 132) and an intervention group (n = 401) testing a procedure to prevent neonatal hypoglycemia. MAIN OUTCOME MEASURES Data collection on blood glucose levels, hypoglycemia incidence with a cut-off of <2.5 mmol/l, breastfeeding within the first two hours after birth, breastfeeding frequency within the first six hours, and amount of formula given to hypoglycemic infants. RESULTS Mean blood glucose levels in the intervention group at two and four hours were within safe limits: 3.37 mmol/l (95% CI: [3.30, 3.44]) and 3.40 mmol/l (95% CI: [3.34, 3.46]), respectively. Infants suffering a hypoglycemic event within four hours after birth decreased from 22.7% (n = 30/132) in the control group to 10.2% (n = 41/401) in the intervention group. The mean number of breastfeeds in the intervention group (six hours) was 2.41 compared to 1.34 in the control group (seven hours), an increase of 80%. Only 41 of 401 infants in the intervention group were interrupted in immediate interaction with their mother because of hypoglycemia. We failed to obtain sufficient data on skin-to-skin contact. CONCLUSION Maintaining skin-to-skin contact for infants of mothers with diet-treated GDM, monitoring blood glucose levels until obtaining two values >2.4 mmol/l and encouraging early frequent breastfeeding is a safe strategy to prevent hypoglycemia.
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Affiliation(s)
- Bente Thorup Dalsgaard
- Maternity Ward, Clinic for Woman-Child Diseases and Urology, Aalborg University Hospital, Denmark.
| | | | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Denmark
| | - Helle Haslund
- Clinical Nursing Research Unit, Clinical Institute, Aalborg University, Denmark; Maternity Ward, Clinic for Woman-Child Diseases and Urology, Aalborg University Hospital, Denmark
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17
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Environmental and individual predictors of 25-hydroxyvitamin D concentrations in Denmark measured from neonatal dried blood spots: the D-tect study. Br J Nutr 2019; 121:567-575. [PMID: 30526709 DOI: 10.1017/s0007114518003604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Environmental factors such as sunshine hours, temperature and UV radiation (UVR) are known to influence seasonal fluctuations in vitamin D concentrations. However, currently there is poor understanding regarding the environmental factors or individual characteristics that best predict neonatal 25-hydroxyvitamin D (25(OH)D) concentrations. The aims of this study were to (1) identify environmental and individual determinants of 25(OH)D concentrations in newborns and (2) investigate whether environmental factors and individual characteristics could be used as proxy measures for neonatal 25(OH)D concentrations. 25-Hydroxyvitamin D3 (25(OH)D3) was measured from neonatal dried blood spots (DBS) of 1182 individuals born between 1993 and 2002. Monthly aggregated data on daily number of sunshine hours, temperature and UVR, available from 1993, were retrieved from the Danish Meteorological Institute. The individual predictors were obtained from the Danish National Birth register, and Statistics Denmark. The optimal model to predict 25(OH)D3 concentrations from neonatal DBS was the one including the following variables: UVR, temperature, maternal education, maternal smoking during pregnancy, gestational age at birth and parity. This model explained 30 % of the variation of 25(OH)D3 in the neonatal DBS. Ambient UVR in the month before the birth month was the best single-item predictor of neonatal 25(OH)D3, accounting for 24 % of its variance. Although this prediction model cannot substitute for actual blood measurements, it might prove useful in cohort studies ranking individuals in groups according to 25(OH)D3 status.
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18
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Baerug A, Sletner L, Laake P, Fretheim A, Løland BF, Waage CW, Birkeland KI, Jenum AK. Recent gestational diabetes was associated with mothers stopping predominant breastfeeding earlier in a multi-ethnic population. Acta Paediatr 2018; 107:1028-1035. [PMID: 29432660 DOI: 10.1111/apa.14274] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/29/2017] [Accepted: 02/07/2018] [Indexed: 01/09/2023]
Abstract
AIM It has previously been shown that breastfeeding may reduce the risk of type 2 diabetes in mothers with recent gestational diabetes mellitus (GDM). This study compared the cessation of predominant breastfeeding in mothers with and without recent GDM in a multi-ethnic population. METHODS From May 2008 to May 2010, healthy pregnant women attending antenatal care provided by community health services in Eastern Oslo, Norway were recruited. We included 616 women-58% non-Western-and interviewed and examined them at a mean of 15 and 28 weeks of gestation and 14 weeks' postpartum. Cox regression models examined the association between GDM, as assessed by the 2013 World Health Organization criteria, and breastfeeding cessation. RESULTS Overall, 190 of the 616 (31%) mothers had GDM and they ended predominant breastfeeding earlier than mothers without GDM, with an adjusted hazard ratio (aHR) of 1.33 and 95% confidence interval (95% CI) of 1.01-1.77. Mothers of South Asian origin ended predominant breastfeeding earlier than Western European mothers in the adjusted analysis (aHR 1.53, 95% CI: 1.04-2.25), but Middle Eastern mothers did not. CONCLUSION Recent gestational diabetes was associated with earlier cessation of predominant breastfeeding in Western European and non-Western women.
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Affiliation(s)
- Anne Baerug
- Norwegian National Advisory Unit on Breastfeeding; Oslo University Hospital; Oslo Norway
| | - Line Sletner
- Department of Pediatric and Adolescents Medicine; Akershus University Hospital; Lørenskog Norway
| | - Petter Laake
- Oslo Centre for Biostatistics and Epidemiology; Department of Biostatistics; University of Oslo; Oslo Norway
| | - Atle Fretheim
- Division for Health Services; Norwegian Institute of Public Health; Oslo Norway
- Institute of Health and Society; University of Oslo; Oslo Norway
| | - Beate Fossum Løland
- Norwegian National Advisory Unit on Breastfeeding; Oslo University Hospital; Oslo Norway
| | - Christin W. Waage
- Department of General Practice; Institute of Health and Society; Faculty of Medicine; University of Oslo; Oslo Norway
| | - Kåre I. Birkeland
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Transplantation Medicine; Oslo University Hospital; Oslo Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE); Department of General Practice; Institute of Health and Society; University of Oslo; Oslo Norway
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19
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Hui LL, Li AM, Nelson EAS, Leung GM, Lee SL, Schooling CM. In utero exposure to gestational diabetes and adiposity: does breastfeeding make a difference? Int J Obes (Lond) 2018; 42:1317-1325. [PMID: 29777227 DOI: 10.1038/s41366-018-0077-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Short-term breastfeeding from mothers with gestational diabetes (GDM) may programme metabolism and increase offspring diabetes risk. We examined the association of in utero GDM exposure with adiposity from infancy to adolescence, and whether any association was modified by breastfeeding during early infancy. METHODS In the prospective Chinese birth cohort "Children of 1997" (n = 7342, 88% follow-up rate), generalised estimate equations with multiple imputation were used to assess associations of in utero GDM exposure with age- and sex-specific body mass index (BMI) z-score during infancy (3 and 9 months), childhood (2- < 8 years) and adolescence (8-16 years), adjusted for sex, parity, maternal age, birth place, preeclampisa, smoking, and family socio-economic position. We also tested whether the associations differed by mode of infant feeding (always formula-fed, mixed, always breastfed) during the first three months of life. RESULTS In utero GDM exposure (7.5%) was associated with a lower BMI z-score during infancy (-0.13, 95% confidence interval (CI) -0.22, -0.05) but higher BMI z-scores during childhood (0.14, 95% CI 0.03, 0.25) and adolescence (0.25 95% CI 0.11, 0.38). Breastfeeding for the first three months did not modify the association of in utero GDM status with subsequent BMI (all p values for interaction >0.4). CONCLUSIONS In utero GDM exposure was associated with greater adiposity during childhood and adolescence. Breastfeeding in early infancy from mothers with GDM was not associated with greater adiposity in children and thus should still be encouraged.
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Affiliation(s)
- L L Hui
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A M Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - E A S Nelson
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - S L Lee
- Department of Paediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China. .,CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
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20
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Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, East C, Ford R, Amir LH. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. Lancet 2017; 389:2204-2213. [PMID: 28589894 DOI: 10.1016/s0140-6736(17)31373-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/09/2017] [Accepted: 04/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia, admission to a neonatal intensive care unit (NICU), and not being exclusively breastfed. Many clinicians encourage women with diabetes in pregnancy to express and store breastmilk in late pregnancy, yet no evidence exists for this practice. We aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy. METHODS We did a multicentre, two-group, unblinded, randomised controlled trial in six hospitals in Victoria, Australia. We recruited women with pre-existing or gestational diabetes in a singleton pregnancy from 34 to 37 weeks' gestation and randomly assigned them (1:1) to either expressing breastmilk twice per day from 36 weeks' gestation (antenatal expressing) or standard care (usual midwifery and obstetric care, supplemented by support from a diabetes educator). Randomisation was done with a computerised random number generator in blocks of size two and four, and was stratified by site, parity, and diabetes type. Investigators were masked to block size but masking of caregivers was not possible. The primary outcome was the proportion of infants admitted to the NICU. We did the analyses by intention to treat; the data were obtained and analysed masked to group allocation. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000217909. FINDINGS Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [<1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [<1%] of 315). INTERPRETATION There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia.
| | - Anita M Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia
| | - Susan E Jacobs
- Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Peter G Davis
- Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
| | | | - Gillian F Opie
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | | | | | - Christine East
- School of Nursing and Midwifery, Monash University and Monash Health, Clayton, VIC, Australia
| | - Rachael Ford
- Royal Women's Hospital, Parkville, VIC, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia
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