The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production

The prospective associations of fetal growth-related pregnancy complications with subsequent breastfeeding duration and markers of human milk production

BACKGROUND

The development of the breast for lactation occurs throughout pregnancy. It is unknown whether pregnancy complications resulting in poor fetal growth can affect breastfeeding (BF) success.

OBJECTIVES

We examined whether fetal growth-related pregnancy complications were associated with earlier BF cessation and changes in the concentrations of human milk biomarkers of low milk production.

METHODS

We used data from the Growing Up in Singapore Toward healthy Outcomes study (n = 954). Human milk concentrations of protein, lactose, citrate, sodium, potassium, and zinc at 3 wk postpartum were available for 180 mother-infant dyads. We examined the associations of fetal growth measures, including term infants born small-for-gestational-age (SGA) (<10th percentile), pregnancies complicated by fetal growth deceleration (second to third trimester fetal growth dropped between major centiles), elevated umbilical artery resistance (>90th percentile) or hypertensive disorders of pregnancy (HDP) with 1) risk of ceasing BF (Cox regression) and 2) concentrations of human milk components (weighted linear regression).

RESULTS

Adjusting for maternal education, smoking exposure, BF intentions, and prepregnancy BMI (in kg/m2), individuals who delivered SGA infants and those with HDP were more likely to breastfeed for a shorter duration when compared to those with uncomplicated pregnancies {adjusted hazard ratio [95% confidence interval (CI)]: 1.45 (1.11, 1.89) and 1.61 (1.14, 2.29), respectively}; associations were nonsignificant for fetal growth deceleration and umbilical artery resistance. SGA was not associated with concentrations of human milk biomarkers, but compared to participants with uncomplicated pregnancies, milk produced by those with HDP contained lower zinc concentrations [adjusted β coefficient (95% CI): -0.56 mg/L (-1.08, -0.04) mg/L].

CONCLUSIONS

Individuals with HDP and those with SGA infants tend to breastfeed for a shorter duration; however, only HDP appear to be associated with biomarkers of compromised milk production. Further research and support are needed to help individuals with HDP and SGA achieve their BF goals. This trial was registered at clinicaltrials.gov as NCT01174875.

Gestational Diabetes Mellitus, Breastfeeding, and Progression to Type 2 Diabetes: Why Is It So Hard to Achieve the Protective Benefits of Breastfeeding? A Narrative Review

Women diagnosed with gestational diabetes mellitus (GDM) face a significantly heightened risk of developing type 2 diabetes mellitus (T2DM) later in life. Breastfeeding (BF) has been identified as a potential strategy to delay or prevent T2DM; however, women with GDM often encounter barriers in initiating and maintaining adequate BF practices compared to those with uncomplicated pregnancies. This paradox prompts an exploration into the causes of these BF challenges and considers the possibility of reverse causation: Does prolonged and intensive BF mitigate the risk of subsequent glucose dysregulation and T2DM? Alternatively, do women with compromised insulin secretion and sensitivity, who are predisposed to T2DM, struggle to sustain intensive BF practices? This narrative review aims to explore the interplay between GDM, BF, and T2DM development by examining the different factors that present BF challenges among women with GDM. Understanding these dynamics is crucial for establishing realistic BF expectations and developing effective clinical and public health strategies to support BF in this high-risk population.

The Association Between Prenatal Food Insecurity and Breastfeeding Initiation and Exclusive Breastfeeding Duration: A Longitudinal Study Using Oregon PRAMS and PRAMS-2, 2008-2015

Background: In the United States, 11.1% of households experience food insecurity; however, pregnant women are disproportionately affected. Maternal food insecurity may affect infant feeding practices, for example, through being a source of chronic stress that may alter the decision to initiate and continue breastfeeding. Thus, we sought to determine whether prenatal food insecurity was associated with breastfeeding (versus not) and exclusive breastfeeding duration among Oregon women. Method: The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) data of live births from 2008 to 2015 and the Oregon PRAMS-2 follow-up survey were used (n = 3,624) in this study. Associations with breastfeeding initiation and duration were modeled with multivariable logistic regression and accelerated failure time (AFT), respectively. Models were adjusted for maternal sociodemographic and pre-pregnancy health characteristics. Results: Nearly 10% of women experienced prenatal food insecurity. For breastfeeding initiation, unadjusted models suggested non-significant decreased odds (odds ratio (OR) 0.88 [confidence intervals (CI): 0.39, 1.99]), whereas adjusted models revealed a non-significant increased odds (OR 1.41 [CI: 0.58, 3.47]). Unadjusted AFT models suggested that food-insecure mothers had a non-significant decrease in exclusive breastfeeding duration (OR 0.76 [CI: 0.50, 1.17]), but adjustment for covariates attenuated results (OR 0.89 [CI: 0.57, 1.39]). Conclusions: Findings suggest minimal differences in breastfeeding practices when exploring food security status in the prenatal period, though the persistence of food insecurity may affect exclusive breastfeeding duration. Lower breastfeeding initiation may be due to other explanatory factors correlated with food insecurity and breastfeeding, such as education and marital status.

Explaining the experience of breastfeeding in women with gestational diabetes and designing and implementing an educational program based on planned behavior theory: a combined exploratory study protocol

BACKGROUND

Gestational diabetes is a type of carbohydrate intolerance that is diagnosed for the first time during pregnancy. Researches have shown that gestational diabetes is associated with many negative prenatal and birth outcomes. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. Research findings indicate a decrease in breastfeeding in mothers with gestational diabetes/ or contradictory tissues regarding the factors affecting the breastfeeding behavior of mothers with gestational diabetes and a special program to promote breastfeeding for these mothers based on the social and cultural conditions of Iranian society. The present study aims to design an interventional program with a mixed qualitative study based on the theory of planned behavior (PBT) to prevent the decrease of breastfeeding in diabetic mothers.

METHODS/DESIGN

A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase (qualitative): The purpose of the first phase is to understand the experience of breastfeeding mothers who had gestational diabetes, which will be done using the directed content analysis method. The purposive sampling will be used on pregnant mothers with gestational diabetes 30-34 weeks and mothers with infants (up to 6 months) with a history of gestational diabetes. The second phase include designing and implementing an educational program based on the PBT: Education will be conducted based on the needs assessment of the qualitative phase, the opinions of the focus group, and the literature review, then the breastfeeding behavior will be measured using the survey tool of "breastfeeding drop". The third phase: Interventional quantitative phase: The sample size will be carried out by a pilot study, then a designed program as an educational intervention for teaching breastfeeding behavior based on the PBT for 30-34 weeks pregnant mothers with gestational diabetes will be implemented during 3-4 sessions and breastfeeding behavior will be evaluated after delivery.

DISCUSSION

This is the first mixed-method study in Iran that led to implement an interventional program based on the theory of planned behavior. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. We hope that the result of this research will be a step in solving breastfeeding problems in mothers with gestational diabetes.

Delayed secretory activation and low milk production in women with gestational diabetes: a case series

Background

Gestational diabetes mellitus (GDM) is major pregnancy complication that is associated with short- and long-term consequences for both mother and infant, including increased risk of diabetes later in life. A longer breastfeeding duration has been associated with a reduced risk of diabetes, however, women with GDM are less likely to exclusively breastfeed and have shorter breastfeeding duration. While the timing of breastfeeding initiation and milk removal frequency affects subsequent breastfeeding outcomes, little is known about early infant feeding practices and milk production in women with GDM. This case series offers detailed prospective breastfeeding initiation data, as well as the first report of objective measures of milk production in women with GDM.

Case presentation

In this case series, we present the early infant feeding practices of eight women with GDM that gave birth at term gestation. Women recorded the timing of initiation of breastfeeding and secretory activation, as well as their breastfeeding, expression and formula feeding frequencies on postpartum days 1, 7 and 21. Measurement of 24 h milk production volume was performed at 3 weeks postpartum using the test weight method. We observed a delayed first breastfeed (> 1 h) in 6 (75%) cases, formula use in hospital in 5 (63%) cases and delayed secretory activation in 3 (38%) cases. At 3 weeks postpartum, 2 cases had measured milk productions that were insufficient to sustain adequate infant weight gain.

Conclusions

Our data suggest that despite early and frequent milk removal, women with GDM are at greater risk of delayed secretory activation and low milk supply. Cohort studies that consider co-morbidities such as obesity are needed to determine the lactation outcomes of women with GDM.

25 Years of Research in Human Lactation: From Discovery to Translation

Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.