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

Decision-making process of breastfeeding behavior in mothers with gestational diabetes mellitus based on health belief model

BACKGROUND

Gestational diabetes mellitus (GDM) threatens GDM mothers and their offspring's health and breastfeeding is one of the most effective ways to decrease the risk. However, the prevalence of breastfeeding among GDM mothers is far from optimal and how GDM mothers develop their feeding behavior is still unclear. Thus, this study aimed to explore the formation of GDM mothers' breastfeeding behaviors based on the health belief model (HBM).

METHODS

A questionnaire survey was conducted on 324 GDM mothers who have given birth within 6 months from January 1 to February 6, 2022. According to HBM, GDM mothers' knowledge, the perceived threat from GDM, the perceived value of breastfeeding, self-efficacy, social support and GDM mothers' breastfeeding behavior were measured. Exclusive breastfeeding (EBF) was defined as an infant who received only breast milk in the past 24 h before the survey. Structural equation modeling (SEM) was applied to explore how GDM mothers form their breastfeeding behaviors based on HBM.

RESULTS

The prevalence of EBF among GDM mothers was 33.95%. GDM mothers had limited knowledge of GDM (average 63.14% correct answer to 7 questions), especially poor on the long-term effect of GDM (39.81%) and protective effect of breastfeeding (34.57%-45.99%). Although GDM mothers showed high perceived benefits (Mean: 3.35, SD: 0.46), high self-efficacy (Mean: 3.43, SD: 0.97) and high level of social support for breastfeeding (Mean: 3.74, SD: 0.74), the various barriers (Mean: 2.20, SD: 0.47) hindered their success in EBF. The SEM results showed that a higher level of social support and more self-efficacy of breastfeeding resulted in a higher likelihood of EBF, while the higher level of knowledge of GDM, perceived higher barriers and benefits of breastfeeding and higher susceptibility to GDM consequences led to less EBF.

CONCLUSION

To promote EBF, physicians' education, emphasizing the protective effect of breastfeeding and how to correct breastfeeding, is highly recommended. In addition, social support for GDM mothers is also important to reduce their barriers to breastfeeding and help enhance self-efficacy in breastfeeding.

Maternal Gestational Diabetes Is Associated with High Risk of Childhood Overweight and Obesity: A Cross-Sectional Study in Pre-School Children Aged 2–5 Years

Background and Objectives: Childhood obesity is a global public health concern with long-term and serious health implications. An important factor for childhood obesity is maternal gestational diabetes mellitus (GDM), which in turn impacts maternal and offspring long-term health. This study aimed to investigate the associations between maternal GDM and childhood weight status and multiple anthropometric and sociodemographic factors and perinatal outcomes. Materials and Methods: A total of 5348 children aged 2–5 years old and their paired mothers took part in the study. Questionnaires were utilized to evaluate the sociodemographic factors and perinatal outcomes as well as smoking habits, educational level, economic status, age, and parity status. Children’s anthropometric parameters were measured, and maternal medical history, preterm birth records, and anthropometric measures during pregnancy were retrieved by their medical records. Results: Overall, 16.4% of the children aged at 2–5 years were overweight, and 8.2% of them were affected by obesity, leading to a total 24.6% of children with overweight/obesity. Further, 5.5% of the enrolled mothers were diagnosed with gestational diabetes mellitus. GDM doubles the probability of childhood overweight/obesity at ages 2–5 years old independently of multiple confounding factors. Pre-pregnancy overweight and obesity, older maternal age, and smoking are risk factors for GDM, while GDM additionally increases the risk of preterm birth. Children of mothers that developed GDM were at greater risk of overweight or obesity, with the association between GDM and offspring’s weight status being independent of confounding factors. Conclusions: GDM is a severe public health issue with prolonged complications for both the mother and their children. Public health approaches and programs need to promote the negative role of pre-pregnancy weight and smoking status as well as the significance of a good glycemic control throughout gestation in women of childbearing age.

Relationship between Maternal Postpartum Intention to Breastfeed and Actual Breastfeeding Duration - Four Provinces, China, 2015-2017

What is already known about this topic?

Several studies have reported that maternal antenatal intention to breastfeed is a strong predictor of actual breastfeeding duration. However, little research has investigated whether maternal postpartum intention also extends breastfeeding duration.

What is added by this report?

Maternal postpartum intention to breastfeed was a protective factor for extending actual breastfeeding duration after controlling potential confounders.

What are the implications for public health practice?

It is crucial to address and promote intrinsic and extrinsic factors that influence a mother's intention to breastfeed after delivery, thereby extending the actual breastfeeding duration.

Factors Influencing Early Initiation of Breastfeeding in Healthy Term Newborns: A Cross-Sectional Study at a Tertiary Care Center in South India

Background: Despite well-known benefits, rates of exclusive breastfeeding and early initiation of breastfeeding are very low. This study was conducted to identify most important and easily modifiable barriers to Early Initiation of Breast Feeding (EIBF).Methods: This hospital-based cross-sectional study was conducted from January 2018 to December 2018. Data on factors which could impact EIBF was collected by interviewing with mothers using semi-structured questionnaire.Results: Only 306 (33.7 percent) of the total 908 mother-neonate dyads enrolled received breastfeeding within 1 hour of birth. Factors affecting EIBF included: delivery by lower segment cesarean section (LSCS), lack of prenatal advice on breastfeeding, use of prelacteal feeds, and maternal illness.Conclusion: Rates of EIBF were very low in present setting. Counseling during antenatal visits on the importance of EIBF, and having adequate staff to support initiation of BF, may improve the EIBF.

Predictors of Prenatal Breastfeeding Self-Efficacy in Expectant Mothers with Gestational Diabetes Mellitus

Breastfeeding is beneficial for mothers with gestational diabetes mellitus (GDM). Saudi Arabia is considered one of the countries with the highest prevalence of GDM. Mothers with GDM have a low intention to breastfeed and are less likely to continue breastfeeding. This study aimed to measure breastfeeding self-efficacy among expectant mothers with GDM and quantify its determinants. This cross-sectional study recruited expectant mothers with GDM from an antenatal care clinic and queried them on breastfeeding knowledge and attitudes using the Arabic validated prenatal breastfeeding self-efficacy scale (PBSES). The study took place at the Medical City of King Saud University, during January–April 2021. The average PBSES score among 145 GDM Saudi participants was 64.07 ± 16.3. Higher academic level, previous satisfactory breastfeeding experiences, breastfeeding intention, six months or more breastfeeding experience, and health education were significantly positively correlated with PBSES score. A higher knowledge score was also correlated with a higher PBSES score (p = 0.002). Longer breastfeeding duration (β.197, p = 0.036), satisfactory previous breastfeeding experience (β.218, p = 0.020), and higher knowledge score (β.259, p = 0.004) were significant predictors of a high PBSES score. Breastfeeding self-efficacy is low among expectant Saudi mothers with GDM, especially those with unsatisfactory previous experience or low knowledge scores. Establishing systematic education about breastfeeding during antenatal care is recommended to improve breastfeeding experience and improve GDM outcomes.

How breastfeeding behavior develops in women with gestational diabetes mellitus: A qualitative study based on health belief model in China

BACKGROUND

Gestational diabetes mellitus (GDM) is a condition in which women develop hyperglycemia during pregnancy, and is associated with long-term health burden on both mother and their offspring, such as future type 2 diabetes mellitus (T2DM). Although breastfeeding was expected to mitigate metabolic sequelae for both mothers and their newborns, the prevalence of breastfeeding in GDM mothers are sub-optimal worldwide.

OBJECTIVE

To explore the experience of disease among mothers with GDM and how they develop feeding behaviors.

METHODS

This study was conducted in three branches of an integrated tertiary hospital in the central area of China. Mothers who were diagnosed with GDM, had no other complications, and gave birth before no more than 6 months were approached based on a purposive sampling. GDM mothers' experience of the disease and breastfeeding were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM.

RESULTS

16 GDM mothers were included in the current study, with nine using breastfeeding, six mixed feeding and one artificial feeding, respectively. Nine themes were identified, including: 1) GDM diagnosis and severity; 2) information searching and GDM knowledge;3) GDM management; 4) perceived susceptibility of future diabetes;5) perceived severity of future diabetes;6) perceived benefits of breastfeeding;7) perceived barriers of breastfeeding;8) decision making process of feeding and social support. Generally, mothers with GDM lack reliable sources of information, considered the disease as a minor and transient illness during pregnancy, and failed to realize the long-term risk of GDM and the protective effect of breastfeeding to themselves and their babies. They rarely considered GDM in their feeding decision. Instead, the formation of feeding behaviors depends on the balance between the benefits and barriers of breastfeeding as well as the level of social support.

CONCLUSION

To promote breastfeeding, a multi-facet intervention targeted on healthcare providers (HCPs), GDM mothers and their networks was important to help GDM mothers better and correctly understand the disease and breastfeeding, and increase their capacity of breastfeeding.

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.

Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review

A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute’s methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.