Duration of Lactation and Maternal Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis

A specific metabolomic and lipidomic signature reveals the postpartum resolution of gestational diabetes mellitus or its evolution to type 2 diabetes in rat

Gestational diabetes mellitus (GDM) represents a major public health concern due to adverse maternal postpartum and long-term outcomes. Current strategies to manage GDM fail to reduce the maternal risk to develop later impaired glucose tolerance (IGT) and type 2 diabetes (T2D). In a rodent model of diet-induced GDM without obesity, we explored the perinatal metabolic adaptations in dams with gestational IGT followed by either persistent or resolved postpartum IGT. Female Sprague-Dawley rats were fed a high-fat high-sucrose (HFHS) or a chow [control group (CTL)] diet, 1 wk before mating and throughout gestation (G). Following parturition, HFHS dams were randomized to two subgroups: one switched to a chow diet and the other one maintained on an HFHS diet throughout lactation (L). Oral glucose tolerance tests (OGTTs) were performed, and plasma metabolome-lipidome were characterized at G12 and L12. We found that 1) in GDM-pregnant dams, IGT was associated with incomplete fatty acid oxidation (FAO), enhanced gluconeogenesis, altered insulin signaling, and oxidative stress; 2) improved glucose tolerance postpartum seemed to restore complete FAO along with elevation of nervonic acid-containing sphingomyelins, assumed to impart β-cell protection; and 3) persistence of IGT after delivery was associated with metabolites known to predict the early onset of insulin and leptin resistance, with maintained liver dysfunction. Our findings shed light on the impact of postpartum IGT evolution on maternal metabolic outcome after an episode of GDM. They suggest innovative strategies, implemented shortly after delivery and targeted on these biomarkers, should be explored to curb or delay the transition from GDM to T2D in these mothers.NEW & NOTEWORTHY Specific metabolomic/lipidomic features are associated with GDM postpartum outcomes. GDM-pregnant dams exhibit partial fatty acid oxidation and boosted gluconeogenesis. Resolution of postpartum IGT relies on nervonic acid-sphingomyelin, a β-cell protector. Postpartum IGT persistence suggests muscle insulin resistance and liver dysfunction.

Cardiometabolic Risk Clusters and Their Reproductive Correlates: A Latent Class Analysis of Indian Women

Background

Cardiometabolic conditions are rising among women in low- and middle-income countries and appearing at younger ages. The role of female reproductive characteristics in cardiometabolic risk is not well understood.

Methods

We analyzed seven reproductive characteristics and seven cardiometabolic indicators obtained from 644,191 non-pregnant women aged 15-49 years in the 2019-2021 India National Family and Health Survey (NFHS-5). We conducted a latent class analysis of cardiometabolic indicators (systolic and diastolic blood pressure, random blood glucose, body mass index, waist circumference, and use of anti-hyperglycemic and antihypertensive pharmacotherapy) to identify risk clusters. Multinomial logistic regression models accounting for age and sociodemographic characteristics assessed associations between reproductive characteristics (age at menarche, age at first birth, natural or surgical menopause, parity, time since last birth, experience of pregnancy loss, current contraceptive use) and cluster membership.

Results

Women had a median age of 29.4 (IQR: 21.5-38.4) years, were mostly married (71%), and resided in rural areas (68%). Five cardiometabolic clusters emerged: normal (36%), high-normal (46%), isolated-overweight (12%), hypertension-overweight (6%), and glucose dysregulation-overweight (1%). Early menarche (<13 years), early age at first birth (<20 years), and natural or surgical menopause were positively associated with two or more high-risk clusters (ORs: 1.13-1.62). Higher parity was associated with higher relative odds of isolated-overweight (ORs: 1.31-1.39), while longer time since last birth (≥ 8 years) was associated with hypertension-overweight (OR: 1.25 95% CI: 1.18-1.31) and glucose dysregulation-overweight (OR: 1.21, 95% CI: 1.07-1.37). Pregnancy loss increased the odds of all high-risk clusters (ORs: 1.21-1.42), while contraceptive use decreased the odds (ORs: 0.88-0.93).

Conclusions

Five cardiometabolic risk clusters were identified in Indian women, with cluster membership linked to reproductive characteristics. The timing of fertility milestones and reproductive history appear relevant for early risk stratification among women in early to middle adulthood.

Key Messages

Indian women aged 15-49 years exhibited 5 distinct patterns of cardiometabolic risk clustering: normal, high-normal, isolated-overweight, hypertension-overweight, and glucose dysregulation-overweight clusters.Early age at menarche (<13 years), early age at first birth (<20 years), natural or surgical menopause, higher parity, longer time since last birth, and pregnancy losses were associated with at least one of the high-risk cardiometabolic clusters.Reproductive history and the timing of reproductive milestones may improve early disease risk stratification in Indian women.

The Impact of Maternal Chronic Inflammatory Conditions on Breast Milk Composition: Possible Influence on Offspring Metabolic Programming

Breastfeeding is the best way to provide newborns with crucial nutrients and produce a unique bond between mother and child. Breast milk is rich in nutritious and non-nutritive bioactive components, such as immune cells, cytokines, chemokines, immunoglobulins, hormones, fatty acids, and other constituents. Maternal effects during gestation and lactation can alter these components, influencing offspring outcomes. Chronic inflammatory maternal conditions, such as obesity, diabetes, and hypertension, impact breast milk composition. Breast milk from obese mothers exhibits changes in fat content, cytokine levels, and hormonal concentrations, potentially affecting infant growth and health. Similarly, diabetes alters the composition of breast milk, impacting immune factors and metabolic markers. Other pro-inflammatory conditions, such as dyslipidemia and metabolic syndrome, have been barely studied. Thus, maternal obesity, diabetes, and altered tension parameters have been described as modifying the composition of breast milk in its macronutrients and other important biomolecules, likely affecting the offspring's weight. This review emphasizes the impact of chronic inflammatory conditions on breast milk composition and its potential implications for offspring development through the revision of full-access original articles.

Improvements in Insulin Resistance and Glucose Metabolism Related to Breastfeeding Are Not Mediated by Subclinical Inflammation

Background: Lactation is known to improve insulin resistance, but this phenomenon remains poorly understood. Our goal was to evaluate whether subclinical inflammation could mediate the association between breastfeeding (BF) and improvement in glucose metabolism and markers of insulin resistance (MIRs) in the postpartum. Methods: A total of 95 adult women (≥18 years) with a BMI ≥ 25 kg/m2 from the outpatient clinic of the Federal University of São Paulo were followed from early pregnancy until 60 to 180 days postpartum. The patients were divided based on their BF status: BF and non-BF groups. A latent variable termed SubInf was created incorporating inflammation-related biomarkers: adiponectin, E-selectin, branched-chain amino acids, zonulin, copeptin, and lipopolysaccharides. The association of BR with MIRs in the postpartum was evaluated through linear regression analysis, and mediation analysis was performed to evaluate the role of SubInf in this association. Results: The groups were similar regarding gestational diabetes mellitus (GDM) prevalence, pre-gestational BMI, caloric intake, physical activity, and postpartum weight loss. The BF group presented lower levels of triglycerides (TGs), fasting glucose, fasting insulin, TG/HDLcholesterol ratio (TG/HDL), TyG index, and HOMA-IR compared to the non-BF group. A linear regression analysis adjusted for scholarity, parity, pre-gestational BMI, GDM, weight gain during pregnancy, and mode of delivery revealed an inverse association between BF and fasting glucose [-6.30 (-10.71 to -1.89), p = 0.005), HOMA-IR [-0.28 (-0.50 to -0.05), p = 0.017], TyG index [-0.04 (-0.06 to -0.01), p = 0.002], and TG/HDL ratio [-0.23 (-0.46 to -0.01), p = 0.001]. In the mediation analysis, SubInf did not mediate the indirect effect of BF on MIRs. Conclusions: In overweight and obese women, an association between BF and improvement in MIRs in the postpartum was seen, corroborating that BF should be stimulated, especially in these cardiometabolic high-risk women. Subclinical inflammation did not seem to mediate this association.

Lifestyle Factors Influencing Metabolic Syndrome after Adjusting for Socioeconomic Status and Female Reproductive Health Indicators: A National Representative Survey in Korean Pre- and Postmenopausal Women

Metabolic syndrome (MetS) is increasing markedly among postmenopausal women. Although studies suggest multiple risk factors for its development, few have investigated changes in socioeconomic status (SES), female reproductive health indicators (menarche age, experience of pregnancy, delivery, breastfeeding, and postmenopausal status), and lifestyle factors. This study investigated lifestyle factors affecting MetS prevalence among pre- and post-menopausal women after adjusting for SES and female reproductive health indicators. Data from the Korea National Health and Nutrition Examination Survey VII (2016-2018) on 2856 pre- and postmenopausal women aged 40-59 years were analyzed. Differences in SES (e.g., age, education, and household income), female reproductive health indicators (e.g., age of menarche and menopause), and lifestyle (e.g., total calorie intake, fats, and proteins, percentage of energy from carbohydrates, fats, and proteins, smoking, physical activity, and obesity) between MetS and non-MetS groups were calculated by performing χ2 or t-tests. Consequently, current smoking, physical inactivity, overweight, and obesity were significantly associated with increased MetS after adjusting for SES and female reproductive health indicators using logistic regression analysis. Hence, health policies and programs focusing on modifiable MetS risk factors-encouraging healthy eating habits, smoking cessation, and regular exercise-must be formulated to prevent the development of MetS in pre- and postmenopausal women.

Machine learning analysis for the association between breast feeding and metabolic syndrome in women

This cross-sectional study aimed to develop and validate population-based machine learning models for examining the association between breastfeeding and metabolic syndrome in women. The artificial neural network, the decision tree, logistic regression, the Naïve Bayes, the random forest and the support vector machine were developed and validated to predict metabolic syndrome in women. Data came from 30,204 women, who aged 20 years or more and participated in the Korean National Health and Nutrition Examination Surveys 2010-2019. The dependent variable was metabolic syndrome. The 86 independent variables included demographic/socioeconomic determinants, cardiovascular disease, breastfeeding duration and other medical/obstetric information. The random forest had the best performance in terms of the area under the receiver-operating-characteristic curve, e.g., 90.7%. According to random forest variable importance, the top predictors of metabolic syndrome included body mass index (0.1032), medication for hypertension (0.0552), hypertension (0.0499), cardiovascular disease (0.0453), age (0.0437) and breastfeeding duration (0.0191). Breastfeeding duration is a major predictor of metabolic syndrome for women together with body mass index, diagnosis and medication for hypertension, cardiovascular disease and age.

Association between parities and duration of breastfeeding and the severity of coronary artery disease in women above 30 years old age (A pilot study)

Background

The prevalence and mortality of CVD in women increase over time. We conducted this research to evaluate the severity of coronary artery disease with the number of live births and breastfeeding duration.

Methods

Patients aged 30-50 years old with positive exercise tests or evidence of cardiac ischemia who were candidates for coronary angiography were included. All the participants had at least one child. Syntax score was used to evaluate the severity of coronary arteries.

Results

Mean number of children was 3.72±1.85, in those patients with <2 live births no one had a syntax score≥1, but in the>5 live births group most patients had a syntax score≥1. In patients with zero syntax score, it was estimated as 4.91±39.7; in patients with 1≤ syntax score, it was 4.48±7.29 (P =0.76). Among patients with > 5 birth lives, those with higher syntax scores had older ages (P=0.497). After adjusting age, the association between live births and syntax score became non-significant (P=0.850).

Conclusion

By increasing the number of live births >5, the severity of coronary artery disease, increases. However, this association was not significant after adjusting the age of patients.

The dynamic nexus: exploring the interplay of BMI before, during, and after pregnancy with Metabolic Syndrome (MetS) risk in Chinese lactating women

BACKGROUND AND AIM

The health implications of BMI and MetS in lactating women are significant. This study aims to investigate the relationship between risk of Mets in lactation and BMI in four stages: pre-pregnancy, prenatal period, 42 days postpartum, and current lactation.

METHODS AND RESULTS

A total of 1870 Lactating Women within 2 years after delivery were included from "China Child and Lactating Mother Nutrition Health Surveillance (2016-2017)". Logistic regression model and Restricted cubic spline (RCS) were used to estimate the relationship between BMI and risk of MetS. ROC analysis was used to determine the threshold for the risk of MetS. Chain mediating effect analysis was used to verify the mediating effect. BMI of MetS group in all stages were higher than non-MetS group (P < 0.0001). There were significant positive correlations between BMI in each stage and ORs of MetS during lactation (P < 0.05). The best cut-off values for BMI in the four stages were 23.47, 30.49, 26.04 and 25.47 kg/m2. The non-linear spline test at BMI in 42 days postpartum, current and MetS in lactation was statistically significant (P non-linear = 0.0223, 0.0003). The mediation effect of all chains have to work through lactation BMI. The total indirect effect accounted for 80.95% of the total effect.

CONCLUSIONS

The risk of MetS in lactating women is due to a high BMI base before pregnancy and postpartum. High BMI in all stages of pregnancy and postpartum were risk factors for MetS in lactation. BMI during lactation plays a key role in the risk of MetS.

The association of female reproductive factors with risk of metabolic syndrome in women from NHANES 1999-2018

BACKGROUND

Female reproductive factors such as age at first birth (AFB), age at last birth (ALB), number of pregnancies and live births play an essential role in women's health. However, few epidemiological studies have evaluated the association between female reproductive factors and metabolic syndrome (MetS). We therefore conducted a cross-sectional study to investigate the association between MetS risk and female reproductive factors.

METHODS

We investigated the relationship between AFB, ALB, number of pregnancies and live births and the incidence of MetS using publicly available data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Weighted multivariable logistic regression analysis, restricted cubic spline (RCS) model, and subgroup analysis were used to evaluate the association between AFB and ALB and the risk of MetS in women. In addition, the relationship between the number of pregnancies, live births and MetS risk was also explored.

RESULTS

A total of 15,404 women were included in the study, and 5,983 (38.8%) had MetS. RCS models showed an N-shaped relationship between AFB and MetS risk, whereas ALB, number of pregnancies, and live births were linearly associated with MetS. Weighted multivariable logistic regression analysis showed that the number of live births was associated with MetS risk, with ORs of 1.18 (95% CI: 1.04, 1.35) for women with ≥ 5 deliveries compared to women with ≤ 2 births.

CONCLUSIONS

AFB was associated with the risk of MetS in an N-shaped curve in women. In addition, women with high live births have a higher incidence of MetS.

The interaction between CRY1 Polymorphism and Alternative Healthy Eating Index (AHEI) on cardiovascular risk factors in overweight women and women with obesity: a cross-sectional study

BACKGROUND

According to some studies, diet can be interaction with CRY1 polymorphism and may be related to obesity and the risk of cardiovascular diseases (CVD). So, this study examined the interaction between CRY1 polymorphism and AHEI on cardiovascular risk factors in overweight women and women with obesity.

METHODS

This cross-sectional study was performed on 377 Iranian women with overweight and obesity aged 18-48(BMI ≥ 25 kg/m2). Dietary intake was evaluated by the use of a food frequency questionnaire (FFQ) with 147 items. The AHEI was calculated based on previous studies. Anthropometric and biochemical measurements were assessed and the bioelectrical impedance analysis method was used for body analysis. The rs2287161 was genotyped by the restriction fragment length polymorphism (PCR-RFLP) method. Objects were divided into three groups based on rs2287161 genotypes.

RESULTS

Our findings determined that the prevalence of the C allele was 51.9% and the G allele was 48.0%. The mean age and BMI were 36.6 ± 9.1years and 31 ± 4 kg/m2 respectively. After controlling for confounders (BMI, age, total energy intake, and physical activity), this study demonstrated that there was a significant interaction between CC genotype and adherence to AHEI on odds of hyper LDL (OR = 1.94, 95% CI = 1.24-3.05, P for interaction = 0.004), hypertension (OR = 1.80, 95% CI = 1.11-2.93, P for interaction = 0.01) and hyperglycemia (OR = 1.56, 95% CI = 0.98-2.47, P for interaction = 0.05).

CONCLUSIONS

This study indicated that adherence to AHEI can reduce the odds of hyper LDL, hypertension, and hyperglycemia in the CC genotype of rs2287161.

Breastfeeding and insulin requirements in women with Type 1 diabetes mellitus in the first year postpartum

AIMS

To explore whether breastfeeding affects postpartum insulin requirements, HbA1c levels, and pregnancy weight retention in women with Type 1 Diabetes Mellitus (T1DM).

METHODS

This prospective study included 66 women with T1DM. The women were divided into two groups based on whether they were breastfeeding (BF) at 6 months postpartum (BF_yes, n = 32) or not (BF_no, n = 34). Mean daily insulin requirement (MDIR), HbA1c levels, and pregnancy weight retention at 5 time-points from discharge to 12 months postpartum were compared.

RESULTS

MDIR increased by 35% from 35.7 IU at discharge to 48.1 IU at 12 months postpartum (p < 0.001). MDIR in BF_yes and BF_no were comparable, however in BF_yes, MDIR were continuously lower compared to BF_no. Postpartum HbA1c increased rapidly from 6.8% at 1 month to 7.4% at 3 months postpartum and settled at 7.5% at 12 months postpartum. The increase in HbA1c during the first 3 months postpartum was most pronounced in BF_no (p < 0.001). Although neither were statistically significant, from 3 months postpartum HbA1c levels were highest in the BF_no and BF_no had a higher pregnancy weight retention compared to BF_yes (p = 0.31).

CONCLUSION

In women with T1DM, breastfeeding did not significantly affect postpartum insulin requirements, HbA1c levels or pregnancy weight retention in the first year after delivery.

Lactation duration and lifetime progression to metabolic syndrome in women according to their history of gestational diabetes: a prospective longitudinal community-based cohort study

BACKGROUND

Despite the many signs of progress in pharmacotherapies, metabolic syndrome (MetS) is one of the main public-health burdens worldwide. Our study aimed to compare the effect of breastfeeding (BF) in women with and without gestational diabetes mellitus (GDM) on MetS incidence.

METHODS

Of females who participated in the Tehran Lipid and glucose study, women who met our inclusion criteria were selected. The Cox proportional hazards regression model, with adjustment of potential confounders, was done to evaluate the relationship between duration of BF and incident of MetS in women with a GDM history compared to non-GDM.

RESULTS

Out of 1176 women, there were 1001 non-GDM and 175 GDM. The median follow-up was 16.3 (11.9, 19.3) years. Results of the adjusted model illustrated that the total BF duration was negatively associated with MetS incidence risk (hazard ratio (HR) 0.98, 95% CI 0.98-0.99) in total participants indicating that per one-month increase of BF duration, the hazard of MetS reduced by 2%. The HR of MetS in Comparison between GDM and non-GDM women demonstrated significantly more reduced MetS incidence with a longer duration of exclusive BF (HR 0.93, 95% CI 0.88-0.98).

CONCLUSIONS

Our findings illustrated the protective effect of BF, especially exclusive BF, on MetS incidence risk. BF is more effective in reducing the risk of MetS among women with a history of GDM than among women without such a history.

Factors associated with exclusive formula feeding among individuals with low-risk pregnancies in the United States

BACKGROUND

Better understanding of the factors associated with formula feeding during the hospital stay can help in identifying potential lactation problems and promote early intervention. Our aim was to ascertain factors associated with exclusive formula feeding in newborns of low-risk pregnancies.

METHODS

A population-based, retrospective study using the United States vital statistics datasets (2014-2018) evaluating low-risk pregnancies with a nonanomalous singleton delivery from 37 to 41 weeks. People with hypertensive disorders, or diabetes, were excluded. Primary outcome was newborn feeding (breast vs exclusive formula feeding) during hospital stay. Adjusted relative risks (aRRs) with 95% confidence intervals (CI) were calculated.

RESULTS

Of the 19 623 195 live births during the study period, 11 605 242 (59.1%) met inclusion criteria and among them, 1 929 526 (16.6%) were formula fed. Factors associated with formula feeding included: age < 20 years (aRR 1.31 [95% CI 1.31-1.32]), non-Hispanic Black (1.42, 1.41-1.42), high school education (1.69, 1.69-1.70) or less than high school education (1.94, 1.93, 1.95), Medicaid insurance (1.52, 1.51, 1.52), body mass index (BMI) < 18.5 (1.10, 1.09-1.10), BMI 25-29.9 (1.09, 1.09-1.09), BMI 30-34.9 (1.19, 1.19-1.20), BMI 35-39.9 (1.31, 1.30-1.31), BMI ≥ 40 (1.43, 1.42-1.44), multiparity (1.29, 1.29-1.30), lack of prenatal care (1.49, 1.48-1.50), smoking (1.75, 1.74-1.75), and gestational age (ranged from 37 weeks [1.44, 1.43-1.45] to 40 weeks [1.11, 1.11-1.12]).

CONCLUSIONS

Using a large cohort of low-risk pregnancies, we identified several modifiable factors associated with newborn feeding (eg, prepregnancy BMI, access to prenatal care, and smoking cessation). Improving the breast feeding initiation rate should be a priority in our current practice to ensure equitable care for all neonates.

Reproductive factors and metabolic syndrome among Chinese women aged 40 years and older

BACKGROUND

The aim of this study is to explore the relationship between reproductive variables and the prevalence of metabolic syndrome (MetS) and its components among Chinese women aged 40 years and older.

METHODS

A cross-sectional study was conducted among 4453 women aged 40 years and older in Guangxi, China. The associations between women's reproductive factors and MetS were analyzed using a logistic regression model.

RESULTS

The prevalence of MetS was 23.9% in this population. Women with MetS were mostly older, more likely to be postmenopausal, and had higher parity. Compared to women with one prior live birth, those with three or more live births had the highest odds of having MetS (odds ratio [OR] = 1.56; 95% CI, 1.23-1.99). Similarly, compared to premenopausal women, postmenopausal participants had higher odds of having MetS (OR = 1.86; 95% CI, 1.49-2.31). No associations were observed between MetS and abortion or with age at menarche.

CONCLUSIONS

Our study suggests that multiparity and menopausal status may be associated with the development of MetS. The inconsistency seen in epidemiological research to date calls for further investigation.

Breastfeeding duration and subsequent risk of mortality among US women: A prospective cohort study

BACKGROUND

Breastfeeding has been associated with a reduced maternal long-term risk of chronic diseases, but its association with mortality is poorly known.

METHODS

We included 166,708 female United States (US) nurses from the Nurses' Health Study (1986-2016) and the Nurses' Health Study II (1989-2019) who experienced at least one pregnancy lasting at least six months across their reproductive lifespan. Hazard ratios and 95% confidence intervals (CI) for mortality according to lifetime breastfeeding duration were estimated with time-dependent Cox proportional hazards regression models.

FINDINGS

During 4,705,160 person-years of follow-up, 36,634 deaths were documented in both cohorts, including 9880 from cancer and 7709 from cardiovascular disease (CVD). Lifetime total breastfeeding duration was associated with a lower subsequent risk of all-cause mortality in a non-linear manner (p-value for non-linearity=0.0007). The pooled multivariable-adjusted hazard ratios of all-cause mortality were 0.95 (95% CI: 0.92 to 0.98), 0.94 (95% CI: 0.91 to 0.98), 0.93 (95% CI: 0.90 to 0.97), and 0.93 (95% CI: 0.89 to 0.97), respectively, for women reporting lifetime total breastfeeding duration of 4-6, 7-11, 12-23, and ≥24 months, compared to women who breastfed for ≤3 months over their reproductive lifespan. Cause-specific analysis showed a similar pattern of non-linear inverse associations between lifetime total breastfeeding duration and CVD and cancer mortality (both p-values for non-linearity <0.01). There was no evidence of interactions between breastfeeding duration and pre-pregnancy lifestyle factors on mortality risk.

INTERPRETATION

Parous women with longer lifetime breastfeeding duration had a modestly lower risk of mortality.

FUNDING

The National Institutes of Health grants.

Perception and practice of breastfeeding in public in Poland

BACKGROUND

The aim of the study was to get to know polish women's opinions and experiences regarding breastfeeding in public.

MATERIAL AND METHODS

A one-time 11-question survey aimed at women during lactation or breastfeeding in the past who completed a paper questionnaire or online questionnaire on the website (www.laktacja.pl). The study was conducted electronically from 1 September 2019 to 31 March 2020 in Maternity and Neonatal Departments, primary health-care clinics in various Polish cities. Data from 700 questionnaires were statistically analysed with the use of Pearson's chi-squared test of independency or Fisher's exacts test when applicable (small cell counts).

RESULTS

90% of the surveyed women expressed the opinion that it should be possible to breastfeed in public, and 78% of women have had such an experience. Most often it was their own cars, a room for a mother and child, a hall or just a place available when there was a need to feed the child (e.g., a bench, cafe, toilet). About 10% of women faced criticism while breastfeeding in a public place, and 8.6% of women have never breastfed the child out of the house due to the lack of proper place and conditions, embarrassment and no sympathy from other people.

CONCLUSION

Taking into account the benefits of long-term breastfeeding and the comfort of breastfeeding women, their children and the environment, it is necessary to create dedicated places for breastfeeding in public places.

Primary Care-Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review

Several common adverse pregnancy outcomes can reveal subclinical or latent cardiovascular disease (CVD) risk, transiently exposed through the physiologic stress of pregnancy. The year after pregnancy may be a singular opportunity to identify and initiate treatment for CVD risk, even before the onset of traditional CVD risk factors. However, clinical guidance regarding CVD risk management after adverse pregnancy outcomes is lacking. We therefore conducted a systematic review of US clinical practice guidelines and professional society recommendations to inform primary care-based CVD risk management after adverse pregnancy outcomes. We identified 13 relevant publications. While most recommendations were based on limited or weak evidence, we identified several areas of consensus. First, individuals with an adverse pregnancy outcome associated with future CVD are likely to benefit from CVD risk assessment-accompanied by education, counseling, and support for lifestyle modification-beginning within the first postpartum year. Second, among clinicians, clear and consistent documentation about adverse pregnancy outcomes and recommended follow-up is important to coordinate care after pregnancy. In addition, patients need to be informed about their pregnancy complications and associated CVD risks, so that they can make informed health care and lifestyle decisions. Finally, in general, CVD prevention in the year after an adverse pregnancy outcome focuses on lifestyle modification, reserving pharmacotherapy for the highest-risk patients and those with traditional CVD risk factors. While postpartum lifestyle interventions show promise for reducing CVD risk after adverse pregnancy outcomes, continued research to determine the optimal content, timing, and long-term effects of such interventions is needed.

Women who breastfeed exhibit cognitive benefits after age 50

Background and objectives

Women who breastfeed may experience long-term benefits for their health in addition to the more widely appreciated effects on the breastfed child. Breastfeeding may induce long-term effects on biopsychosocial systems implicated in brain health. Also, due to diminished breastfeeding in the postindustrial era, it is important to understand the lifespan implications of breastfeeding for surmising maternal phenotypes in our species’ collective past. Here, we assess how women’s breastfeeding history relates to postmenopausal cognitive performance.

Methodology

A convenience sample of Southern California women age 50+ was recruited via two clinical trials, completed a comprehensive neuropsychological test battery and answered a questionnaire about reproductive life history. General linear models examined whether cognitive domain scores were associated with breastfeeding in depressed and non-depressed women, controlling for age, education and ethnicity.

Results

Women who breastfed exhibited superior performance in the domains of Learning, Delayed Recall, Executive Functioning and Processing Speed compared to women who did not breastfeed (P-values 0.0003–0.015). These four domains remained significant in analyses limited to non-depressed and parous subsets of the cohort. Among those depressed, only Executive Functioning and Processing Speed were positively associated with breastfeeding.

Conclusions and implications

We add to the growing list of lifespan health correlates of breastfeeding for women’s health, such as the lower risk of type-2 diabetes, cardiovascular disease and breast cancer. We surmise that women’s postmenopausal cognitive competence may have been greater in past environments in which breastfeeding was more prevalent, bolstering the possibility that postmenopausal longevity may have been adaptive across human evolutionary history.

Lay Summary

Breastfeeding may affect women’s cognitive performance. Breastfeeding’s biological effects and psychosocial effects, such as improved stress regulation, could exert long-term benefits for the mother’s brain. We found that women who breastfed performed better on a series of cognitive tests in later life compared to women who did not breastfeed.

Association of lactation with maternal risk of type 2 diabetes: A systematic review and meta-analysis of observational studies

AIM

To investigate the association between lactation and maternal risk of type 2 diabetes, including a potential graded association according to lactation duration.

METHODS

A systematic review and meta-analysis of observational studies that investigated the reported association between lactation (irrespective of duration, intensity or mode) and maternal risk of type 2 diabetes was conducted.

RESULTS

A total of 22 studies (17 cohort studies and five cross-sectional studies) were included in this systematic review, and 16 contributed to the meta-analysis. Studies that investigated the association of lactation with risk of type 2 diabetes in the first months after birth in women with gestational diabetes reported conflicting results. Studies with a longer follow-up showed a graded protective association for lactation and the risk of type 2 diabetes, with a potentially larger risk reduction in women with gestational diabetes than in those without gestational diabetes. Overall, ever versus never lactation was associated with a 27% lower risk of type 2 diabetes (RR 0.73, 95% CI [0.65, 0.83]). Each additional month of lactation was associated with a 1% lower risk of type 2 diabetes (RR 0.99, 95% CI [0.98, 0.99]). However, the overall quality of the studies was modest.

CONCLUSIONS

Lactation is associated with a significantly reduced risk of maternal type 2 diabetes over the life course, particularly in women with gestational diabetes. The protective effect seems to increase with longer duration of lactation. Further research is warranted to understand whether this association is modified by exposure to other risk factors.

Management of Ischemic Heart Disease in Pregnancy

PURPOSE OF REVIEW

Cardiovascular disease is an escalating cause of maternal morbidity and mortality. Women are at risk for acute myocardial infarction (MI), and more are living with risk factors for ischemic heart disease (IHD). The purpose of this review is to describe the evaluation and management of women at risk for and diagnosed with IHD in pregnancy.

RECENT FINDINGS

Pregnancy can provoke MI which has been estimated as occurring in 1.5-10/100, 000 deliveries or 1/12,400 hospitalizations, with a high inpatient mortality rate of approximately 5-7%. An invasive strategy may or may not be preferred, but fetal radiation exposure is less of a concern in comparison to maternal mortality. Common medications used to treat IHD may be continued successfully during pregnancy and lactation, including aspirin, which has an emerging role in pregnancy to prevent preeclampsia, preterm labor, and maternal mortality. Hemodynamics can be modulated during pregnancy, labor, and postpartum to mitigate risk for acute decompensation in women with IHD. Cardiologists can successfully manage IHD in pregnancy with obstetric partners and should engage women in a lifetime of cardiovascular care.

Metabolic Syndrome and Coronary Artery Disease Risk: A Meta-Analysis of Observational Studies

Although numerous studies have described the link between metabolic syndrome (MetS) and Coronary Artery Disease (CAD), no meta-analysis has been carried out on this relationship. Thus, the present study intended to address this limitation. A systematic search was carried out using electronic databases, such as PubMed, CINAHL Plus, Medline, and Web of Science. A sum of 10 studies (n = 9327) was incorporated in the meta-analysis. Compared with non-MetS, MetS was significantly associated with high CAD risk (OR = 4.03, 95% CI = 3.56–4.56). The MetS components were also significantly correlated with high CAD risk (OR = 3.72, 95% CI = 3.22–4.40). The presence of two (OR = 3.93, 95% CI = 2.81–5.49), three (OR = 4.09, 95% CI = 2.85–5.86), four (OR = 4.04, 95% CI = 2.83–5.78), or all five MetS components (OR = 3.92, 95% CI = 3.11–4.93), were significantly associated with a high risk of CAD. MetS and its individual or combined elements were linked with high CAD risk based on contemporary evidence. Thus, the assessment of MetS and its components might help identify people at a higher risk of advancing CAD in the future.