The BLIiNG study - Breastfeeding length and intensity in gestational diabetes and metabolic effects in a subsequent pregnancy: A cohort study

Sarah J Melov; Lisa White; Michelle Simmons; Adrienne Kirby; Virginia Stulz; Suja Padmanabhan; Thushari I Alahakoon; Dharmintra Pasupathy; N Wah Cheung

doi:10.1016/j.midw.2022.103262

The BLIiNG study - Breastfeeding length and intensity in gestational diabetes and metabolic effects in a subsequent pregnancy: A cohort study

Midwifery. 2022 Apr:107:103262. doi: 10.1016/j.midw.2022.103262. Epub 2022 Feb 9.

Authors

Sarah J Melov¹, Lisa White², Michelle Simmons³, Adrienne Kirby⁴, Virginia Stulz⁵, Suja Padmanabhan⁶, Thushari I Alahakoon⁷, Dharmintra Pasupathy⁸, N Wah Cheung⁹

Affiliations

¹ Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Westmead, NSW, Australia. Electronic address: sarah.melov@health.nsw.gov.au.
² Division of Women's and Children's, Blacktown and Mount Druitt Hospitals, Blacktown, NSW, Australia. Electronic address: lisa.white@health.nsw.gov.au.
³ Women's and Newborn Health, Westmead Hospital, Westmead, NSW, Australia. Electronic address: michelle.simmons@health.nsw.gov.au.
⁴ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. Electronic address: adrienne.kirby@sydney.edu.au.
⁵ Western Sydney University, Nepean Hospital, Centre for Nursing & Midwifery Research, Nepean Hospital, Penrith, NSW, Australia. Electronic address: v.stulz@westernsydney.edu.au.
⁶ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia. Electronic address: suja.padmanabhan@sydney.edu.au.
⁷ Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Westmead, NSW, Australia; Discipline of Obstetrics Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Electronic address: indika.alahakoon@health.nsw.gov.au.
⁸ Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. Electronic address: dharmintra.pasupathy@sydney.edu.au.
⁹ Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia. Electronic address: wah.cheung@sydney.edu.au.

PMID: 35189450
DOI: 10.1016/j.midw.2022.103262

Abstract

Background: Gestational diabetes mellitus is associated with higher risk for developing type 2 diabetes. Breastfeeding is protective against the development of type 2 diabetes after gestational diabetes. There are no data regarding the effect of breastfeeding on the development of recurrent gestational diabetes.

Objective: Investigate the relationship of previous breastfeeding duration and intensity with the recurrence of gestational diabetes, and second pregnancy glucose tolerance test results.

Methods: We conducted a questionnaire-based pilot cohort study, enrolling 210 women during a subsequent second pregnancy, after a gestational diabetes-affected first pregnancy. Models for length and intensity of breastfeeding as predictors of the oral glucose tolerance test and for diagnosis of gestational diabetes in second pregnancy were fitted and then adjusted for possible confounders.

Results: Recurrent gestational diabetes rate in the study cohort was 70% (n = 146). In a fully adjusted model high intensity breastfeeding was associated with a lower 2-hour glucose level on the oral glucose tolerance test (by 0.66 mmol/L, 95% CI [0.15-1.17]; p = 0.01) and breastfeeding greater than six months with a lower 1-hour glucose on the oral glucose tolerance test (by 0.67 mmol/L, 95% CI [0.16-1.19]; p = 0.01), compared to women who breastfed less intensively or for a shorter duration respectively. There was an 18% reduction in the risk of gestational diabetes if a woman breastfed for more than six months (RR 0.82, 95% CI [0.69-0.98]; p = 0.03). The association was attenuated in the fully adjusted model (RR 0.89, 95% CI [0.78-1.02]; p = 0.09).

Conclusions and implications for practice: We found the risk of recurrent gestational diabetes was reduced by both increased duration and intensity of breastfeeding. Antenatal lactation education should be embedded into care pathways for women diagnosed with gestational diabetes.

Keywords: Breastfeeding; Cardiovascular disease; Diabetes; Gestational diabetes mellitus; Lactation; Pregnancy; Type 2 diabetes mellitus.

MeSH terms

Blood Glucose
Breast Feeding
Cohort Studies
Diabetes Mellitus, Type 2* / epidemiology
Diabetes Mellitus, Type 2* / etiology
Diabetes Mellitus, Type 2* / prevention & control
Diabetes, Gestational* / epidemiology
Diabetes, Gestational* / etiology
Female
Humans
Pilot Projects
Pregnancy

Substances

Blood Glucose