Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study.

Sumali S Hewage,Wei Wei Pang,Falk Müller-Riemenschneider,Shu E Soh,Marjorelee T Colega,Sok Bee Lim,Kok Hian Tan,Xin Yu Hazel Koh,Shirong Cai,Joanne Yoong,Fabian Yap,Doris Fok,Mei Chien Chua,Yap-Seng Chong,Mary F F Chong,Shiao-Yng Chan,Keith M Godfrey

doi:10.3390/nu13020408

Abstract

(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; p = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; p = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.

Highlights

Gestational diabetes mellitus (GDM) is associated with increased risk of type 2 diabetes mellitus (T2DM) development [1,2]
Unadjusted incidence rate ratios (IRRs) showed an inverse association between dysglycemia risk and ≥1 month to
The final statistical analyses were based on data for 116 women who had been diagnosed with GDM in the index pregnancy, had breastfeeding data, and had completed an oral glucose tolerance test (OGTT) four to seven years (median 5.1; interquartile range (IQR) 4.1–5.2 years) postpartum

Summary

Introduction

Gestational diabetes mellitus (GDM) is associated with increased risk of type 2 diabetes mellitus (T2DM) development [1,2]. It has been suggested that hyperglycemia, which arises primarily due to the effects of placental hormones during pregnancy, results in a lasting deterioration of insulin sensitivity, leading to the onset of T2DM, typically years after delivery [1,3]. Another explanation is that both diseases have common risk factors such as increased body mass index (BMI), advanced age, and a family history of T2DM [2]. Relative to women of Western ethnicity, Asian women are at higher risk for GDM [4] and T2DM [5]. Understanding the modifiable risk factors or behaviors that can influence the risk of developing T2DM in women with a history of GDM in an Asian setting is of pressing interest

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