Gestational Diabetes Mellitus Is Associated with Differences in Human Milk Hormone and Cytokine Concentrations in a Fully Breastfeeding United States Cohort.

Yuni Choi,Ellen W Demerath,David A Fields,Kelsey E Johnson,Harmeet Kharoud,Katy Duncan,Tipper Gallagher,Katherine Jacobs,Elyse O Kharbanda,David R Jacobs,Cheryl A Gale,Emily M Nagel

doi:10.3390/nu14030667

Abstract

It is unclear whether gestational diabetes mellitus (GDM) alters breast milk composition. We prospectively examined associations of GDM status with concentrations of six potentially bioactive elements (glucose, insulin, C-reactive protein (CRP), interleukin-6 (IL-6), leptin, and adiponectin) in human milk. These were measured at both 1 and 3 months postpartum in 189 fully breastfeeding women. Mixed-effects linear regression assessed GDM status-related differences in these milk bioactives, adjusting for demographics, maternal factors, and diet. At 1 and 3 months postpartum, milk CRP was higher (1.46 ± 0.31 ng/mL; p < 0.001 and 1.69 ± 0.31 ng/mL; p < 0.001) in women with GDM than in women without GDM, whereas milk glucose (−5.23 ± 2.22 mg/dL; p = 0.02 and −5.70 ± 2.22; p = 0.01) and milk insulin (−0.38 ± 0.17 μIU/mL; p = 0.03 and −0.53 ± 0.17; p = 0.003) were lower in women with GDM. These significant associations remained similar after additional adjustment for maternal weight status and its changes. No difference was found for milk IL-6, leptin, and adiponectin. There was no evidence of association between these milk bioactive compounds and 1 h non-fasting oral glucose challenge serum glucose in the women without GDM. This prospective study provides evidence that potentially bioactive elements of human milk composition are altered in women with GDM.

Highlights

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that develops or manifests during pregnancy and affects about 7% of pregnancies in the US [1]
We found that oral glucose challenge test (OGCT) glucose did not predict milk glucose in women without GDM
While we found associations between concentrations of milk C-reactive protein (CRP), glucose, and insulin and GDM status, we did not observe differences in milk IL-6, adiponectin, or leptin between women with and without GDM

Summary

Introduction

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that develops or manifests during pregnancy and affects about 7% of pregnancies in the US [1]. GDM is associated with subsequent health problems, including maternal cardiovascular disease and type 2 diabetes, shorter lactation duration, and short- and long-term adverse health outcomes in their children [2,3,4]. GDM increases the risk of obesity, impaired glucose tolerance, and type 2 diabetes in the child [5,6]. It is important to better understand GDM and other maternal factors as they relate to milk composition variation because of their potential to influence growth in children at high risk of future obesity, and because this information is necessary in order to design interventions that can optimize this critical first food

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