Breastfeeding Intensity Research Articles

Women's Perception Regarding Breastfeeding Support in Workplace: A Scoping Review

Background: Newborns mostly require breast milk. Women who choose to work are equally responsible for maintaining breastfeeding. Prior studies have identified variations in the time and intensity of breastfeeding before and after returning to work. Disparities exist in the assistance provided for women to breastfeed in the workplace, with past studies revealing insufficient facilities. This study intends to examine women's views on the support for breastfeeding in the workplace.Method: A scoping review was carried out using the PubMed, Google Scholar, and ScienceDirect databases, following PRISMA procedures. The papers were selected based on specific criteria: they had to be cross-sectional and qualitative studies focusing on women's opinions of breastfeeding in the workplace. Additionally, the articles were to be written in English, give the entire text, and have been done between 2019 and 2023.Results: Ten publications were examined from different workplaces. The research examines different forms of work and workplaces. Women's views on breastfeeding support focus on instrumental support, such as inappropriate or unavailable lactation rooms, work hours and policies, lack of breastfeeding groups, facilities for breastfeeding and breast milk pumping, insufficient storage, inadequate childcare facilities, and lack of caregivers at home, which impede exclusive breastfeeding. Emotional support refers to the assistance provided by colleagues in the workplace. Form of information support, namely the absence of communication and information support. There is a common belief that breastfeeding is seen as a personal issue connected to one's knowledge and self-confidence. Cross-sectoral collaboration needs to be involved, including family, workplace commitment, and government support to support the success of breastfeeding in the workplace.

Understanding the Impact of Perceived Social Support for Breastfeeding Among African American Women: Results From the Mama Bear Feasibility Trial.

Perceived Social Support (PSS) can impact breastfeeding behaviors, and a lack of PSS potentially contributes to disparities in breastfeeding rates for African American women (AA). Objectives were to describe PSS at two timepoints and test associations between PSS and breastfeeding intensity for AA. Data are from a feasibility trial of breastfeeding support among AA. The Hughes Breastfeeding Support Scale was used to measure PSS (Emotional, Informational, Tangible; total range = 30-120) in pregnancy (T1, n = 32) and early postpartum (T2, n = 31). Scale means were compared with t-tests. Associations between PSS at T1 and breastfeeding intensity (ie, quantitative measure of breastfeeding) were assessed with linear regression. Total PSS (mean ± SE) was high at both time points (T1 = 90.5 ± 4.8; T2 = 92.8 ± 3.1). At T2, older participants or those living with a partner had higher total PSS scores compared to those younger or living alone. Emotional PSS was significantly higher at T2 than T1 with no differences in tangible or informational PSS over time. Mixed-feeding, exclusive breastfeeding, and exclusive formula feeding was distributed at 39%, 32%, and 29%, respectively. Total PSS was not associated with breastfeeding intensity. Women reported high levels of social support, and emotional PSS increased over time in this small sample of AA. PSS and sources of PSS are understudied, especially among AA, and future studies should explore quantitative methods to assess PSS. The results of such assessments can then be used to design breastfeeding support interventions.

Breastfeeding Intensity and Associated Factors Among GDM Mothers: Evidence from Malaysia

Introduction: Breastfeeding confers numerous protective health effects, particularly concerning mothers associated with gestational diabetes mellitus (GDM). However, breastfeeding rates recorded in the National Health and Morbidity Survey (2016 ) remain unsatisfactory and research shows that breastfeeding practices are notably poor in GDM mothers. This study aimed to investigate the factors associated with breastfeeding intensity among mothers with and without a previous history of GDM. Methods: This cross-sectional study conducted across Malaysia involving 322 mothers with (n=161) and without (n=161) a previous history of GDM. Eligible mothers were randomly recruited and were asked to complete the Infant Feeding Survey through an online survey. Breastfeeding intensity was measured as the percentage of feedings per 24-hour that were from breast milk. Pearson’s Chi-Square test and independent t-test were used to investigate potential significant association between a previous history of GDM and breastfeeding intensity. Multiple linear regression was used to explore any association between sociodemographic and obstetrical variables and breastfeeding intensity. Results: No statistically significant association was found between a previous history of GDM (p=0.612) and breastfeeding intensity (p= 0.410). Mothers without a previous history of GDM who received less than 12 years of education (p= 0.009) and were in the upper-middle wealth quantile (RM3000 – RM6000) (p= <0.001) had significantly reduced rates of breastfeeding intensity. Conclusion: Efforts need to be shifted to strategize and prioritize less educated mothers and working mothers within the identified income capacity so that the aim of intensifying breastfeeding practices can be achieved.

Collateral benefits from a school-readiness intervention on breastfeeding: A cross-domain impact evaluation.

This study evaluated the collateral, or unanticipated, impacts of Smart Beginnings (SB), a two-site, tiered intervention designed to promote responsive parenting and school readiness, on breastfeeding intensity in a low-income sample. Impact analyses for the SB intervention were conducted using an intent-to-treat design leveraging a two-arm random assignment structure. Mothers assigned to the SB intervention group were more than three times more likely to give breastmilk as the only milk source at infant age 6 months than mothers assigned to the control group at one site, an effect not evident at the other study site. As development and growth are the two most salient domains of child health, understanding how interventions impact subsequent parenting practices across both domains is critical to address long-term economic and racial/ethnic disparities. Implications of the findings are discussed for improving the efficacy of interventions based on paediatric primary care.

Racial and Ethnic Differences in Infant Feeding Practices and Growth Trajectories Among Low-Income Households

Objectives(1) To examine duration and intensity of breastfeeding, age of introduction to solids/other liquids, and complementary feeding choices among racial/ethnic minority infants living in low-income households. (2) To determine the association between feeding choices and model growth trajectory from early to late infancy in the study population.MethodsMother-infant dyads were recruited from a pediatric clinic mainly serving low-income and/or Medicaid-recipient families. Mothers were interviewed in English or Spanish to collect sociodemographic, food security status, and feeding practices when the infant was 2, 4, 6, 9, and 12 months of age (n = 249). From 6-months onwards, 24-hour feeding recalls were conducted to estimate daily nutrient intake. Infant height and weight were retrieved from the electronic medical record to estimate growth trajectories from early to late infancy.ResultsBy race/ethnicity, the majority of the participants were African American (46%) or Hispanic (35%). The prevalence of low to very low food insecurity was 10%. Exclusive breastfeeding was not common among dyads at 2 (26%), 4 (17%), and 6 months (4%). Partial breastfeeding was significantly higher among Hispanic mothers (P < .05). For instance, at 4 months 72% of Hispanic mothers partially breastfed compared to 34% African American and 31% of non-Hispanic White mothers (p < .001). Early introduction to solids/other liquids was more common within African American dyads (p < .05). Preliminary growth trajectory modeling indicated some racial/ethnic differences, especially the weight of Hispanic infants was marginally higher compared to non-Hispanic white infants (p = .072) in late infancy.ConclusionsSignificant differences in infant feeding practices, including breastfeeding and introduction to solids/liquids, exist by race/ethnicity. Examination of these differences in feeding practices will be critical to understanding how they affect growth trajectory from early to late infancy.Funding SourcesNational Institute of Health NICHD.

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

BackgroundGestational 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. ObjectiveInvestigate the relationship of previous breastfeeding duration and intensity with the recurrence of gestational diabetes, and second pregnancy glucose tolerance test results. MethodsWe 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. ResultsRecurrent 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 practiceWe 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.

Relationship between pre-pregnancy maternal body mass index and infant weight trajectories in HIV-exposed and HIV-unexposed infants.

Maternal HIV and antiretroviral therapy (ART) exposure in utero may influence infant weight, but the contribution of maternal y body mass index (BMI) to early life overweight and obesity is not clear. To estimate associations between maternal BMI at entry to antenatal care (ANC) and infant weight through approximately 1year of age and to evaluate whether associations were modified by maternal HIV status, maternal HIV and viral load, breastfeeding intensity through 6months or timing of entry into ANC. We followed HIV-uninfected and -infected pregnant women initiating efavirenz-based ART from first antenatal visit through 12months postpartum. Infant weight was assessed via World Health Organization BMI and weight-for-length z-scores (WLZ) at 6weeks, 3, 6, 9 and 12months. We used multivariable linear mixed-effects models to estimate associations between maternal BMI and infant z-scores over time. In 861 HIV-uninfected infants (454 HIV-exposed; 407 HIV-unexposed), nearly 20% of infants were overweight or obese by 12months of age, regardless of HIV exposure status. In multivariable analyses, increasing maternal BMI category was positively associated with higher infant BMIZ and WLZ scores between 6weeks and 12months of age and did not differ by HIV exposure status. However, HIV-exposed infants had slightly lower BMIZ and WLZ trajectories through 12months of age, compared with HIV-unexposed infants across all maternal BMI categories. Differences in BMIZ and WLZ scores by HIV exposure were not explained by timing of entry into ANC or maternal viral load pre-ART initiation, but z-scores were slightly higher for HIV-exposed infants who were predominantly or exclusively versus partially breastfed. These findings suggest maternal BMI influences early infant weight gain, regardless of infant HIV exposure status. Intervention to reduce maternal BMI may help to address growing concerns about obesity among HIV-uninfected children.

Diet Beverage Intake during Lactation and Associations with Infant Outcomes in the Infant Feeding Practices Study II

Consumption of diet beverages (DB) containing low-calorie sweeteners (LCS) is widespread in the United States. LCS are ingested by nursing infants upon maternal DB consumption, which may impact infants’ weight and health. This study aims to examine cross-sectional associations between infants’ LCS exposure via maternal DB intake during lactation and infants’ health outcomes. Six hundred and eighty-two mother–infant dyads at three months postpartum, from the Infant Feeding Practices Study II, 2005–2007, were included in the analysis. Maternal DB consumption during lactation was estimated using the serving size and frequency of DB consumption reported on the diet history questionnaire. Infants’ LCS exposure was estimated by multiplying maternal DB consumption and breastfeeding intensity. Infant outcomes included weight, weight-for-age and BMI-for-age z-scores, overweight, and gastrointestinal (GI) symptoms including diarrhea, reflux, and vomiting. Associations between infants’ LCS exposure and continuous and categorical outcomes were examined using linear and logistic regressions adjusting for confounders, respectively. Forty-three percent of lactating women reported DB consumption. While no significant associations were observed between infants’ LCS exposure and BMI-for-age or risk of overweight, infants’ LCS exposure was associated with a 2.78-fold increased risk of vomiting (95% confidence interval 1.05–7.34). Potential adverse effects of LCS exposure on GI symptoms require further study, and null findings on infant weight should be interpreted with caution, given the small sample size. Additional research is needed to inform recommendations for or against DB consumption during lactation.

Infant eating behaviors and Milk feeding independently predict infant size.

This study investigates the association of infant eating behaviors with infant size, and if those associations are mediated by infant feeding. Mothers with infants less than 12 months of age and living in Central North Carolina were enrolled (N=61). Data were collected at baseline and at 3- and 6-month follow up visits. Modified constructs from the Baby Eating Behavior Questionnaire (BEBQ) and Child Eating Behavior Questionnaire (CEBQ) measured parents' perceptions of infant eating behaviors related to food approach (enjoyment of food, and food responsiveness) and food avoidance (food fussiness, satiety responsiveness, and slowness in eating). Linear mixed effects models tested longitudinal associations among infant eating behavior ratings, infant feeding (breastfeeding intensity, timing of introduction of complementary foods), and anthropometry (weight, length, and weight-for-length z-scores). Path analyses were stratified by age and tested for direct and indirect effects of mothers' ratings of infant eating behaviors and infant feeding on infant anthropometry. Linear mixed models showed that general appetite was associated with higher weight-for-age, and satiety responsiveness was associated with lower length-for-age. Path analyses showed that infant milk feeding did not mediate associations. Breastfeeding intensity was independently associated with lower weight- and length-for-age z-scores. Age at complementary feeding initiation was associated with lower length-for-age z-scores. Associations between parental perceptions of general appetite, satiety responsiveness, and infant weight and length are observed early in life. These findings suggest that parental perceptions of infant eating behaviors may contribute to the early developmental programming of later health outcomes.

Breastfeeding Behaviors and Maternal Interaction Quality in a Low-Income, Ethnic Minority Population.

To examine the associations between breastfeeding intensity and underexplored features of maternal-child interaction quality over and above the influence of breastfeeding initiation. The current study leveraged an on-going, multisite randomized controlled trial of a tiered parenting program for 462 Medicaid-eligible mothers and their infants in the United States. We examined whether breastfeeding intensity and exclusivity was associated with observed maternal sensitivity, intrusiveness, and detachment, as well as self-reported maternal verbal responsiveness, 6 months infant age. Analyses controlled for breastfeeding initiation, demographics, and early parenting experiences. Higher intensity breastfeeding at 6 months was significantly related to higher maternal sensitivity (β = 0.12, p = 0.004) and lower maternal intrusiveness (β = -0.10, p = 0.045). There was no significant association between breastfeeding intensity at 6 months and detachment (β = -0.02, no significant [ns]) or self-reported verbal responsiveness (β = 0.11, ns). Results were the same when intensity was measured as a dichotomous indicator for exclusive breastfeeding. Effect sizes were small-to-moderate, ranging from Cohen's d = 0.26 to 0.31. Associations did not vary by site, race/ethnicity, infant difficultness, or household poverty. The finding that breastfeeding intensity was significantly and independently associated with maternal sensitivity and intrusiveness is novel in the literature on low-income families from the United States. These findings have implications for breastfeeding promotion strategies and indicate that future research should explore synergistic or spillover effects of interventions aimed at maternal-child interaction quality into the infant feeding domain, particularly in the primary care setting.

Putting the "M" in Breastfeeding Medicine.

Putting the "M" in Breastfeeding Medicine.

Maternal Time Use and Nurturing: Analysis of the Association Between Breastfeeding Practice and Time Spent Interacting with Baby.

Breastfeeding supports child development through complex mechanisms that are not well understood. Numerous studies have compared how well breastfeeding and nonbreastfeeding mothers interact with their child, but few examine how much interaction occurs. Our study of weekly time use among 156 mothers of infants aged 3-9 months investigated whether lactating mothers spend more time providing emotional support or cognitive stimulation of their infants than nonbreastfeeding mothers, and whether the amount of such interactive time is associated with breastfeeding intensity. Mothers were recruited via mother's and baby groups, infant health clinics, and childcare services, and used an electronic device to record their 24-hour time use for 7 days. Sociodemographic and feeding status data were collected by questionnaire. Statistical analysis using linear mixed modeling and residual maximum likelihood analysis compared maternal time use for those giving "some breastfeeding" and those "not breastfeeding." Analysis was also conducted for more detailed feeding subgroups. Breastfeeding and nonbreastfeeding mothers had broadly similar socioeconomic and demographic characteristics. Breastfeeding was found to be associated with more mother-child interaction time, a difference only partially explained by weekly maternal employment hours or other interactive care activities such as play or reading. This study presents data suggesting that lactating mothers spent significantly more hours weekly on milk feeding and on carrying, holding, or soothing their infant than nonlactating mothers; and on providing childcare. Understanding the mechanisms by which child mental health and development benefits from breastfeeding may have important implications for policies and intervention strategies, and could be usefully informed by suitably designed time use studies.

64: Benefits of greater breastfeeding intensity on endothelial function and metabolic profile

64: Benefits of greater breastfeeding intensity on endothelial function and metabolic profile

Association Of Breastfeeding On Infant Lead Exposure In The First Year Of Life In A Mexican Population Of Mother-Infant Pairs

Introduction: Bone lead and breastfeeding intensity are important predictors of maternal blood lead levels (MBLLs). There is concern about potential for infant breastfeeding exposure though limited data exist to quantify effects over time. Methods: We quantified effects of breastfeeding on infant BLLs among 360 mother-infant pairs in the Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT) birth cohort study. We measured maternal and infant BLLs and breastfeeding status at four times (0, 3, 6, 12 months postpartum). The effect of breastfeeding on infant BLLs was estimated with a linear mixed effect model with a saturated three-way interaction to estimate effects of breastfeeding by time and MBLL adjusting for: maternal age, education years, infant date of birth, and time-varying covariates (infant weight, breastfeeding, MBLL). Results: Breastfeeding (%) at 3, 6, and 12 months was: 81.8, 61.6 and 30.1. Mean±SD BLLs (µg/dL) at each postpartum visit for mothers and infants, respectively, were: 8.2±4.5, 7.4±4.2, 6.2±4.1 and 3.7±2.9, 4.1±2.7, 4.9±3.2. Breastfeeding was associated with an overall increase in infant BLL of 2.9 (1.5, 4.2) µg/dL; this association varied over time and by MBLL. Comparing breastfeeding to non-breastfeeding infants, and adjusting for cord lead, mean difference (95% CI) in BLLs was: 0.6 (-0.3, 1.5) and 0.04 (-1.8, 1.9) µg/dL at 3 and 6 months, respectively. By 12 months, mean difference (95% CI) for MBLL

Breastfeeding Intentions and Practices among Women in the U.S. With Gestational Diabetes Mellitus

ObjectiveTo compare breastfeeding intention and behaviors in women with and without gestational diabetes mellitus (GDM) in a U.S. sample.MethodsWe used chi square tests to investigate the associations between GDM, intention to breastfeed exclusively, ever breastfeeding, and ever exclusively breastfeeding. To assess associations between GDM and duration of any breastfeeding, duration of exclusive breastfeeding, and breastfeeding intensity, Wilcoxon rank‐sum tests were used. Further analysis using multivariable regression modeling with adjustment for potential confounders will be undertaken.ResultsSignificantly fewer pregnant women with GDM planned to exclusively breastfeed their infants (49.7% vs. 57.9% in women without GDM, p=0.005). Compared with new mothers without GDM, fewer women with GDM pregnancies initiated breastfeeding (79.6% vs. 85.8%, p=0.02) and breastfed exclusively for any period of time (29.1% vs. 44.9%, p&lt;0.001). Likewise, breastfeeding intensity in the infant's first 6 months of life was lower among women with GDM (p=0.02). GDM was significantly associated with duration of exclusive breastfeeding (p&lt;0.001), but not duration of any breastfeeding (p=0.14).ConclusionsOur findings suggest that pregnant women with GDM were less likely than their counterparts without GDM to intend to breastfeed exclusively. After delivery, these women were also less likely to initiate breastfeeding and to breastfeed exclusively for any length of time. We plan to explore the factors that mediate these relationships in subsequent analyses.

Breastfeeding and maternal weight changes during 24 months post-partum: a cohort study.

The relationship between breastfeeding and the loss of weight gained during pregnancy remains unclear. This study aimed to investigate the association between breastfeeding and maternal weight changes during 24 months post-partum. We studied a dynamic cohort comprising 315 women living in two cities in the state of Bahia, Brazil. The outcome variable was change in the post-partum weight; the exposure variable was the duration and intensity of breastfeeding. Demographic, socio-economic, environmental, reproductive and lifestyle factors were integrated in the analysis as covariates. The data were analysed using multiple linear regression and linear mixed-effects models. The average cumulative weight loss at 6 months post-partum was 2.561 kg (SD 4.585), increasing at 12 months (3.066 kg; SD 5.098) and decreasing at 18 months (1.993 kg; SD 5.340), being 1.353 kg (SD, 5.574) at 24 months post-partum. After adjustment, the data indicated that for every 1-point increase in breastfeeding score, the estimated average post-partum weight loss observed was 0.191 kg at 6 months (P = 0.03), 0.090 kg at 12 months (P = 0.043), 0.123 kg at 18 months (P < 0.001) and 0.077 kg at 24 months (P = 0.001). Based on these results, we concluded that despite the low expressiveness, the intensity and duration of breastfeeding was associated with post-partum weight loss at all stages of the study during the 24-month follow-up.

MULTILEVEL ORDINAL RESPONSE MODELING OF TREND OF BREASTFEEDING INITIATION

The amount of health benefits derived from breastfeeding is influenced by age of the child at initiation of the first breast milk, the duration and intensity of breastfeeding and age at which the child is introduced to supplementary foods and other liquids. In this study, the general trend of timing of breastfeeding initiation among nursing mothers in Nigeria between 1990 and 2003 is examined. The timing of initiation of the first breast milk to a child by her mother is measured in a three-level ordinal scale (immediately, within 24 h and days after birth) and the impacts of some socio-economic and maternal factors on this are determined. Results from this study revealed a significant improvement in the trend of early initiation of breast milk among Nigeria mothers between 1990 and 2003 (p

Breastfeeding Education and Support Trial for Overweight and Obese Women: A Randomized Trial

To evaluate a specialized breastfeeding peer counseling (SBFPC) intervention promoting exclusive breastfeeding (EBF) among overweight/obese, low-income women. We recruited 206 pregnant, overweight/obese, low-income women and randomly assigned them to receive SBFPC or standard care (controls) at a Baby-Friendly hospital. SBFPC included 3 prenatal visits, daily in-hospital support, and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers. Standard care involved routine access to breastfeeding support from hospital personnel, including staff peer counselors. Data collection included an in-hospital interview, medical record review, and monthly telephone calls through 6 months postpartum to assess infant feeding practices, demographics, and health outcomes. Bivariate and logistic regression analyses were conducted. The intervention had no impact on EBF or breastfeeding continuation at 1, 3, or 6 months postpartum. In adjusted posthoc analyses, at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding (adjusted odds ratio [aOR]: 3.76 [95% confidence interval (CI): 1.07-13.22]), and giving at least 50% of feedings as breast milk (aOR: 4.47 [95% CI: 1.38-14.5]), compared with controls. Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth (aOR: 0.24 [95% CI: 0.07-0.86]). In a Baby-Friendly hospital setting, SBFPC targeting overweight/obese women did not impact EBF practices but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth.

Postpartum Depression, Infant Feeding Practices, and Infant Weight Gain at Six Months of Age

IntroductionThis study examined postpartum depression (PPD) as a potential risk factor for non-adherence to infant feeding guidelines and subsequent infant weight gain. MethodsParticipants were mother-infant dyads from the Infant Feeding Practices Study II (N = 1447). Main study variables were PPD, breastfeeding intensity, addition of cereal to infant formula, and age of introduction to solid foods. ResultsIn logistic models adjusted for sociodemographic factors, mothers with PPD were 1.57 times (95% confidence interval [CI]: 1.16, 2.13) more likely to breastfeed at low intensity and 1.77 times (95% CI: 1.16, 2.68) more likely to add cereal to infant formula. Although PPD was associated with the early introduction to solid foods (odds ratio: 1.42; 95% CI: 1.07, 1.89), this relationship was not significant after adjusting for potential confounders. A small but significantly greater average weight gain at 6 months was observed among infants of mothers with PPD (10.15 lb, SD = 2.32 vs. 9.85 lb, SD = 2.32). DiscussionScreening for PPD at well-child visits may lead to improved maternal health outcomes and the prevention of early life risk factors for childhood obesity.

Lactation Intensity and Postpartum Maternal Glucose Tolerance and Insulin Resistance in Women With Recent GDM

OBJECTIVETo examine the association between breastfeeding intensity in relation to maternal blood glucose and insulin and glucose intolerance based on the postpartum 2-h 75-g oral glucose tolerance test (OGTT) results at 6–9 weeks after a pregnancy with gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSWe selected 522 participants enrolled into the Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT), a prospective observational cohort study of Kaiser Permanente Northern California members diagnosed with GDM using the 3-h 100-g OGTT by the Carpenter and Coustan criteria. Women were classified as normal, prediabetes, or diabetes according to American Diabetes Association criteria based on the postpartum 2-h 75-g OGTT results.RESULTSCompared with exclusive or mostly formula feeding (>17 oz formula per 24 h), exclusive breastfeeding and mostly breastfeeding (≤6 oz formula per 24 h) groups, respectively, had lower adjusted mean (95% CI) group differences in fasting plasma glucose (mg/dL) of −4.3 (−7.4 to −1.3) and −5.0 (−8.5 to −1.4), in fasting insulin (μU/mL) of −6.3 (−10.1 to −2.4) and −7.5 (−11.9 to −3.0), and in 2-h insulin of −21.4 (−41.0 to −1.7) and −36.5 (−59.3 to −13.7) (all P < 0.05). Exclusive or mostly breastfeeding groups had lower prevalence of diabetes or prediabetes (P = 0.02).CONCLUSIONSHigher intensity of lactation was associated with improved fasting glucose and lower insulin levels at 6–9 weeks’ postpartum. Lactation may have favorable effects on glucose metabolism and insulin sensitivity that may reduce diabetes risk after GDM pregnancy.