Breastfeeding in Women With Type 1 Diabetes

Abstract

OBJECTIVETo identify predictive factors for initiation and maintenance of breastfeeding with a focus on mothers with type 1 diabetes.RESEARCH DESIGN AND METHODSThis is a prospective observation survey, using a case-control design, comparing the outcomes of 108 mothers with type 1 diabetes with 104 mothers without diabetes that were matched for parity and gestational age. Mother and infant outcomes were collected from medical records and through telephone interviews 2 and 6 months after delivery. Predictive factors were calculated by logistic regression analyses.RESULTSMothers with diabetes were less likely to partly or exclusively breastfeed their children at 2 months (OR 0.42 [95% CI 0.18–0.96], P = 0.041) and 6 months (0.50 [0.27–0.90], P = 0.022) than mothers without diabetes. On multivariable analysis, type 1 diabetes did not remain an independent predictive factor. Instead, higher education level and breastfeeding at discharge from hospital were predictive factors for breastfeeding at 2 months postpartum. These variables as well as delivery >37 weeks and early breastfeeding predicted breastfeeding 6 months postpartum.CONCLUSIONSFactors associated with maternal diabetes, such as problems with establishing breastfeeding in the early postpartum period, affects the likelihood of long-term breastfeeding.

Differences in breast-feeding initiation and continuation by maternal diabetes status

“…A retrospective study conducted in the UK of ninety-four women with diabetes found that breast-feeding at 4 months was inversely associated with early prenatal BMI and at 6 months was significantly predicted by higher socio-economic status (30) . Similarly, in a case-control study in Sweden of 212 women, maternal type 1 diabetes status was not a factor in the adjusted model predicting breast-feeding at 2 months postpartum, while significant predictors were maternal education and having breast-fed at discharge (31) . The researchers explained that they excluded women with type 2 diabetes since they are rare in Sweden, as well as women with GDM since there is usually a resolution of diabetes PDM v. NDM 0·78 0·62, 0·98 0·81 0·64, 1·04 1·26 0·83, 1·93 0·71 0·54, 0·94 0·69 0·56, 0·86 0·71 0·56, 0·91 GDM v. NDM 0·92 0·81, 1·03 0·93 0·81, 1·06 1·31 1·03, 1·69 0·83 0·72, 0·97 0·87 0·78, 0·97 0·89 0·79, 1·00 GDM v. PDM 1·17 0·91, 1·51 1·14 0·87, 1·49 1·03 0·64, 1·66 1·17 0·86, 1·59 1·25 0·99, 1·59 1·25 0·96, 1·63 NDM, no diabetes; PDM, pregestational diabetes mellitus; GDM, gestational diabetes mellitus.…”

“…Women who answered 'yes' to the initiation question were asked about breast-feeding continuation, 'How many weeks or months did you breast-feed or pump milk to feed your baby?' Breast-feeding continuation was defined as breast-feeding for at least 2 months, as this time point has previously been used to define breast-feeding continuation (31) and reflects the minimum amount of time after delivery that the survey is administered.…”

Person-Centered Web Support to Women with Type 1 Diabetes in Pregnancy and Early Motherhood—The Development Process

“…6 The duration of breastfeeding is shorter because of several aggravating circumstances. 18,[24][25][26] In Sweden there is a gap in organizational arrangements after childbirth, in that the mothers with diabetes are left in between maternity care and diabetes care. This makes their transition to motherhood challenging, as they try to structure a daily routine that includes caring for the newborn, establishing breastfeeding, and at the same time managing fluctuating blood glucose levels and adapting to lower insulin doses.…”

Reprioritizing life: a conceptual model of how women with type 1 diabetes deal with main concerns in early motherhood

“…Newborns to mothers with T1DM are more likely to develop neonatal hypoglycaemia and other morbidities, which often leads to treatment at neonatal care units (Ringholm, Mathiesen, Kelstrup, & Damm, 2012; Sparud-Lundin, Wennergren, Elfvin, & Berg, 2011). Breastfeeding is strongly encouraged due to its benefits for the mother and her baby (Ringholm et al, 2012; Sorkio et al, 2010).…”

“…Breastfeeding is strongly encouraged due to its benefits for the mother and her baby (Ringholm et al, 2012; Sorkio et al, 2010). However, studies concerning breastfeeding rates and duration have shown contradictory results, with some indicating less breastfeeding in women with type 1 diabetes (Hummel et al, 2007; Schoen, Sichert-Hellert, Hummel, Ziegler, & Kersting, 2008), and others finding that lower rates were explained by maternal factors other than diabetes (Sorkio et al, 2010; Sparud-Lundin et al, 2011). In a previous case control study conducted by our research group, comprising mothers with T1DM and a reference group without diabetes, we found that both groups had high levels of confidence and assessed breastfeeding as a positive and important experience.…”