Delayed secretory activation and low milk production in women with gestational diabetes: a case series

Abstract

Background Gestational diabetes mellitus (GDM) is major pregnancy complication that is associated with short- and long-term consequences for both mother and infant, including increased risk of diabetes later in life. A longer breastfeeding duration has been associated with a reduced risk of diabetes, however, women with GDM are less likely to exclusively breastfeed and have shorter breastfeeding duration. While the timing of breastfeeding initiation and milk removal frequency affects subsequent breastfeeding outcomes, little is known about early infant feeding practices and milk production in women with GDM. This case series offers detailed prospective breastfeeding initiation data, as well as the first report of objective measures of milk production in women with GDM. Case presentation In this case series, we present the early infant feeding practices of eight women with GDM that gave birth at term gestation. Women recorded the timing of initiation of breastfeeding and secretory activation, as well as their breastfeeding, expression and formula feeding frequencies on postpartum days 1, 7 and 21. Measurement of 24 h milk production volume was performed at 3 weeks postpartum using the test weight method. We observed a delayed first breastfeed (> 1 h) in 6 (75%) cases, formula use in hospital in 5 (63%) cases and delayed secretory activation in 3 (38%) cases. At 3 weeks postpartum, 2 cases had measured milk productions that were insufficient to sustain adequate infant weight gain. Conclusions Our data suggest that despite early and frequent milk removal, women with GDM are at greater risk of delayed secretory activation and low milk supply. Cohort studies that consider co-morbidities such as obesity are needed to determine the lactation outcomes of women with GDM.

Causes of Low Milk Supply: The Roles of Estrogens, Progesterone, and Related External Factors

“…Gestational diabetes mellitus (GDM) is the most common pregnancy complication and is increasing in prevalence globally [ 42 ]. A few studies have found that women with GDM are at greater risk of delayed secretory activation and LMS [ [43] , [44] , [45] ]. Insulin regulates the expression of genes involved in milk protein synthesis, including signal transducer and activator of transcription 5 (STAT5a) and E74-like factor 5, which are key components of prolactin signaling [ 46 , 47 ].…”

“…Insulin regulates the expression of genes involved in milk protein synthesis, including signal transducer and activator of transcription 5 (STAT5a) and E74-like factor 5, which are key components of prolactin signaling [ 46 , 47 ]. Therefore, insulin resistance might be a potential mechanism underpinning the link between GDM and LMS that has been shown in a recent case series [ 43 ]. There is no doubt that pre-existing type 1 and type 2 diabetes mellitus (T1DM and T2DM) are also associated with poor breastfeeding outcomes [ 48 ].…”

Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases

“…Milk production depends on the proper development of breast during pregnancy. Insulin metabolism controls milk secretion, supporting mammary gland differentiation [ 142 ]. Insulin upregulates genes related to mammary epithelial cell (MEC) proliferation and downregulates genes responsible for MEC differentiation [ 143 , 144 ].…”

Human Milk-Derived Levels of let-7g-5p May Serve as a Diagnostic and Prognostic Marker of Low Milk Supply in Breastfeeding Women

“…In addition, numerous social, psychological, and behavioral factors are associated with early breastfeeding cessation [ 3 , 4 , 5 , 6 ]. Several studies reported associations between maternal metabolic conditions such as malnutrition [ 7 ], excessive maternal fat mass [ 8 ], and gestational diabetes [ 9 ] and milk supply. Moreover, we and others determined that genetic variations in genes critical for mammary gland function (i.e., prolactin ( PRL ) [ 10 ], prolactin receptor ( PRLR ) [ 11 ], ZnT2 ( SLC30A2 ) [ 12 ], and milk fat globule-epidermal factor 8 protein ( MFGE8 ) [ 13 ]) are associated with the ability to produce milk, providing evidence that biological factors are also responsible for low milk supply.…”