Glycaemic behaviour during lactation: postpartum practical guidelines for women with type 1 diabetes

Saez-de-Ibarra, Lourdes; Gaspar, Ruth; Obesso, A.; Herranz, Lucrecia

doi:10.1002/pdi.529

Cited by 19 publications

(13 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In spite of evidence that stress and social support may impact on health behaviours and outcomes of diabetes pregnancy [9,14]; few studies have examined the effect of social support immediately after pregnancy in women with T1DM.…”

Section: Introductionmentioning

confidence: 99%

Transition to motherhood in type 1 diabetes: design of the pregnancy and postnatal well-being in transition questionnaires

Rasmussen

Dunning

Hendrieckx

et al. 2013

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

BackgroundLife transitions are associated with high levels of stress affecting health behaviours among people with Type 1 diabetes. Transition to motherhood is a major transition with potential complications accelerated by pregnancy with risks of adverse childbirth outcomes and added anxiety and worries about pregnancy outcomes. Further, preparing and going through pregnancy requires vigilant attention to a diabetes management regimen and detailed planning of everyday activities with added stress on women. Psychological and social well-being during and after pregnancy are integral for good pregnancy outcomes for both mother and baby. The aim of this study is to establish the face and content validity of two novel measures assessing the well-being of women with type 1 diabetes in their transition to motherhood, 1) during pregnancy and 2) during the postnatal period.MethodsThe approach to the development of the Pregnancy and Postnatal Well-being in T1DM Transition questionnaires was based on a four-stage pre-testing process; systematic overview of literature, items development, piloting testing of questionnaire and refinement of questionnaire. The questionnaire was reviewed at every stage by expert clinicians, researchers and representatives from consumer groups. The cognitive debriefing approach confirmed relevance of issues and identified additional items.ResultsThe literature review and interviews identified three main areas impacting on the women’s postnatal self-management; (1) psychological well-being; (2) social environment, (3) physical (maternal and fetal) well-being. The cognitive debriefing in pilot testing of the questionnaire identified that immediate postnatal period was difficult, particularly when the women were breastfeeding and felt depressed.ConclusionsThe questionnaires fill an important gap by systematically assessing the psychosocial needs of women with type 1 diabetes during pregnancy and in the immediate postnatal period. The questionnaires can be used in larger data collection to establish psychometric properties. The questionnaires potentially play a key role in prospective research to determine the self-management and psychological needs of women with type 1 diabetes transitioning to motherhood and to evaluate health education interventions.

show abstract

Section: Introductionmentioning

confidence: 99%

Transition to motherhood in type 1 diabetes: design of the pregnancy and postnatal well-being in transition questionnaires

Rasmussen

Dunning

Hendrieckx

et al. 2013

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…In the literature, only a few articles describe changes in insulin treatment during lactation. Some found a reduced insulin requirement of 16 -25% during lactation (19) compared with 0 -10% in bottle-feeding women (19), whereas others found comparable reductions in insulin dose in lactating and bottle-feeding women (20,21) or even no reduction in insulin dose compared with the prepregnancy insulin dose (22,23). However, these studies included only a relatively small number of women and were mainly performed before modern insulin treatment with multiple insu- lin injections and home blood glucose monitoring were available.…”

Section: Breast-feeding In Women With Diabetesmentioning

confidence: 99%

Long-Term Breast-Feeding in Women With Type 1 Diabetes

Stage

Nørgård²,

Damm³

et al. 2006

Diabetes Care

View full text Add to dashboard Cite

OBJECTIVE -Breast-feeding may be more difficult in women with diabetes because of neonatal morbidity and fluctuating maternal blood glucose values. The frequency of long-term breast-feeding and the possible predictors for successful breast-feeding were investigated.RESEARCH DESIGN AND METHODS -One hundred two consecutive women with type 1 diabetes were interviewed about breast-feeding using a semistructured questionnaire 5 days and 4 months after delivery. Clinical data were collected from the medical records.RESULTS -Five days after delivery, 86% of the women were breast-feeding. Four months after delivery, 55 (54%) women were exclusively, 14 (14%) were partly, and 33 (32%) were not breast-feeding compared with 50, 26, and 24% in the background population (NS). Mothers exclusively breast-feeding at 4 months were characterized by previous experience with breastfeeding, a higher educational level, and vaginal delivery and included a high proportion of nonsmokers, whereas there were no associations with diabetes-related parameters such as white classes, duration of diabetes, HbA 1c , and insulin dose at conception. Breast-fed offspring had a significantly higher birth weight and gestational age and were less often receiving glucose intravenously compared with the remaining offspring. Independent predictors of exclusive breastfeeding at 4 months were previous experience with breast-feeding (odds ratio 6.3 [95% CI 2.4 -17]) and higher educational level (7.1 [2.4 -21]). Cessation of breast-feeding was mainly due to common nursing problems, such as perceived milk supply, and not related to maternal diabetes status.CONCLUSIONS -The majority of the women with type 1 diabetes initiated breast-feeding, and the prevalence of breast-feeding at 4 months was comparable to that in the background population. Independent predictors of exclusive breast-feeding at 4 months were previous experience with breast-feeding and higher educational level. Diabetes Care 29:771-774, 2006I n Denmark, as well as globally, exclusive breast-feeding is recommended for the first 4 -6 months of life (1,2). Health care workers are encouraged to play a role in promoting breast-feeding and providing mothers with the appropriate information and support (1). In women with diabetes, much attention is given during pregnancy to preventing morbidity for both mother and child (3), whereas less attention is paid to breastfeeding (4). Breast-feeding is suggested to prevent future diseases and may prevent future obesity (2,5). Breast-feeding probably protects against the development of both type 1 diabetes (6,7) and type 2 diabetes (8) in offspring. Therefore, it is of special importance to encourage women with diabetes to breast-feed for at least 4 -6 months and to prevent early exposure of their offspring to cow's milk. Breast-feeding in women with type 1 diabetes may be more difficult to establish and of shorter duration compared with the background population because of increased maternal and neonatal morbidity.Fluctuating maternal blood glucose values with...

show abstract

“…Overall, mothers reduced their basal insulin dose to below prepregnancy values by week 4 post-partum, consistent with previous observations. 7 It may be appropriate to modify current advice and suggest that post-partum, mothers should reduce their insulin doses to below pre-pregnancy values to avoid developing prolonged hypoglycaemia. Dietary advice regarding increased carbohydrate intake and use of low glycaemic index carbohydrate would also be appropriate.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies of pregnant mothers with type 1 diabetes have also failed to recruit a substantial number of participants, and have reported high drop-out rates postpartum. 4,7,12 The performance of meaningful studies may require multi-centre collaboration to recruit a sufficient number of pregnant mothers, and study protocols carefully designed to maximise ease of participation by avoiding additional hospital visits and allowing flexibility of timing.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, little evidence is available on which to base advice on insulin dosage for these patients. [3][4][5][6][7] Unsurprisingly, qualitative evidence suggests that many women with type 1 diabetes find post-partum selfmanagement to be challenging, to which fear of hypoglycaemia may contribute. 8,9 The aim of the present study was to monitor glycaemic control in women with type 1 diabetes for 4 weeks post-partum, with a particular focus on the frequency of hypoglycaemia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Post-partum hypoglycaemia in lactating women with type 1 diabetes: a pilot study using continuous glucose monitoring

et al. 2015

View full text Add to dashboard Cite

Aims: To observe glucose profiles in post-partum women with type 1 diabetes with a particular focus on hypoglycaemia. Methods: Post-partum women with type 1 diabetes were studied for 4 weeks using home blood glucose monitoring (HBGM) and continuous glucose monitoring (CGM). Episodes of hypoglycaemia were documented using self-reported questionnaires. Results: Of 15 consenting participants, only six women completed the study, four of whom breastfed their baby. HBGM was performed a median of 7 times per day. No severe hypoglycaemia (requiring third party assistance) occurred, but a median of 17 (range 10-23) episodes of mild hypoglycaemia occurred. In all participants, CGM revealed several episodes of hypoglycaemia that were not detected by capillary blood glucose testing. Conclusions: Asymptomatic hypoglycaemia is common during breastfeeding. Recruitment and retention difficulties illustrate the challenge of studying glycaemia and intensive interventions in the post-partum period. Education programmes may help to reduce post-partum hypoglycaemia in women with type 1 diabetes. Br J Diabetes Vasc Dis 2015;15:119-122

show abstract

Glycaemic behaviour during lactation: postpartum practical guidelines for women with type 1 diabetes

Cited by 19 publications

References 14 publications

Transition to motherhood in type 1 diabetes: design of the pregnancy and postnatal well-being in transition questionnaires

Transition to motherhood in type 1 diabetes: design of the pregnancy and postnatal well-being in transition questionnaires

Long-Term Breast-Feeding in Women With Type 1 Diabetes

Post-partum hypoglycaemia in lactating women with type 1 diabetes: a pilot study using continuous glucose monitoring

Contact Info

Product

Resources

About