Infant feeding patterns in families with a diabetes history – observations from The Environmental Determinants of Diabetes in the Young (TEDDY) birth cohort study

Abstract

Objective To assess the association between diabetes family history and infant feeding patterns. Design Data on breast-feeding duration and age at first introduction of cow’s milk and gluten-containing cereals were collected in 3-month intervals during the first 24 months of life. Setting Data from the multicentre TEDDY (The Environmental Determinants of Diabetes in the Young) study, including centres in the USA, Sweden, Finland and Germany. Subjects A total of 7026 children, including children with a mother with type 1 diabetes (T1D; n 292), gestational diabetes mellitus (GDM; n 404) or without diabetes but with a father and/or sibling with T1D (n 464) and children without diabetes family history (n 5866). Results While exclusive breast-feeding ended earlier and cow’s milk was introduced earlier in offspring of mothers with T1D and GDM, offspring of non-diabetic mothers but a father and/or sibling with T1D were exclusively breast-fed longer and introduced to cow’s milk later compared with infants without diabetes family history. The association between maternal diabetes and shorter exclusive breast-feeding duration was attenuated after adjusting for clinical variables (delivery mode, gestational age, Apgar score and birth weight). Country-specific analyses revealed differences in these associations, with Sweden showing the strongest and Finland showing no association between maternal diabetes and breast-feeding duration. Conclusions Family history of diabetes is associated with infant feeding patterns; however, the associations clearly differ by country, indicating that cultural differences are important determinants of infant feeding behaviour. These findings need to be considered when developing strategies to improve feeding patterns in infants with a diabetes family history.

Regional differences in milk and complementary feeding patterns in infants participating in an international nutritional type 1 diabetes prevention trial

“…Infants should room-in with their mothers and the mothers should be encouraged to breastfeed at least 8 to 12 times per day (Hall & Carroll 2000). In the present study, most infants received mother’s breast milk during the first 2 weeks of life which is consistent with the findings of another international cohort study of infants at increased genetic risk for T1D (Hummel et al 2014). Breastfeeding was less common among mothers with T1D and may be related to their higher percentage of caesarean sections, earlier delivery, lower age and education (Sorkio et al 2010) as well as maintaining good glycemic control while breastfeeding (Murtaugh et al 1998).…”

Infant Feeding and Timing of Complementary Foods in the Development of Type 1 Diabetes

“…Although international infant feeding recommendations do not vary widely, infant feeding patterns differ between countries due to socio-demographic factors such as parental education and age, and cultural differences in food habits [9–13]. The World Health Organization (WHO) and American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for the first 6 months of life followed by continued breastfeeding as complementary foods are introduced [14–16].…”

“…Worldwide breastfeeding initiation rates have been reported to range from 91 to 97 % in Australia [34], 74 to 99.5 % in Europe, 69 to 83 % (average 73 %) in Canada, and 27 to 69.5 % in the USA [35, 36]. In The international Environmental Determinants of Diabetes in the Young (TEDDY) study ( n =7026), the rates of breastfeeding initiation were 96 % in infants of mothers with T1D and 98 % in infants with a father or sibling with T1D [13]. However, the duration of exclusive breastfeeding as recommended by the WHO and AAP was met by <20 % of the infants at high risk for T1D in these research populations [13, 32, 33, 37].…”

“…In the Finnish DIPP study cohort, infants were introduced to complementary foods at the median age of 3.5 months (range, 1 to 6 months) [33]. In the TEDDY study, the introduction of cow's milk (including cow's milk-based infant formulas) occurred earliest in infants of mothers with T1D and gestational diabetes followed by infants with a father and/or sibling with T1D and latest in infants without a family member with diabetes [13]. In contrast, gluten-containing foods were introduced later in TEDDY infants with a parent and/or sibling with T1D (median age 6 months) compared to infants without diabetes in the family (median age 5 months).…”

First Infant Formula Type and Risk of Islet Autoimmunity in The Environmental Determinants of Diabetes in the Young (TEDDY) Study

“…As a result, health care professionals and mothers are uncertain regarding the choice of infant formula if breast-feeding is not possible or additional milk feeding is needed. This is of particular interest to mothers with type 1 diabetes, who experience difficulties with exclusive breast-feeding and have to introduce infant formula in the early postpartum period (14). …”