Lactation and progression to type 2 diabetes in patients with gestational diabetes mellitus: A systematic review and meta‐analysis of cohort studies

Abstract

Aims/IntroductionTo explore the association between lactation and type 2 diabetes incidence in women with prior gestational diabetes.Materials and MethodsWe searched PubMed, Embase and the Cochrane Library for cohort studies published through 12 June 2017 that evaluated the effect of lactation on the development of type 2 diabetes in women with prior gestational diabetes. A random effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs).ResultsA total of 13 cohort studies were included in the meta‐analysis. The pooled result suggested that compared with no lactation, lactation was significantly associated with a lower risk of type 2 diabetes (RR 0.66, 95% CI 0.48–0.90, I 2 = 72.8%, P < 0.001). This relationship was prominent in a study carried out in the USA (RR 0.66, 95% CI 0.43–0.99), regardless of study design (prospective design RR 0.56, 95% CI 0.41–0.76; retrospective design RR 0.63, 95% CI 0.40–0.99), smaller sample size (RR 0.52, 95% CI 0.30–0.92, P = 0.024) and follow‐up duration >1 years (RR 0.75, 95% CI 0.56–1.00), and the study used adjusted data (RR 0.69, 95% CI 0.50–0.94). Finally, by pooling data from three studies, we failed to show that compared with no lactation, long‐term lactation (>1 to 3 months postpartum) was associated with the type 2 diabetes risk (RR 0.69, 95% CI 0.41–1.17).ConclusionsThe present meta‐analysis showed that lactation was associated with a lower risk of type 2 diabetes in women with prior gestational diabetes. Furthermore, no significant relationship between long‐term lactation and type 2 diabetes risk was detected. The impact of long‐term lactation and the risk of type 2 diabetes should be verified in further large‐scale studies.

Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study

“…Recently published meta-analyses have reported positive effects of long-term breastfeeding of any intensity to reduce diabetes risk in women with a history of GDM [ 35 , 36 ]. In addition, Feng et al (2018) evaluated 13 observational studies and compared the effect of lactation with that of no lactation on diabetes risk reduction; they found a significant diabetes risk reduction in the lactation group [ 55 ]. The authors reported that exclusive lactation for more than six weeks and up to nine weeks postpartum showed an association with a lower risk of T2DM compared to exclusive formula feeding [ 55 ].…”

“…In addition, Feng et al (2018) evaluated 13 observational studies and compared the effect of lactation with that of no lactation on diabetes risk reduction; they found a significant diabetes risk reduction in the lactation group [ 55 ]. The authors reported that exclusive lactation for more than six weeks and up to nine weeks postpartum showed an association with a lower risk of T2DM compared to exclusive formula feeding [ 55 ]. Still, the meta-analyses reported by Tanase-Nakao et al (2017) and Feng et al (2018) lacked prospective data of cohorts with long-term follow-up.…”

Improving Breastfeeding by Empowering Mothers in Vietnam: A Randomised Controlled Trial of a Mobile App

“…Obesity is also less in breastfeeding mothers; on average, obese mothers who breastfed are 8 kg lighter six years after delivery compared to mothers who had not breastfed their infants [ 31 ]. Type 2 diabetes, hypertension, and hyperlipidaemia are also less, although these effects could, at least in part, result from reductions in obesity rates [ 32 , 33 ]. A large meta-analysis of cohort studies reported an approximately 30% significantly lower risk of maternal type 2 diabetes comparing mothers with the longest duration of breastfeeding versus those the shortest duration [ 34 ].…”

Lactobacillus bulgaricus improves antioxidant capacity of black garlic in the prevention of gestational diabetes mellitus: a randomized control trial

“…Gestational diabetes mellitus (GDM) refers to abnormal glucose tolerance during pregnancy [1]. GDM is potentially harmful to both mother and offspring, including increased amniotic fluid [2], preeclampsia [3], premature birth [4], ketoacidosis [5] and the development of type 2 diabetes mellitus (T2DM) [6] for mother, and abnormalities in intrauterine development [7], neonatal malformations [8], macrosomia [9], neonatal respiratory distress syndrome [10] and neonatal hypoglycemia [11] for offspring. At present, the study mainly focuses on GDM treatment after the middle and late pregnancy.…”