Lactation Intensity and Postpartum Maternal Glucose Tolerance and Insulin Resistance in Women With Recent GDM

Gunderson, Erica P.; Hedderson, Monique M.; Chiang, Vicky; Crites, Yvonne; Walton, David; Azevedo, Robert A.; Fox, Gary M.; Elmasian, Cathie; Young, Stephen; Salvador, Nora; Lum, Michael; Quesenberry, Charles P.; Lo, Joan C.; Sternfeld, Barbara; Ferrara, Assiamira; Selby, Joseph V.

doi:10.2337/dc11-1409

Cited by 171 publications

(171 citation statements)

References 22 publications

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“…Results from Project Viva showed no association between lactation and fasting insulin in a multivariate model (26). In women with a pregnancy complicated with GDM from the SWIFT cohort, compared with exclusive or mostly formula feeding, women who were exclusively breastfeeding or mostly breastfeeding 6-9 weeks after delivery had lower fasting and 2-h post-OGTT insulin concentrations (9). These results combined with results from this study suggest that lactation is associated with lower insulin concentrations and reduced insulin response following a glucose challenge.…”

Section: Discussionmentioning

confidence: 99%

“…In a larger study of women with prior GDM, the Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT), 522 participants were tested at 6-9 weeks after a GDM-complicated pregnancy (9). Exclusive breastfeeding or mostly breastfeeding women had lower HOMA-IR index but no differences were found with the mixed or inconsistent feeders compared with the formula feeding group (9). Whether the apparent benefit of lactation on insulin sensitivity persists after weaning is uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, an observational study of 26 women with prior GDM showed that insulin sensitivity was not significantly different between breastfeeding and non-breastfeeding women 3 months after a GDM-complicated pregnancy (10). In a larger study of women with prior GDM, the Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT), 522 participants were tested at 6-9 weeks after a GDM-complicated pregnancy (9). Exclusive breastfeeding or mostly breastfeeding women had lower HOMA-IR index but no differences were found with the mixed or inconsistent feeders compared with the formula feeding group (9).…”

Section: Discussionmentioning

confidence: 99%

“…Lactation is encouraged for women with prior GDM because it may confer health benefits to women with a history of GDM (6,7,8) and has been suggested to be associated with increased insulin sensitivity (9), improved insulin secretion (10), and improved glucose tolerance (6,11). A study by Gunderson et al (9) showed that lactation may exert favorable effects on insulin sensitivity.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between lactation duration and insulin and glucose response among women with prior gestational diabetes

Chouinard-Castonguay

Weisnagel

Tchernof

et al. 2013

European Journal of Endocrinology

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Background: Few studies have investigated whether favorable effects of lactation persist after weaning and protect women with prior gestational diabetes mellitus (GDM) against later development of insulin resistance and insulin secretion defects. Objective: To investigate the impact of lactation duration on insulin and glucose response among women with prior GDM. Design/methods: The study group comprised 144 women with a history of GDM between 2003 and 2010. Plasma insulin and glucose concentrations were obtained from a 75 g oral glucose tolerance test (OGTT). Total lactation duration (exclusive breastfeeding and breast and bottle-feeding) for all infants was self-reported in months. Results: Mean age was 36.5G5.0 years. Time between delivery and metabolic testing was 4.0G1.9 years. Women breastfed for an average of 13.9G16.8 months. Most women (80.6%) reported a history of lactation. Women who lactated had higher homeostasis model assessment for insulin sensitivity (HOMA-IS) and Matsuda indices and lower fasting and 2-h post-OGTT insulin concentrations as well as area under the curve (AUC) for insulin (P%0.01 for all). Compared with women who lactated for !10 months, women who lactated for R10 months had improved insulin sensitivity-secretion index, higher HOMA-IS and Matsuda indices, lower fasting and 2-h post-OGTT insulin concentrations as well as AUC for insulin, and lower incidence of impaired glucose intolerance (P%0.05 for all). In multiple linear regression analyses, lactation duration emerged as an independent predictor of fasting insulin concentrations (bZK0.02) and insulin sensitivity indices (bZ0.02) (P%0.05 for all). Conclusions: These results suggest that longer duration of lactation is associated with improved insulin and glucose response among women with prior GDM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Relationship between lactation duration and insulin and glucose response among women with prior gestational diabetes

Chouinard-Castonguay

Weisnagel

Tchernof

et al. 2013

European Journal of Endocrinology

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show abstract

“…Women who report more than 9 cumulative months of breastfeeding over their reproductive lifetime are less likely to develop hypertension, hyperlipidemia, and metabolic syndrome 32, 33, 34, 35, 36, 37. Further, evidence suggests that a longer duration of breastfeeding is associated with a lower risk of developing type 2 diabetes mellitus,38, 39, 40, 41, 42, 43 and reduced maternal postpartum weight 44, 45, 46, 47…”

Section: Introductionmentioning

confidence: 99%

Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative

Jacobson

Hade

Collins

et al. 2018

JAHA

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BackgroundStroke is the third leading cause of death among US Hispanic and non‐Hispanic black women aged 65 and older. One factor that may protect against stroke is breastfeeding. Few studies have assessed the association between breastfeeding and stroke and whether this association differs by race and ethnicity.Methods and ResultsData were taken from the Women's Health Initiative Observational Study with follow‐up through 2010; adjusted hazard ratios for stroke subsequent to childbirth were estimated with Cox regression models accounting for left and right censoring, overall and stratified by race/ethnicity. Of the 80 191 parous women in the Women's Health Initiative Observational Study, 2699 (3.4%) had experienced a stroke within a follow‐up period of 12.6 years. The average age was 63.7 years at baseline. Fifty‐eight percent (n=46 699) reported ever breastfeeding; 83% were non‐Hispanic white, 8% were non‐Hispanic black, 4% were Hispanic, and 5% were of other race/ethnicity. After adjustment for nonmodifiable potential confounders, compared with women who had never breastfed, women who reported ever breastfeeding had a 23% lower risk of stroke (adjusted hazard ratio=0.77; 95% confidence interval 0.70‐0.83). This association was strongest for non‐Hispanic black women (adjusted hazard ratio=0.52; 95% confidence interval 0.37‐0.71). Further, breastfeeding for a relatively short duration (1‐6 months) was associated with a 19% lower risk of stroke (adjusted hazard ratios=0.81; 95% confidence interval 0.74‐0.89). This association appeared stronger with longer breastfeeding duration and among non‐Hispanic white and non‐Hispanic black women (test for trend P<0.01).ConclusionsStudy results show an association and dose‐response relationship between breastfeeding and lower risk of stroke among postmenopausal women after adjustment for multiple stroke risk factors and lifestyle variables. Further investigation is warranted.

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Lactation Duration and the Risk of Subtypes of Stroke Among Parous Postmenopausal Women From the China Kadoorie Biobank

et al. 2022

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IMPORTANCEPrevious studies have reported favorable associations between lactation and cardiovascular diseases. Various stroke subtypes are caused by different pathological processes; however, to date, the associations of lactation duration with different stroke subtypes are less well established. OBJECTIVE To examine the associations of lactation duration with stroke and its subtypes in parous postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS This population-based prospective cohort study included parous postmenopausal women aged 45 to 79 years in the China Kadoorie Biobank (CKB) study at baseline (2004-2008). Lactation duration was counted as lifetime, mean per child, and for the first child. New-onset stroke and its subtypes (ischemic stroke, intracerebral hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) were assessed via disease registries and national health insurance claim databases during follow-up (2008-2015). Data were analyzed from June to December 2021. EXPOSURES Lactation duration (lifetime, mean per child, and for the first child). MAIN OUTCOMES AND MEASURESThe main outcomes were total stroke, ischemic stroke, ICH, and SAH. Multivariable Cox regression was applied to calculate the adjusted hazard ratios (aHRs) with 95% CIs for stroke and subtypes. RESULTSOf 129 511 parous postmenopausal women (median [IQR] age, 58.3 [54.0-64.6] years)without prior stroke at baseline, 15 721 developed stroke, with median (IQR) lifetime lactation duration of 42.0 (24.0-70.0) months among 13 427 women who had ischemic stroke, 54.0 (36.0-84.0) months among 2567 women who had ICH, and 36.0 (24.0-64.5) months among 284 women with SAH. Compared with parous postmenopausal women who had never lactated, those with lifetime lactation duration of at least 7 months had lower risks of ischemic stroke (aHRs varying from 0.52 [95% CI, 0.50-0.55] to 0.64 [95% CI, 0.59-0.69]) and ICH (aHRs, 0.56 [95% CI, 0.49-0.63] to 0.78 [95% CI, 0.64-0.96]). However, for SAH, such associations were found only in participants with lifetime lactation duration longer than 24 months (aHR, 0.61 [95% CI, 0.47-0.79]).Additionally, women with mean lactation duration per child or lactation duration for the first child of 7 months or longer were less likely to develop stroke (aHRs varying from 0.53 [95% CI, 0.52-0.54] to 0.65 [95% CI, 0.63-0.67]) and its subtypes (aHRs varying from 0.51 [95% CI, 0.30-0.87] to 0.75 [95% CI, 0.69-0.81]). CONCLUSIONS AND RELEVANCEIn this cohort study, lactation was significantly associated with a lower risk of stroke, especially ischemic stroke, emphasizing the importance of promoting breastfeeding as a targeted prevention strategy of stroke.

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Lactation Intensity and Postpartum Maternal Glucose Tolerance and Insulin Resistance in Women With Recent GDM

Cited by 171 publications

References 22 publications

Relationship between lactation duration and insulin and glucose response among women with prior gestational diabetes

Relationship between lactation duration and insulin and glucose response among women with prior gestational diabetes

Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative

Lactation Duration and the Risk of Subtypes of Stroke Among Parous Postmenopausal Women From the China Kadoorie Biobank

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