Breastfeeding after gestational diabetes reduces the risk of diabetes in both the mother and baby

In this post we share the evidence that shows breastfeeding after gestational diabetes pregnancy can help reduce the risk of diabetes in both the mother AND baby.

There is plenty of well established evidence showing the benefits to both the mother and baby of breastfeeding. This post is not designed to explain all the reasons why breastfeeding is beneficial, but will concentrate on the benefits specifically with regards to breastfeeding after gestational diabetes and how it can help prevent the development of Type 2 diabetes.

Health benefits of breastfeeding

According to UNICEF The Baby Friendly Initiative:

Breastfed babies have a lower risk of:

Type 1 diabetes
Type 2 diabetes
Obesity
SIDS (sudden infant death syndrome)
Respiratory infections
Gastroenteritis
Allergies

Benefits to mothers who breastfeed:

Lowers the risk of developing type 2 diabetes
The longer mothers breastfeed, the greater their protection against breast and ovarian cancer, and hip fractures in later life.
Recent evidence has demonstrated an association between prolonged breastfeeding and postmenopausal risk factors for cardiovascular (CV) disease.
The World Cancer Research Fund includes breastfeeding as one of 10 recommendations to reduce the risk.

Prevelance of type 2 diabetes in the mother following gestational diabetes pregnancy

Gestational diabetes increases your risk of developing type 2 diabetes after the pregnancy.

Statistics from Diabetes UK state that there is a seven-fold increased risk in women with gestational diabetes developing type 2 diabetes in later life.

This risk increases if you gain weight too, for every 1kg gain over the pre-pregnancy weight there is a 40% increased risk of developing type 2 diabetes.

NICE state that up to 50% of women diagnosed with gestational diabetes develop type 2 diabetes within 5 years of the birth.

Other factors for increased risk of type 2 diabetes following GD

Whilst having gestational diabetes itself increases the risk of developing type 2 diabetes significantly, other factors are:

pre-pregnancy weight (BMI)
needing insulin during the pregnancy
not breastfeeding

We also have an article which goes hand in hand with this post on preventing Type 2 diabetes after gestational diabetes.

Risks to children born to mothers with gestational diabetes

Diabetes UK statitics state

Children born to mothers with diabetes during pregnancy tend to have a greater BMI, raised fasting glucose levels and an increased risk of developing Type 2 diabetes later in life. The latest research suggests they have a six-fold increased risk of developing Type 2.

Importance of the first breast feed following birth

importance of the first feed Babies born to diabetic mothers have a higher risk of hypoglycaemia (low blood sugar levels) and jaundice following birth. Feeding is required to raise the baby’s blood sugar levels.

A study was carried out on the Importance of the first breast feed following birth:

It has been recognised that babies of diabetic mothers are at greater risk of hypoglycaemia and as such, an early feed is recommended. A study was carried out to ascertain both the impact of an early feed and to establish what type of feeding provided the best option to reduce the risk of hypoglycaemia. The researchers used a prospective pilot study of 84 infants born to gestational diabetic women to measure blood glucose levels of infants who were breastfed in the delivery room compared to those who were not. The study also compared the blood glucose levels of infants who breastfed with those who received infant formula for their first feed.

The researchers found that infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period (10% versus 28%, P = 0.05) and had significantly higher mean blood glucose level compared to infants who were not breastfed in the delivery room (3.17 versus 2.86 mmol/l, P = 0.03). Breastfed infants had a significantly higher mean blood glucose level compared to those who received infant formula for their first feed (3.20 versus 2.68 mmol/l, P = 0.002). The researchers concluded that an early breastfeed may facilitate stable blood glucose levels in the infants of mothers with gestational diabetes.

Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes

Colostrum harvesting

colostrum harvesting Babies born to mothers with diabetes have an increased risk of hypoglycaemia (low blood sugar levels) and jaundice.

colostrum capped syringe2 To raise blood sugar levels the baby needs to feed as much as possible. Even though many mothers manage to successfully breast feed, some babies still require further top up feeds and some have difficulties feeding, therefore require bottle or cup feeds. In more concerning situations, babies born to gestational diabetes mothers may need an NG tube or a glucose/dextrose infusion.

Colostrum, is the secretion from the mammary glands, rich in antibodies. It is a sticky liquid from the nipples which is made before the milk has ‘come in’ (before breast milk is produced). It is produced from around the 20th week in pregnancy, up until the first few days after the baby has been born.

In preparation for birth, many diabetic mothers try to express colostrum and freeze it for use once the baby is born. This ensures there is extra colostrum readily available should your baby require additional top up feeds or help with feeding.

To learn more about colostrum harvesting, the benefits and to read a detailed guide on antenatal expressing to harvest or collect colostrum before birth, please see our Colostrum harvesting page.

Concerns over milk supply because of gestational diabetes

lactation and milk supply with gestational diabetes A question that is often raised is whether gestational diabetes impacts on lactation. These research articles explains some of the difficulties women with gestational diabetes may face:

Lactation may be more difficult for women with GDM because both maternal diabetes and obesity can delay the onset of lactogenesis (52,53). Furthermore, medical management of their newborns that involves provision of supplemental milk feedings may interfere with maternal milk production. In obese women, lactogenesis may be impaired because of lower physiological levels of prolactin in response to suckling (52). Delayed milk production may lead to lower rates of breastfeeding and shorter duration among obese women (53). A small sample of women with GDM were observed to have no marked delays based on similar concentration of lactose in the colostrum of GDM women compared with control women at 40–50 h postpartum (54). However, GDM women had more difficulty expressing colostrum from their breasts during the first 2 days of lactation.

Breastfeeding After Gestational Diabetes Pregnancy

One-third of women with recent GDM experienced delayed onset of stage II lactogenesis (OL). Maternal obesity, insulin treatment, and suboptimal in-hospital breastfeeding were key risk factors for delayed OL. Early breastfeeding support for GDM women with these risk factors may be needed to ensure successful lactation.

Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus

PCOS and milk supply

PCOS (polycystic ovarian syndrome) causes insulin resistance and so many ladies with PCOS may be diagnosed with gestational diabetes. PCOS can cause milk supply issues and so some ladies may experience either over production of milk or low supply.

You can read more about PCOS and breastfeeding on the following websites:

Kelly Mom

La Leche League

PCOS Diva

The longer you breastfeed the better

older baby breastfeeding Studies suggest that the longer you breastfeed, the risks of developing Type 2 diabetes is lowered further.

Breastfeeding after gestational diabetes for more than three months postpartum has a protective effect on the body and could provide women with some protection from type 2 diabetes for up to 15 years

Lactation is associated with altered metabolomic signatures in women with gestational diabetes

Longer duration of breastfeeding is associated with reduced incidence of type 2 diabetes according to a large study from the USA.

Research among two large groups of parous women (n=83585 and n=73418) found that for each additional year of lactation, women had a 14 to 15 per cent reduction in risk of type 2 diabetes.

Duration of Lactation and Incidence of Type 2 Diabetes

Evidence based research articles

Results: Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years later; 113 (11.8%) developed incident Diabetes Mellitus (DM). There were graded inverse associations for lactation intensity at baseline with incident DM and adjusted hazard ratios of 0.64, 0.54, and 0.46 for mostly formula or mixed/inconsistent, mostly lactation, and exclusive lactation versus exclusive formula feeding, respectively (P trend = 0.016). Time-dependent lactation duration showed graded inverse associations with incident DM and adjusted hazard ratios of 0.55, 0.50, and 0.43 for greater than 2 to 5 months, greater than 5 to 10 months, and greater than 10 months, respectively, versus 0 to 2 months (P trend = 0.007). Weight change slightly attenuated hazard ratios.

Limitation: Randomized design is not feasible or desirable for clinical studies of lactation.

Conclusion: Higher lactation intensity and longer duration were independently associated with lower 2-year incidences of DM after GDM pregnancy. Lactation may prevent DM after GDM delivery.

Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study

In conclusion, the results of observational studies and a small number of prospective studies suggest that breastfeeding is associated with improvements in glucose and lipid metabolism together with reduced risk of T2DM in women with GDM. However, because women who breastfeed are more likely to engage with other healthy behaviors and are more likely to be highly educated or have a lower BMI, the results of observational and retrospective studies must be interpreted with caution.

Beneficial effects of breastfeeding in women with gestational diabetes mellitus

A systematic review of published evidence examined the relationship between infant feeding and type 2 diabetes in later life or risk factors for diabetes. Children and adults without diabetes who had been breastfed had marginally lower fasting insulin concentrations than those who were formula fed. Breastfed infants had lower mean preprandial blood glucose and insulin concentrations than those who were formula fed.

The authors conclude that breastfeeding is associated with a reduced risk of type 2 diabetes, with lower blood glucose and serum insulin concentrations in infancy and marginally lower insulin concentrations in later life.

Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence

Breastfeeding and diabetes

Breastfeeding in women with gestational diabetes

Breastfeeding After Gestational Diabetes Pregnancy

Promoting Breastfeeding Among Obese Women and Women with Gestational Diabetes Mellitus

Breastfeeding initiation in women with gestational diabetes mellitus

Promoting Health After Gestational Diabetes: A National Diabetes Education Program Call to Action

Impact of Breastfeeding on Maternal Metabolism: Implications for Women with Gestational Diabetes

Breast-Feeding and Diabetes: Long-Term Impact on Mothers and Their Infants

Association between History of Gestational Diabetes and Exclusive Breastfeeding at Hospital Discharge

Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years

Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus