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Gestational Diabetes

September 2014

With the rapidly rising rates of gestational diabetes mellitus (GDM) seen today, it’s worthwhile reviewing the research. The paper that I’d like you to read and print out for your colleagues clearly shows how chronic diabetes mellitus develops frequently and very quickly when a mother does not breastfeed following a GDM-affected pregnancy. The full text of this journal article is freely available online.

The article, published in the journal Diabetes, studied women who had GDM with the outcome measure being the development of diabetes mellitus after delivery. The follow-up period was extensive, up to 19 years (and still continuing). The variables studied included islet cell antibody status (positive or negative), diabetes treatment during pregnancy (diet or insulin), BMI (obese or not obese) and lactation (no breastfeeding, breastfeeding ≤3 months, breastfeeding >3 months, no full breastfeeding).

The small number of mothers who were islet cell antibody positive all developed diabetes mellitus within 6 months of delivering.

For the remaining mothers, not breastfeeding or weaning within the first 3 months had an enormous impact on their development of diabetes mellitus. The study demonstrated upwards of 18 diabetes-free years in the women who breastfed compared to an average of 2 years in formula-feeding women 3(Ziegler et al, 2013). Pause a moment and consider how this fact impacts on the personal and national levels.

Unfortunately, compared to the national average, fewer women who have GDM even initiate breastfeeding. Additionally mothers can experience delayed onset of lactation 1 (Matias SL, 2014) and newborns of mothers with GDM are more frequently admitted to NICU 2(Cordero L, 2013). Quality prenatal education and proactive evidence-based newborn and maternal care will make a difference to these poor statistics.

Questions to think about

  1. When a woman is diagnosed with gestational diabetes in your Unit what discussion occurs with the mother and her support people?
  2. Are they explicitly told of the effect their feeding choice will have on the mother’s and infant’s health?
  3. Is this discussion led by knowledgeable staff who can appropriately support and encourage initiation of breastfeeding?
  4. With both mother and baby having risk factors for breastfeeding failure what strategies are in place to ensure they receive additional support, encouragement and ideal breastfeeding management postnatally?

Have a great month,

Denise

Denise Fisher, AM, MMP, IBCLC
Director, Step2 Education
 

1. Matias SL, Dewey KG, Quesenberry CP Jr, Gunderson EP. (2014) Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. Am J Clin Nutr. 99(1):115-21. doi: 10.3945/ajcn.113.073049. Epub 2013 Nov 6.

2. Cordero L, Gabbe SG, Landon MB, Nankervis CA. (2013) Breastfeeding initiation in women with gestational diabetes mellitus. J Neonatal Perinatal Med. 6(4):303-10. doi: 10.3233/NPM-1372513.

3. Ziegler AG, Wallner M, Kaiser I, Rossbauer M, Harsunen MH, Lachmann L, Maier J, Winkler C, Hummel S. (2012) Long-term protective effect of lactation on the development of type 2 diabetes in women with recent gestational diabetes mellitus. Diabetes. 61(12):3167-71. doi: 10.2337/db12-0393. Epub 2012 Oct 15. http://diabetes.diabetesjournals.org/content/61/12/3167.long

 
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