Why it's important to keep the research-based link between pre-pregnancy or gestational diabetes and compromised milk production in perspective

We need to keep the effects of diabetes on breastfeeding success in perspective

It's important to know that more than two thirds of Australian women with Type 1 or Type 2 diabetes mellitis are breastfeeding their babies at three months postpartum, and that intention to breastfeed when a mother has pre-pregnancy diabetes still significantly increases the odds of breastfeeding. The three month breastfeeding rate for infants of mothers diagnosed with diabetes is much the same as the general breastfeeding prevalence rates at that age in Australia and in Denmark.

Gestational diabetes mellitus occurs in an average of 7% of pregnancies. Also, one percent of females < 44 years of age have pre-existing diabetes.

Women with gestational diabetes are less likely to develop diabetes type 2 later in life if they are able to breastfeed. It's been hypothesised that breastfeeding is important for women with diabetes because metabolic adaptations during lactation may reverse some of the atherogenic and diabetogenic effects of pregnancy. However, it could also be that women with metabolic dysfunctions prior to pregnancy such as pre-pregnancy diabetes are both less likely to be able to breastfeed and are also - regardless of breastfeeding - more likely to develop diabetes in later life. Women with diabetes can experience

• Difficulties with milk supply

• Delayed secretory activation

• Fluctuating maternal blood glucose levels.

Prolactin levels have been shown to be lower in women with metabolic syndrome and type 2 diabetes. However, prolactin levels are not linked to milk yields.

It's also reported that infants of mothers with diabetes may have more immature sucking patterns. However, sucking patterns are contextual, and it is likely that this is a correlation, related to the impact of larger body size on fit and hold rather than to innately compromised sucking patterns.

Cummins et al 2022 shows the importance of maternal confidence and good support on breastfeeding success

A 2021 integrative systematic review selected 26 articles and found that the main modifiable factors associated with improved in-hospital exclusive breastfeeding rates were that the mother

• Had a strong intention to breastfeed

• Was confident that she would be able to breastfeed

• Was feeling supported, and

• Had continuity of education and support.

Women’s main reasons to introduce formula were related to baby’s hypoglycaemia, delayed onset of lactation, and perceived low milk supply. Skin-to-skin contact after birth and frequent breastfeeds were effective ways to improve in-hospital exclusive breastfeeding rates. Women with gestational diabetes are more likely to introduce formula due to delayed onset of lactation, and also due to fear of neonatal hypoglycaemia.

Selected references

Cummins L, Meedya S, Wilson V. Factors that positively influence in-hospital exclusive breastfeeding among women with gestational diabetes: an integrative review. Women and Birth. 2022;18:S1871-5192(1821)00040-00048.