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The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production

The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production
The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production
Background: previous studies focusing on the association between gestational diabetes and breastfeeding duration have been inconclusive.

Objectives: we aimed to determine whether maternal gestational hyperglycemia is associated with the duration of breastfeeding and the concentrations of markers linked to breastmilk production.

Methods: data from the prospective, multi-ethnic Growing Up in Singapore Towards healthy Outcomes (GUSTO) study was used to assess the association of fasting plasma glucose (FPG) and 2-hour post challenge glucose (2hPG) measured at 26-28 weeks’ gestation with duration of breastfeeding and concentrations of protein, lactose, citrate, sodium, potassium and zinc in breastmilk 3 weeks postpartum.

Results: of the 1035 participants, 5.2% and 9.5% had elevated FPG and 2hPG, respectively, consistent with a diagnosis of gestational diabetes mellitus (GDM) based on International Association of Diabetes and Pregnancy Study Groups criteria. FPG ≥ 5.1 mmol/L was associated with a crude reduction in median breastfeeding duration of 2.3 months. In a model adjusted for maternal pre-pregnancy BMI and intention to breastfeed, FPG ≥ 5.1 mmol/L predicted earlier termination of any breastfeeding (Adjusted hazard ratio [95% CI]: 1.47 [1.04, 2.08]) but not full breastfeeding (1.08 [0.76, 1.55]). 2hPG ≥ 8.5 mmol/L was not significantly associated with the durations of any or of full breastfeeding (0.86 [0.62, 1.19] and 0.85 [0.62, 1.18], respectively). Maternal FPG was significantly and positively associated with breastmilk sodium and sodium-to-potassium (Na:K) ratio (Adjusted coefficient [95% CI]: 1.28 [1.08, 1.51] and 1.29 [1.08, 1.54], respectively), but not with other measured breastmilk components.

Conclusions: women with FPG ≥ 5.1 mmol/L during pregnancy breastfeed for a shorter duration. Future work involving measurement of milk production is needed to determine whether low milk production predicts breastfeeding duration among women with elevated FPG.
0002-9165
Pang, Wei Wei
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Geddes, Donna T.
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Lai, Ching-Tat
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Chan, Shiao-Yng
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Chan, Yiong Huak
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Cheong, Clara Y.
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Fok, Doris
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Chua, Mei Chien
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Lim, Sok Bee
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Huang, Jonathan Y.
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Pundir, Shikha
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Tan, Kok Hian
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Yap, Fabian
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Godfrey, Keith
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Gluckman, Peter D.
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Shek, Lynette P.
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Vickers, Mark H.
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Eriksson, Johan G.
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Chong, Yap-Seng
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Wlodek, Mary E.
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Pang, Wei Wei
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Geddes, Donna T.
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Lai, Ching-Tat
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Chan, Shiao-Yng
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Chan, Yiong Huak
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Cheong, Clara Y.
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Fok, Doris
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Chua, Mei Chien
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Lim, Sok Bee
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Huang, Jonathan Y.
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Pundir, Shikha
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Tan, Kok Hian
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Yap, Fabian
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Godfrey, Keith
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Gluckman, Peter D.
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Shek, Lynette P.
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Vickers, Mark H.
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Eriksson, Johan G.
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Chong, Yap-Seng
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Wlodek, Mary E.
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Pang, Wei Wei, Geddes, Donna T., Lai, Ching-Tat, Chan, Shiao-Yng, Chan, Yiong Huak, Cheong, Clara Y., Fok, Doris, Chua, Mei Chien, Lim, Sok Bee, Huang, Jonathan Y., Pundir, Shikha, Tan, Kok Hian, Yap, Fabian, Godfrey, Keith, Gluckman, Peter D., Shek, Lynette P., Vickers, Mark H., Eriksson, Johan G., Chong, Yap-Seng and Wlodek, Mary E. (2021) The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production. American Journal of Clinical Nutrition. (doi:10.1093/ajcn/nqab142).

Record type: Article

Abstract

Background: previous studies focusing on the association between gestational diabetes and breastfeeding duration have been inconclusive.

Objectives: we aimed to determine whether maternal gestational hyperglycemia is associated with the duration of breastfeeding and the concentrations of markers linked to breastmilk production.

Methods: data from the prospective, multi-ethnic Growing Up in Singapore Towards healthy Outcomes (GUSTO) study was used to assess the association of fasting plasma glucose (FPG) and 2-hour post challenge glucose (2hPG) measured at 26-28 weeks’ gestation with duration of breastfeeding and concentrations of protein, lactose, citrate, sodium, potassium and zinc in breastmilk 3 weeks postpartum.

Results: of the 1035 participants, 5.2% and 9.5% had elevated FPG and 2hPG, respectively, consistent with a diagnosis of gestational diabetes mellitus (GDM) based on International Association of Diabetes and Pregnancy Study Groups criteria. FPG ≥ 5.1 mmol/L was associated with a crude reduction in median breastfeeding duration of 2.3 months. In a model adjusted for maternal pre-pregnancy BMI and intention to breastfeed, FPG ≥ 5.1 mmol/L predicted earlier termination of any breastfeeding (Adjusted hazard ratio [95% CI]: 1.47 [1.04, 2.08]) but not full breastfeeding (1.08 [0.76, 1.55]). 2hPG ≥ 8.5 mmol/L was not significantly associated with the durations of any or of full breastfeeding (0.86 [0.62, 1.19] and 0.85 [0.62, 1.18], respectively). Maternal FPG was significantly and positively associated with breastmilk sodium and sodium-to-potassium (Na:K) ratio (Adjusted coefficient [95% CI]: 1.28 [1.08, 1.51] and 1.29 [1.08, 1.54], respectively), but not with other measured breastmilk components.

Conclusions: women with FPG ≥ 5.1 mmol/L during pregnancy breastfeed for a shorter duration. Future work involving measurement of milk production is needed to determine whether low milk production predicts breastfeeding duration among women with elevated FPG.

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More information

Accepted/In Press date: 5 April 2021
Published date: 8 May 2021

Identifiers

Local EPrints ID: 448197
URI: http://eprints.soton.ac.uk/id/eprint/448197
ISSN: 0002-9165
PURE UUID: 166b8143-e88a-477d-b341-1bad98f96aa4
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

Catalogue record

Date deposited: 14 Apr 2021 16:42
Last modified: 24 Nov 2021 02:33

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Contributors

Author: Wei Wei Pang
Author: Donna T. Geddes
Author: Ching-Tat Lai
Author: Shiao-Yng Chan
Author: Yiong Huak Chan
Author: Clara Y. Cheong
Author: Doris Fok
Author: Mei Chien Chua
Author: Sok Bee Lim
Author: Jonathan Y. Huang
Author: Shikha Pundir
Author: Kok Hian Tan
Author: Fabian Yap
Author: Keith Godfrey ORCID iD
Author: Peter D. Gluckman
Author: Lynette P. Shek
Author: Mark H. Vickers
Author: Johan G. Eriksson
Author: Yap-Seng Chong
Author: Mary E. Wlodek

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