Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus

Autor: Shanta R. Hurston, Yvonne Crites, Stephen L. Young, Joan C. Lo, Type Diabetes After Gdm Pregnancy Investigators, Erica P. Gunderson, David Walton, Gary M. Fox, Barbara Sternfeld, Charles P. Quesenberry, Michael Lum, Cathie Elmasian, Robert A. Azevedo, Kathryn G. Dewey, Xian Ning, Nora Salvador
Rok vydání: 2015
Předmět:
Blood Glucose
Time Factors
Reproductive health and childbirth
Type 2 diabetes
Medical and Health Sciences
Pregnancy
Risk Factors
Infant Feeding and Type 2 Diabetes After GDM Pregnancy Investigators
Medicine
Prospective Studies
Prospective cohort study
Pediatric
Obstetrics
Incidence
Diabetes
Hazard ratio
General Medicine
Gestational diabetes
Gestational
Disease Progression
Female
Type 2
Adult
medicine.medical_specialty
Article
Clinical Research
General & Internal Medicine
Internal medicine
Diabetes mellitus
Diabetes Mellitus
Internal Medicine
Humans
Lactation
Metabolic and endocrine
Nutrition
business.industry
Prevention
Weight change
Infant
Type 2 Diabetes Mellitus
Perinatal Period - Conditions Originating in Perinatal Period
Lipid Metabolism
medicine.disease
Study of Women
Diabetes
Gestational
Endocrinology
Diabetes Mellitus
Type 2
Socioeconomic Factors
business
Follow-Up Studies
Zdroj: Annals of internal medicine, vol 163, iss 12
ISSN: 1539-3704
0003-4819
Popis: Background Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain. Objective To evaluate lactation and the 2-year incidence of DM after GDM pregnancy. Design Prospective, observational cohort of women with recent GDM. (ClinicalTrials.gov: NCT01967030). Setting Integrated health care system. Participants 1035 women diagnosed with GDM who delivered singletons at 35 weeks' gestation or later and enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy from 2008 to 2011. Measurements Three in-person research examinations from 6 to 9 weeks after delivery (baseline) and annual follow-up for 2 years that included 2-hour, 75-g oral glucose tolerance testing; anthropometry; and interviews. Multivariable Weibull regression models evaluated independent associations of lactation measures with incident DM adjusted for potential confounders. Results Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years later; 113 (11.8%) developed incident 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. Primary funding source National Institute of Child Health and Human Development.
Databáze: OpenAIRE
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