Diabetes and Breastfeeding

on November 2023

Diabetes is commonly caused by the hormonal imbalances which effect/inhibit insulin levels and decrease glucose tolerance, resulting in unstable or high blood sugar levels. When this occurs as a direct result of pregnancy, it is known as Gestational Diabetes Mellitus (GDM).

GDM is an increasingly common complication of pregnancy. With genetic and non-genetic causes, GDM differs from Type 1 or Type 2 diabetes in that is defined as diabetes/insulin resistance diagnosed in pregnancy and resolving postpartum.

Diabetes does not appear to have a negative impact on lactogenesis (physiological changes associated with lactation). However, women who are obese and have a history of Type 1 or Type 2 diabetes certainly may experience delayed lactogenesis.

Diabetic types and classification:

Type 1 Diabetes

Insulin dependent
Beta cells of pancreas do not produce enough insulin for glucose requirements
Low fertility and pregnancy complications
Lactation may be delayed up to 24hours (reasons for this unclear)
Maternal insulin administration is safe for the breastfed baby
Milk production from 7 days onwards has been shown to be the same for diabetic and non-diabetic mothers
While breastfeeding, mothers have a decreased insulin requirement and are able to increase their carbohydrate intake

Type 2 Diabetes

Insulin resistant
Beta cells of pancreas produce enough insulin but body is unable to use it effectively due to insulin resistance in the cells of the body
Can be managed by diet and lifestyle changes alongside medication such as metformin and/or insulin
High risk for gestational diabetes

Gestational Diabetes Mellitus (GDM)

Insulin resistant, typically diet-controlled
Diagnosed in pregnancy during oral glucose tolerance testing and resolves after birth
Requires BGL monitoring frequently throughout day (fasting/non-fasting glucose levels)
Baby will require BGL monitoring post delivery

Gestational Insulin Dependent Diabetes Mellitus (GIDDM)

Insulin resistant, requires Insulin control
Diagnosed in pregnancy during oral glucose tolerance testing and resolves after birth
Requires BGL monitoring frequently throughout day (fasting/non-fasting glucose levels)
Baby will require BGL monitoring post delivery and potential treatment for hypoglycemia (low-blood glucose levels)
Breastfeeding helps to reduce risk of GDM developing into Type 2 diabetes postpartum

Babies of GDM mothers:

During pregnancy, babies of diabetic mothers often receive higher levels of glucose (sugar) which can cause them to grow rapidly in utero and produce extra insulin to stabilize their own glucose levels. Following delivery, the baby is no longer in a high glucose environment but still producing additional insulin. This often causes their blood sugar level to drop (hypoglycemia) and requires treatment via nutrition (oral and/or intravenous)

Breastfeeding with GDM:

Breastfeeding and diabetes have a close relationship. With breastfeeding having an impact on pre-existing diabetes and GDM, and diabetes having an impact on lactation.

Breastfeeding provides numerous benefits to both mother and baby:

For baby:

Colostrum, helps to stabilize baby blood sugar levels
Less likely to over-feed or under-feed baby
Spending time skin-to-skin while breastfeeding regulates baby’s temperature, which is crucial when they have a low blood sugar level
Reduced risks of childhood obesity

For mum:

Increased glucose tolerance and sensitivity to insulin
Reduces the risk of developing type 2 diabetes
Weight loss, improved sleep
Reduces stress and facilitates a better bonding experience with baby

How can you prepare for successful breastfeeding with diabetes?

Educate yourself – know the facts and requirements of what your baby will need, and be willing to accommodate these needs in whatever way you can
Speak to your healthcare provider to advocate for skin-to-skin contact on your chest immediately after birth (if possible) as this helps to stabilize your baby’s blood sugar through thermoregulation, cardio-respiratory stabilization and early breastfeeding initiation.
Antenatal hand expressing – if possible, start hand expressing colostrum from 36 weeks gestation in order to collect a few colostrum syringes to freeze for the hospital. (Check with your doctor/midwife first!)
These syringes of colostrum you have expressed antenatally will be perfect as additional snacks for baby in order to help stabilize potential low blood sugar levels at birth.
If possible, breastfeed within the first hour of birth, if not possible, then try to hand express within 4 hours and give this to your baby.
If breastmilk not available, donor breastmilk preferable prior to use of artificial supplementation
Diabetic mothers are more prone to yeast overgrowth (candida albicans or thrush) so it is important to try prevent nipple damage or mastitis. Ask your healthcare provider to assist you ensuring optimal breastfeeding attachment and milk drainage.
Exclusive breastfeeding for 6months before introducing complementary foods will help to protect your baby from developing diabetes.

References

Alves, J., Figueiroa, J., Meneses, J. and Alves, G., 2012. Breastfeeding Protects Against Type 1 Diabetes Mellitus: A Case–Sibling Study. Breastfeeding Medicine, 7(1), pp.25-28.

Binns, C., Lee, M. and Low, W., 2016. The Long-Term Public Health Benefits of Breastfeeding. Asia Pacific Journal of Public Health, 28(1), pp.7-14.

Chowdhury, R., Sinha, B., Sankar, M., Taneja, S., Bhandari, N., Rollins, N., Bahl, R. and Martines, J., 2015. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatrica, 104, pp.96-113.

Cordero, L., Stenger, M., Landon, M. and Nankervis, C., 2022. Exclusive breastfeeding among women with type 1 and type 2 diabetes mellitus. BMC Pregnancy and Childbirth, 22(1).

Fallon, A. and Dunne, F., 2015. Breastfeeding practices that support women with diabetes to breastfeed. Diabetes Research and Clinical Practice, 110(1), pp.10-17.

Finkelstein, S., Keely, E., Feig, D., Tu, X., Yasseen, A. and Walker, M., 2013. Breastfeeding in women with diabetes: lower rates despite greater rewards. A population-based study. Diabetic Medicine, 30(9), pp.1094-1101.

Gunderson, E., 2014. Impact of Breastfeeding on Maternal Metabolism: Implications for Women with Gestational Diabetes. Current Diabetes Reports, 14(2).

Herskin, C., Stage, E., Barfred, C., Emmersen, P., Ladefoged Nichum, V., Damm, P. and Mathiesen, E., 2015. Low prevalence of long-term breastfeeding among women with type 2 diabetes. The Journal of Maternal-Fetal & Neonatal Medicine, pp.1-6.

Horta, B. and de Lima, N., 2019. Breastfeeding and Type 2 Diabetes: Systematic Review and Meta-Analysis. Current Diabetes Reports, 19(1).

Horta, B., Loret de Mola, C. and Victora, C., 2015. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatrica, 104, pp.30-37.

Jagiello, K. and Azulay Chertok, I., 2015. Women's Experiences With Early Breastfeeding After Gestational Diabetes. Journal of Obstetric, Gynecologic & Neonatal Nursing, 44(4), pp.500-509.

Much, D., Beyerlein, A., Roßbauer, M., Hummel, S. and Ziegler, A., 2014. Beneficial effects of breastfeeding in women with gestational diabetes mellitus. Molecular Metabolism, 3(3), pp.284-292.

Nguyen, P., Pham, N., Chu, K., Van Duong, D. and Van Do, D., 2019. Gestational Diabetes and Breastfeeding Outcomes: A Systematic Review. Asia Pacific Journal of Public Health, 31(3), pp.183-198.

Pereira, P., Alfenas, R. and Araújo, R., 2014. Does breastfeeding influence the risk of developing diabetes mellitus in children? A review of current evidence. Jornal de Pediatria, 90(1), pp.7-15.

Ringholm, L., Mathiesen, E., Kelstrup, L. and Damm, P., 2012. Managing type 1 diabetes mellitus in pregnancy—from planning to breastfeeding. Nature Reviews Endocrinology, 8(11), pp.659-667.