Breastfeeding After Gestational Diabetes Pregnancy
Subsequent obesity and type 2 diabetes in women and their offspring
- Erica P. Gunderson, PHD
- From the Epidemiology and Prevention Section, Division of Research, Kaiser Permanente, Oakland, California
- Address correspondence and reprint requests to Erica P. Gunderson, PhD, Epidemiologist, Research Scientist II, Epidemiology and Prevention Section, Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612. E-mail: epg{at}dor.kaiser.org
Breastfeeding provides important health benefits to both women and their offspring. Health benefits of lactation for women include a lower risk of breast and ovarian cancer (1) and possibly protection against type 2 diabetes (2). For the offspring, breastfeeding confers protection against both undernutrition and overnutrition during early childhood (3) and may lower risk of developing obesity, hypertension, cardiovascular disease, and diabetes later in life (4–7). Postnatal feeding is one of several critical or sensitive developmental periods (fetal life, adiposity rebound in childhood, and adolescence) hypothesized to result in “metabolic programming” of future chronic disease risk (8,9).
In developed countries, there is a robust association between breastfeeding and a lower risk of becoming overweight during childhood and adolescence, even after accounting for maternal obesity and family lifestyle behaviors (10–13). Moreover, greater protection against childhood overweight is associated with more prolonged exclusive breastfeeding. In the U.S., the association of breastfeeding and lower risk of childhood overweight has been observed in Caucasians, but not among low-income Hispanics or African-Americans.
Fetal life is another important developmental period influencing future health. Maternal gestational diabetes mellitus (GDM) alters the intrauterine milieu for fetal development that may affect risk factors for chronic disease later in life (14). In some (15–18), but not all (19) studies, offspring of GDM mothers may be more likely to become overweight and to develop type 2 diabetes later in life. A combination of genetic, intrauterine, and postnatal factors contribute to development of childhood obesity and type 2 diabetes in the offspring of women with GDM.
Whether breastfeeding affects the future health of offspring of women with GDM is uncertain based on limited and conflicting findings from studies of Native Americans or women with diabetes during pregnancy. Furthermore, no studies that examined the …
