Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • Log out
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcast
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcast
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Clinical Care/Education/Nutrition/Psychosocial Research

Lactation After Normal Pregnancy Is Not Associated With Blood Glucose Fluctuations

  1. Rhonda Bentley-Lewis, MD1,
  2. Allison B. Goldfine, MD2,
  3. Dina E. Green, MD3 and
  4. Ellen W. Seely, MD1
  1. 1Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
  2. 2Joslin Diabetes Center, Boston, Massachusetts
  3. 3Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Mount Sinai Medical Center, New York, New York
  1. Address correspondence and reprint requests to Ellen W. Seely, MD, Division of Endocrinology, Diabetes, Hypertension, Brigham and Women's Hospital, Boston, MA 02115. E-mail: eseely{at}partners.org
Diabetes Care 2007 Nov; 30(11): 2792-2793. https://doi.org/10.2337/dc07-1243
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • PDF
Loading
  • AUCg, area under the curve for glucose
  • BWH, Brigham and Women's Hospital
  • CGMS, continuous glucose monitoring system
  • GCRC, general clinical research center

Breastfeeding is the preferred method of feeding infants up to 12 months of age (1). Breastfed infants experience fewer and less severe infections and may be protected against future disease development (2). Mothers who breastfeed potentially experience accelerated weight loss (3), a lower risk of breast and ovarian cancer (3), and a lower risk of type 2 diabetes than mothers who do not breastfeed (4).

Breastfeeding is recommended for all women, including those with gestational (5) or pregestational (6) diabetes. However, data suggest that diabetic women may experience hypoglycemia during breastfeeding; subsequently, they have been advised to eat before or during breastfeeding to avoid hypoglycemia (6). Because data on blood glucose fluctuations in normoglycemic women are limited, we tested the hypothesis that lactation in healthy normoglycemic women will not cause significant blood glucose fluctuations.

RESEARCH DESIGN AND METHODS—

Women were recruited randomly from the Pregnancy Program at Brigham and Women's Hospital (BWH). The BWH Human Research Committee approved the study protocol, and all women provided informed written consent before participation. Healthy women were included if they were 18–40 years of age, 6 weeks to 6 months postpartum, free of a history of gestational or pregestational diabetes, and breastfeeding with no more than one bottle per day of supplementation. Women were excluded if they had an abnormal 1-h glucose challenge test during pregnancy (5), were taking medications known to influence blood glucose, were nursing more than one infant, or were incapable of using the continuous glucose monitoring system (CGMS).

Participants presented to the general clinical research center (GCRC) of BWH, where height and weight were measured and pregnancy history reviewed. A study physician inserted the CGMS according to manufacturer directions and provided participants with instructions regarding CGMS maintenance and Accu-Chek finger-stick blood glucose monitoring for CGMS calibration.

Participants wore the CGMS for 48 h and documented initiation of infant suckling or breast pump use, food intake, finger-stick blood glucose monitoring (at least four times daily), hypoglycemic symptoms, exercise, and sleep. In addition, participants marked these events using CGMS controls. After 48 h, participants returned to the GCRC and had fasting blood drawn for glucose, insulin, and A1C. The physician collected the documentation, removed the CGMS, and downloaded the CGMS data.

Blood samples were iced and centrifuged at 4°C and 2,000 rpm, respectively, for 15 min. Plasma was frozen at −70°C until assays were performed. Serum glucose was measured by the glucose oxidase method (Beckman glucose analyzer; Beckman, Fullerton, CA). Serum insulin was assayed by chemiluminesence (Beckman Chemiluminesence new protocol; Beckman, Chaska, MN). A1C was measured by high-performance liquid chromatography (Tosoh Bioscience, San Francisco, CA).

To optimize data accuracy by allowing for CGMS acclimation, blood glucose levels obtained during the second 24-h CGMS period were analyzed. The first lactation episode free of food or caloric beverage intake for 60 min both before and after lactation initiation was identified, and data were analyzed using SAS (version 9.1; SAS Institute, Cary, NC). ANOVA was used to compare the glucose levels obtained before and after lactation. Paired t tests were used to compare 1) the mean area under the curve for glucose (AUCg) before lactation to the mean AUCg after lactation and 2) the mean glucose before to the mean glucose after lactation. Data are expressed as means ± SD, and P < 0.05 was considered statistically significant.

RESULTS—

The nine women studied were 33 ± 4 years of age and 20.3 ± 7.3 weeks postpartum. They had BMI 24.4 ± 5.3 kg/m2, fasting glucose 82 ± 8 mg/dl, insulin 1.99 ± 0.90 μU/ml, and A1C 5.5 ± 0.3%. The CGMS data revealed no significant fluctuations in glucose levels obtained at 5-min intervals during the prelactation period (P = 0.23) (Fig. 1). Similarly, there were no significant fluctuations among the glucose levels obtained during the period after lactation (P = 0.09). The mean glucose level before lactation did not differ significantly compared with the mean glucose level after lactation (95 ± 14 vs. 96 ± 15 mg/dl; P = 0.93). The mean AUCg before lactation did not differ significantly compared with the mean AUCg after lactation (376.9 ± 53.3 vs. 382.8 ± 56.9 mg · h−1 · dl−1; P = 0.34).

CONCLUSIONS—

We observed no significant glucose changes during the period before or after lactation in women who had pregnancies uncomplicated by pregestational or gestational diabetes. Moreover, these healthy women did not have differences in the mean glucose levels obtained prelactation compared with postlactation, nor did they manifest hypoglycemia in response to lactation.

Our data extend the current literature on blood glucose response to lactation by examining healthy women. Data in type 1 diabetic women have revealed that breastfeeding lowered blood glucose concentrations and made achieving metabolic control more difficult (6). Studies have demonstrated that women with gestational diabetes benefit from lactation, manifesting improved glucose metabolism with a twofold increase in subsequent type 2 diabetes among nonlactating women (7). However, to our knowledge, there are no published data using CGMS to characterize glucose fluctuations in healthy lactating women.

Our main study limitation is sample size. However, although only nine women were studied, each had CGMS data providing blood glucose sampling every 5 min both before and after lactation to understand blood glucose characteristics during this period. Additionally, the validity of our selected blood glucose analysis periods before and after lactation was dependent on participant reliability in documenting food intake.

In conclusion, we observed no significant blood glucose fluctuations in response to lactation among healthy women with a normoglycemic pregnancy history. Therefore, these women do not need to increase caloric intake specifically before or during lactation to prevent hypoglycemia. This is noteworthy because limiting postpartum caloric intake will facilitate the loss of excess pregnancy weight, thereby reducing the risk of developing obesity. Nonetheless, women should be aware of recommendations regarding healthy caloric intake during breast feeding (8). Moreover, further studies of glucose fluctuations during lactation in larger numbers of normoglycemic and diabetic women are warranted.

Figure 1—
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1—

Blood glucose levels (mg/dl) collected every 5 min during the 60 min before and after the start of lactation (time = 0) for each of the nine participants in the study.

Acknowledgments

The authors thank Medtronic, Inc., for their CGMS support and Kyoko Okamura, MD, MPH, and Kathleen Murray for their assistance with data management.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 13 August 2007. DOI: 10.2337/dc07-1243.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted August 1, 2007.
    • Received July 2, 2007.
  • DIABETES CARE

References

  1. ↵
    American Academy of Pediatrics, Work Group on Breastfeeding: Breastfeeding and the use of human milk. Pediatrics 100: 1035–1039, 1997
    OpenUrlAbstract/FREE Full Text
  2. ↵
    Schack-Nielsen L, Michaelsen KF: Advances in our understanding of the biology of human milk and its effects on the offspring. J Nutr 137: 503S–510S, 2007
    OpenUrlAbstract/FREE Full Text
  3. ↵
    Labbok MH: Effects of breastfeeding on the mother. Pediatr Clin North Am 48: 143–158, 2001
    OpenUrlCrossRefPubMedWeb of Science
  4. ↵
    Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB: Duration of lactation and incidence of type 2 diabetes. JAMA 294: 2601–2610, 2005
    OpenUrlCrossRefPubMedWeb of Science
  5. ↵
    American Diabetes Association: Gestational diabetes mellitus (Position Statement). Diabetes Care 27(Suppl. 1): S88–S93, 2004
    OpenUrl
  6. ↵
    Murtaugh MA, Ferris AM, Capacchione CM, Reece EA: Energy intake and glycemia in lactating women with type 1 diabetes. J Am Diet Assoc 98: 642–648, 1998
    OpenUrlCrossRefPubMed
  7. ↵
    Kjos SL, Henry O, Lee RM, Buchanan TA, Mishell DR: The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes. Obstet Gynecol 82: 451–455, 1993
    OpenUrlPubMedWeb of Science
  8. ↵
    Reader D, Franz MJ: Lactation, diabetes, and nutrition recommendations. Curr Diab Rep 4: 370–376, 2004
    OpenUrlCrossRefPubMed
View Abstract
PreviousNext
Back to top
Diabetes Care: 30 (11)

In this Issue

November 2007, 30(11)
  • Table of Contents
  • About the Cover
  • Index by Author
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Lactation After Normal Pregnancy Is Not Associated With Blood Glucose Fluctuations
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
Citation Tools
Lactation After Normal Pregnancy Is Not Associated With Blood Glucose Fluctuations
Rhonda Bentley-Lewis, Allison B. Goldfine, Dina E. Green, Ellen W. Seely
Diabetes Care Nov 2007, 30 (11) 2792-2793; DOI: 10.2337/dc07-1243

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Lactation After Normal Pregnancy Is Not Associated With Blood Glucose Fluctuations
Rhonda Bentley-Lewis, Allison B. Goldfine, Dina E. Green, Ellen W. Seely
Diabetes Care Nov 2007, 30 (11) 2792-2793; DOI: 10.2337/dc07-1243
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • RESEARCH DESIGN AND METHODS—
    • RESULTS—
    • CONCLUSIONS—
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Tables
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Changes in Consumption of Sugary Beverages and Artificially Sweetened Beverages and Subsequent Risk of Type 2 Diabetes: Results From Three Large Prospective U.S. Cohorts of Women and Men
  • Genetic Prediction of Serum 25-Hydroxyvitamin D, Calcium, and Parathyroid Hormone Levels in Relation to Development of Type 2 Diabetes: A Mendelian Randomization Study
  • One Year Clinical Experience of the First Commercial Hybrid Closed-Loop System
Show more Clinical Care/Education/Nutrition/Psychosocial Research

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • BMJ Open - Diabetes Research & Care
  • Standards of Medical Care in Diabetes
  • Scientific Sessions Abstracts
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2019 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.