Dr. Andreas Plageman and Dr. Thomas Harder noted that these findings may help answer key questions for the rapidly expanding fields of perinatal programming and developmental origins of health and disease.
"Differentiation and maturation, however, of affected organs and systems, such as pancreas, adipose tissue, and brain, are not finished at birth. The question therefore arises whether a prolongation of these critical exposures into the neonatal period might have similar effects," they wrote.
The question of whether continuing exposure after birth to altered fuels through breastfeeding might have consequences for child development. "This study by Crume et al. further supports the notion that a long-term breastfeeding (i.e., longer than 6 months) has a protective effect on later overweight risk in ODM [offspring of diabetic mothers]," they wrote.
The results of this study may not be generalizable to larger populations though because mothers in this cohort were screened for gestational diabetes, they noted. "Unfortunately, however, this is not the case in many other populations, although it probably has an important impact on the outcome. Therefore, to allow a comparison with data from other populations, further analyses on the potential impact of the quality of diabetes care on the outcome in breastfed infants of mothers with GDM [gestational diabetes mellitus] will be needed."
When gestational diabetes is identified, "good metabolic control during pregnancy and post partum will necessarily prevent altered milk composition and, consequently, may also prevent potential negative consequences for the developing infant. This might explain discrepancies between the results of this and other clinical studies," they observed.
However, "there is no doubt that breastfeeding should be recommended and promoted in ODM as in the general population. ... Population-wide detection and adequate treatment of GDM both pre- and postnatally should be performed to enhance not only the prenatal but also the neonatal nutritional environment of the offspring."
Dr. Plagemann is head of the division of experimental obstetrics at Charité–University Medicine Berlin. Dr. Harder also is a member of the division of experimental obstetrics at Charité–University Medicine Berlin. They commented in an editorial that accompanied the article by Crume et al. (Diabetes Care 2011;34:779-81). They reported that they had no relevant financial relationships.
