ATLANTA – Targeted education to increase breastfeeding duration among women with gestational diabetes was feasible and effective in a randomized controlled lifestyle intervention trial.
Of 100 women with gestational diabetes mellitus (GDM) who were enrolled in the trial and randomized, 21 and 27 in the experimental and control groups, respectively, attended a study visit. Those who received the intervention initiated breastfeeding earlier after birth than those who did not receive the intervention (37 minutes vs. 112 minutes).
Mothers in the intervention group were also more likely to report any breastfeeding at 6 weeks (85% vs. 59%) and exclusive breastfeeding at 6 weeks (38% vs. 16%), Dr. Alison Stuebe of the University of North Carolina at Chapel Hill reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.
Dr. Alison Stuebe
“When we considered duration of any breastfeeding, we found that participation in the intervention was associated with a markedly longer duration of any breastfeeding,” Dr. Stuebe said.
After adjusting for baseline differences, clinic site, and breastfeeding intention score, the hazard ratio for breastfeeding cessation was 0.40, she noted. For exclusive breastfeeding, the adjusted hazard ratio for cessation was 0.49.
Breastfeeding intensity at 6 weeks also differed in the experimental intervention and control group, with 62% and 36%, respectively, reporting high-intensity breastfeeding (greater than 80% of feedings) at that time point.
Women in the study were enrolled and randomized in the third trimester. Just more than half (52%) were African American, 31% were non-Hispanic white, 9% were American Indian or Alaskan Native, and 8% were multiracial.
Prior to giving birth, each attended a class that addressed the benefits of breastfeeding for both mothers and infants, the importance of skin-to-skin contact, feeding cues, and positioning. The women also received breastfeeding pillows and weekly text messages with breastfeeding tips. At 6 weeks postpartum, they participated in a 12-week nutrition, exercise, and coping skills program that included monthly meetings, and they continued this program on their own for an additional 3 months, Dr. Stuebe said.
The control group received usual care for gestational diabetes, and usual postpartum care. Outcomes were adjusted for race, as a greater proportion of patients in the treatment group were African American.
Women with GDM, which affects up to 9% of pregnancies, are at increased lifetime risk of developing metabolic disease. However, data increasingly suggest that breastfeeding attenuates this risk, Dr. Stuebe said, noting that Gunderson, et al. recently demonstrated a halving of the risk of progressing to type 2 diabetes among women who breastfed for at least 10 months, compared with those with shorter breastfeeding duration (Ann Intern Med. 2015 Dec 15;163(12):889-898. doi: 10.7326/M15-0807).
Given these findings, efforts to promote breastfeeding among women with GDM are particularly important, she said, concluding that the current findings support tailored breastfeeding interventions among women with GDM.
Though limited by factors such as higher-than-expected–loss to follow-up, baseline differences in the two groups, and self-reported breastfeeding intensity outcomes, the study also has several strengths including that it was based on an approach used in an effective randomized controlled trial, it was pragmatic, and it used an intervention that could be incorporated into standard care.
“Our results suggest that targeted breastfeeding support for women with GDM may be feasible and efficacious,” Dr. Stuebe said. “Further studies are needed to test the effectiveness of this strategy in diverse clinical settings. However, if such interventions are found to be effective, breastfeeding support in women with GDM may improve health outcomes across two generations.”
The study was sponsored by the University of North Carolina at Chapel Hill, with support from the National Institute of Diabetes and Digestive and Kidney Diseases.