Lactation has immediate favorable effects on glucose tolerance that may persist after weaning to prevent development of type 2 diabetes mellitus (DM) in women. Development of glucose intolerance during pregnancy, known as gestational diabetes (GDM), is a strong predictor of subsequent development of type 2 DM. In the U.S., GDM occurs in about 3-5% of all pregnancies and affects 135,000 women per year. Within 5 years after delivery, 20 to 50% of women with previous GDM will develop type 2 DM. Risk factors for type 2 DM after GDM pregnancy include pancreatic b-cell dysfunction, severity of glucose intolerance during pregnancy and early postpartum periods, family history of DM, maternal obesity, recurrent GDM and weight gain. Lactation lowers maternal glucose and insulin levels, improves glucose tolerance and the disposition index, indicating better-cell function for their degree of insulin resistance. Whether the intensity and duration of lactation reduces subsequent risk of DM has rarely been examined. Previous studies are limited by qualitative measures of lactation (ever vs. never), current status (yes vs. no), or lifetime months of lactation. No prospective studies have assessed lactation intensity (supplemental feedings) and/or duration in relation to development of type 2 DM after recent GDM pregnancy. We propose a prospective cohort study that will enroll 1,098 women with a recent GDM diagnosis who are free of type 2 DM at 6-8 weeks postpartum in the Kaiser Permanente Health Care System in northern California. Women will be followed annually for two years to administer the 2 hr 75 g oral glucose tolerance test. We will determine whether prolonged, intensive lactation compared with no lactation is associated with a lower incidence of type 2 DM, and more favorable changes in fasting and 2-hr post load plasma glucose and insulin levels, indices of insulin resistance, body weight, waist girth and plasma adiponectin. Because randomization is not feasible, the rigorous assessment of lactation intensity and duration controlling for multiple potential confounders is the most valid study design. The potential public health impact of these findings for women with a history of GDM is substantial given that less than 50% of U.S. women lactate for four months. Lactation is a modifiable behavior that may be translated into a practical, low-cost intervention that has the potential to enhance postpartum interventions that promote healthy dietary intakes and increased physical activity.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
3R01HD050625-04S1
Application #
8204090
Study Section
Pregnancy and Neonatology Study Section (PN)
Program Officer
Grave, Gilman D
Project Start
2007-05-10
Project End
2012-02-29
Budget Start
2010-03-01
Budget End
2011-02-28
Support Year
4
Fiscal Year
2011
Total Cost
$154,041
Indirect Cost
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
150829349
City
Oakland
State
CA
Country
United States
Zip Code
94612
Davis, Jaimie N; Shearrer, Grace E; Tao, Wei et al. (2017) Dietary variables associated with substantial postpartum weight retention at 1-year among women with GDM pregnancy. BMC Obes 4:31
Allalou, Amina; Nalla, Amarnadh; Prentice, Kacey J et al. (2016) A Predictive Metabolic Signature for the Transition From Gestational Diabetes Mellitus to Type 2 Diabetes. Diabetes 65:2529-39
Gunderson, Erica P; Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy Investigators (2016) Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus. Ann Intern Med 165:299-300
Gunderson, Erica P; Hurston, Shanta R; Ning, Xian et al. (2015) Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study. Ann Intern Med 163:889-98
Gunderson, Erica P; Kim, Catherine; Quesenberry Jr, Charles P et al. (2014) Lactation intensity and fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: the SWIFT cohort. Metabolism 63:941-50
Gunderson, Erica P (2014) Impact of breastfeeding on maternal metabolism: implications for women with gestational diabetes. Curr Diab Rep 14:460
Gunderson, Erica P; Chiang, Vicky; Pletcher, Mark J et al. (2014) History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the Coronary Artery Risk Development in Young Adults study. J Am Heart Assoc 3:e000490
Matias, Susana L; Dewey, Kathryn G; Quesenberry Jr, Charles P et al. (2014) Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. Am J Clin Nutr 99:115-21
Gunderson, Erica P (2013) The role of lactation in GDM women. Clin Obstet Gynecol 56:844-52
Gunderson, Erica P; Hedderson, Monique M; Chiang, Vicky et al. (2012) Lactation intensity and postpartum maternal glucose tolerance and insulin resistance in women with recent GDM: the SWIFT cohort. Diabetes Care 35:50-6

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