By Gemma Macdonald, BSc (Hons), Cert 1V (Breastfeeding Education, Counselling)
Diabetes is increasing worldwide and as a consequence is having a greater impact on mothers, revealing concerns for breastfeeding outcomes. Diabetes is a complex condition, combining genetic and non-genetic causes and results in increased sugar (glucose) in the blood due to a lack of or an insufficient amount of insulin (hormone that moves sugar from our blood to our cells so it can be used to make energy), or a resistance to the normal effects of insulin.1
Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition, where the immune system mistakenly attacks and destroys the cells that make insulin.1 Onset of T1DM commonly occurs in childhood, with most T1DM mothers having had the condition for at least a decade.1 Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition with many different mechanisms (cellular, protein, etc.), eventually resulting in not enough insulin being produced and often with the failure of some cells to respond to insulin causing insulin resistance.1 Traditionally, T2DM affected older people (over 45 years). However, with associated lifestyle risk factors, T2DM is increasingly occurring in younger people including children, adolescents and young adults.1
Research provides reassurance to mothers with diabetes that they can successfully breastfeed and that common concerns relate to breastfeeding, rather than diabetes.2
Emotional impact of diabetes and breastfeeding
Diabetes management is complex with constant reminders and lifestyle intrusions, causing stigma, emotional burden and distress. There is enormous pressure to maintain blood sugar levels within a tight range and many women experience fears for their own health and their baby’s health and survival. Complications and interventions are common during pregnancy and birth. This may result in trauma, adding to the emotional burden once baby arrives, especially if these mothers aren’t provided with the appropriate support to help accept and deal with these experiences. All of these burdens weigh heavily on their emotional state and may cause anxiety which can interfere with oxytocin release essential for a healthy breastmilk supply.3
Metabolic benefits of breastfeeding for mothers with diabetes
Breastfeeding mothers with T1DM and T2DM have been shown to have improved metabolic function and greater insulin sensitivity, where the body utilises insulin more efficiently.5 If mothers require insulin to manage their diabetes, breastfeeding may reduce their dose due to more efficient metabolic function, for example one study on T1DM mothers who breastfed showed 21% less insulin was required compared to their pre-pregnancy dose.6 In an extensive review Achong and colleagues explored research for insulin dose changes in new mothers, finding reductions for both breastfeeding and formula-feeding mothers.5 However, there is evidence that breastfeeding mothers experience a greater dose reduction and Achong et al raise the possibility that studies not finding a difference between breastfeeding and formula-feeding mothers may have missed increased low blood sugar levels events in breastfeeding mothers, requiring further dose reductions. 5
Breastfeeding benefits to babies
- Colostrum (first breastmilk) helps stabilise blood glucose levels
- Protection against under-nutrition and over-nutrition3,4
- Reduced risk of childhood obesity/ overweight.3,4
Breastfeeding benefits to mothers
- Improved metabolic function (stable glycaemic patterns and increased insulin sensitivity)5
- Reduced insulin dose5
- Common benefits: weight loss; improved sleep; improved bonding.
Potential breastfeeding challenges
- Delay or decrease in the mother’s mature milk coming in (delayed or decreased lactogenesis).3,6
- Perceived insufficient milk supply6
- Increased breastfeeding of infants who have experienced higher blood sugar levels in the womb3
- Preconception, pregnancy, birth, and postpartum difficulties3,7
- Maternal complications3,8
- Infant complications.3
Preparing to succeed with diabetes
- Increased breastfeeding if baby has low blood sugar level and/or you are worried about a low supply.
- If possible, breastfeed within the first hour after birth and frequently thereafter.
- If unable to breastfeed straight away, express often.
- Breastfeeding confidence — with the right support it’s likely your body can provide everything your baby needs.
- Skin-to-skin contact to improve newborn outcomes, including stabilising sugar levels, encourage baby to follow breastfeeding instincts and improve bonding.
- Hospital snacks for after birth and talk with hospital dietitian.
- Breastfeeding support (The Australian Breastfeeding Association’s resources: breastfeeding education classes, local groups, Breastfeeding Helpline, website, etc)
Also see our Breastfeeding and Gestational Diabetes article.
1. Diabetes Australia: www.diabetesaustralia.com.au
2. Fallon, A., Dunne, F. Breastfeeding practices that support women with diabetes to breastfeed. Diabetes Res Clin Pract. 2015;110(1):10–17.
3. Stuebe, A. Breastfeeding and diabetes - benefits and special needs. Diabetes Voice 2007; 52(1):26–29.
4. Much, D., Beyerlein, A., Roßbauer, M., Hummel, S, Ziegler, Mol Metab A.G. Beneficial effects of breastfeeding in women with gestational diabetes mellitus.. 2014;3(3):284–292.
5. Achong, N., Duncan, E.L., McIntyre, H.D., Callaway, L. The physiological and glycaemic changes in breastfeeding women with type 1 diabetes mellitus. Diabetes Res Clin Pract. 2018;135:93–101.
6. Herskin, C.W., Stage, E., Barfred, C., Emmersen, P., Ladefoged Nichum, V., Damm, P., Mathiesen, E.R. Low prevalence of long-term breastfeeding among women with type 2 diabetes. J Matern Fetal Neonatal Med. 2016;29(15):2513–2518.
7. Feldman, A.Z., Brown, F.M. Management of Type 1 Diabetes in Pregnancy. Curr Diab Rep. 2016;16(8):76.
8. Achong, N., McIntyre, H.D., Callaway, L., Duncan E.L. Glycaemic behaviour during breastfeeding in women with Type 1 diabetes. Diabet Med. 2016;33(7):947–955.