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.1
Gestational diabetes mellitus (GDM) is a pregnancy condition commonly caused by hormones from the placenta blocking the mother’s insulin (hormone that moves sugar from our blood to our cells so it can be used to make energy) and generally goes away after birth.
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 and adds to the emotional burden once baby arrives, especially if these mothers aren’t provided with the appropriate support to help them 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 who have had GDM
Breastfeeding mothers who have had GDM have been shown to have improved metabolic function and greater insulin sensitivity, where the body utilises insulin more efficiently. 4,5
The risk of developing type 2 diabetes later in life is seven times higher in women who have had GDM compared to those who have not had GDM.4 Breastfeeding for over 3 months in mothers with a history of GDM has shown a greater protection against future diabetes. Moreover, in a 30-year study Gunderson and colleagues found breastfeeding for a longer period of time appears to independently lower the incidence of diabetes.6 Therefore, breastfeeding, especially for longer periods is a cost-effective way to prevent against or delay future diabetes.
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 (how the body makes energy)4
- Increased insulin sensitivity and protection against glucose intolerance4,5
- Reduced type 2 diabetes risk4
- Common benefits: weight loss; improved sleep; improved bonding.
Potential breastfeeding challenges
- Delayed lactogenesis (mature milk coming in) in approximately one-third of mothers who had GDM4
- Perceived insufficient milk supply7
- Increased breastfeeding of infants who have experienced higher blood sugar levels in the womb3
- Preconception, pregnancy, birth, and postpartum difficulties8
- Maternal complications4,5,8
- Infant complications.8
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 not breastfeeding within the first hour commence hand expressing as soon as possible.
- 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)
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. Haile, Z.T., Oza-Frank, R., Azulay Chertok, I.R., Passen, N. Association between History of Gestational Diabetes and Exclusive Breastfeeding at Hospital Discharge. J Hum Lact. 2016;32(3):NP 36–43.
6. Gunderson, E. P., Lewis, C. E., Ying Lin, Sorel, M., Gross, M., Sidney, S., Jacobs, D. R., Shikany, J. M. and Quesenberry, C. P. (2018). Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years. The 30-Year CARDIA Study. JAMA Intern Med 178(3):328–337.
7. Jagiello & Chertok Jagiello, K.P., Azulay Chertok, I.R. Women's Experiences With Early Breastfeeding After Gestational Diabetes. J Obstet Gynecol Neonatal Nurs. 2015;44(4):500–509.
8. 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.