Last update: Nov. 23, 2019

Maternal Diabetes

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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This entry can be applied in whole or in part, to type 1, type 2 diabetes and gestational diabetes.

Given the benefits of breastfeeding to mothers and infants, especially in the case of maternal diabetes, it is necessary to encourage breastfeeding and provide as much effective support as possible. Prestigious scientific institutions and various authors recommend it (ADA 2108, Serrano 2015, Lawrence 2013, Cordero 1998).
Breastfeeding decreases the risk of developing type 2 diabetes (Martens 2016, Serrano 2015, Jäger 2014, Stuebe 2005) especially in women who have had gestational diabetes (Gunderson 2015, Bentley 2008) and has a protective effect delaying the onset of diabetes and decreasing its frequency in childhood (Martens 2016, Gerstein 1994, Mayer 1988, Borch 1984).
Occasionally, maternal diabetes mellitus remits during breastfeeding, for prolonged periods, lasting months or years (Lawrence 2016 p 581).

Maternal diabetes is associated with delayed milk production (lactogenesis II) (Matias 2014, Hartmann 2001), low levels of prolactin (Butte 1987) and lack of adequate milk supply (Riddle 2016).
There are usually more difficulties for breastfeeding due to maternal complications (frequent cesarean section) and those related to the newborn (macrosomia, prematurity, early hypoglycemia, hypocalcemia, respiratory problems, jaundice, polyglobulia and malformations) with early separation of mother-baby (Lawrence 2016 p 578, Serrano 2015, Sorkio 2010, Maayan 2009, Cordero 1998).

Therefore, there is a risk of lower prevalence and duration of breastfeeding in maternal diabetes (Oza 2015, Sparud 2011).

Intensive control of glycemia during pregnancy (Golbert 2008), effective support and early initiation of breastfeeding is required (Matias 2014, Sparud 2011, Whichelow 1983), avoiding unnecessary separation and resorting if necessary to the early expression of milk manually or via breastpump (Asselin 1987, Whichelow 1983).

The most important factor for the success of breastfeeding is its early establishment (Whichelow 1983).

Hypoglycaemia in the first few hours can be prevented and treated with frequent oral feeding (Sarkar 2003).

Although there has been much debate about the lack of evidence regarding the benefits and risks of antenatal expression of colostrum to administer to newborns, avoiding the administration of milk formula (Forster 2017 and 2011, East 2014, Chapman 2013, Soltani 2012), the benefits are so great, especially when neonatal problems are anticipated (maternal diabetes, scheduled cesarean section, twins, premature babies, malformations, etc.) that is has become a practice which is recommended by health institutions and several authors (NHS 2018, Wszolek 2015), and is accepted by mothers and improves their self-confidence (Brisbane 2015).

Mothers with diabetes are at greater risk of nipple cracking, mastitis and candidiasis; this must be prevented with frequent breastfeeding, correct positioning, avoiding washes, disinfectants and ointments and energetic antibiotic treatment of mastitis (Lawrence 2016 p 581).

Breastmilk of mothers with diabetes has more glucose (0.7mg/cc) than that of women without diabetes (0.3mg/cc) (Butte 1987) but the total caloric content is not affected because glucose is a very minor sugar in breastmilk. Some authors have found a higher sodium concentration (Butte 1987) but not others (Bitman 1989).

Maternal glucose is used to form lactose (glucose + galactose) in the mother's breast. It is necessary to increase the self-control of the mother due to the risk of hypoglycemia, especially during or after breastfeeding.
Hypoglycemia inhibits (via adrenaline) milk production and ejection.

The need for insulin or oral antidiabetics usually decreases by up to 30% and there is a need for daily caloric increase (Serrano 2015, Whichelow 1983). Adjustments of diet and insulin are also necessary during the introduction of complementary feeding and weaning (Serrano 2015).

During breastfeeding, urine glucose tests using reactive strips are unreliable due to the existence of lactosuria. In all women, the lactose that is reabsorbed from the breast and passes to plasma, is eliminated by urine (Lawrence 2016 p 579, Serrano 2015).

Oral antidiabetics are not useful in type 1 diabetes.
Diet, exercise and breastfeeding improve blood glucose levels.

Insulin, acarbose, glibenclamide or glyburide, glipizide, metformin, miglitol, tolbutamide, exenatide and liraglutide are considered to be safe drugs during breastfeeding (Serrano 2015).
Maternal diet does not cause problems for breastfeeding or the infant.


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Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Maternal Diabetes belongs to this group or family:

References

  1. ADA - American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Abstract Full text (link to original source) Full text (in our servers)
  2. NHS. Royal Berkshire. Expressing colostrum in pregnancy. Brochure. 2018 Full text (link to original source) Full text (in our servers)
  3. Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, East C, Ford R, Amir LH. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. Lancet. 2017 Abstract
  4. Martens PJ, Shafer LA, Dean HJ, Sellers EA, Yamamoto J, Ludwig S, Heaman M, Phillips-Beck W, Prior HJ, Morris M, McGavock J, Dart AB, Shen GX. Breastfeeding Initiation Associated With Reduced Incidence of Diabetes in Mothers and Offspring. Obstet Gynecol. 2016 Abstract
  5. Riddle SW, Nommsen-Rivers LA. A Case Control Study of Diabetes During Pregnancy and Low Milk Supply. Breastfeed Med. 2016 Abstract Full text (link to original source) Full text (in our servers)
  6. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  7. Brisbane JM, Giglia RC. Experiences of expressing and storing colostrum antenatally: A qualitative study of mothers in regional Western Australia. J Child Health Care. 2015 Abstract
  8. Wszolek K. Hand expressing in pregnancy and colostrum harvesting—preparation for successful breastfeeding? British Journal of Midwifery 2015 23:4, 268-274 2015 Abstract
  9. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015 Abstract
  10. Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, Dewey KG, Azevedo RA, Young S, Fox G, Elmasian CC, Salvador N, Lum M, Sternfeld B, Quesenberry CP Jr; Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy Investigators.. Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study. Ann Intern Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  11. Oza-Frank R, Chertok I, Bartley A. Differences in breast-feeding initiation and continuation by maternal diabetes status. Public Health Nutr. 2015 Abstract
  12. East CE, Dolan WJ, Forster DA. Antenatal breast milk expression by women with diabetes for improving infant outcomes. Cochrane Database Syst Rev. 2014 Abstract
  13. East CE, Dolan WJ, Forster DA. Extracción prenatal de leche materna por pacientes con diabetes para mejorar los resultados del lactante. Cochrane Database Syst. 2014 Full text (link to original source) Full text (in our servers)
  14. Jäger S, Jacobs S, Kröger J, Fritsche A, Schienkiewitz A, Rubin D, Boeing H, Schulze MB. Breast-feeding and maternal risk of type 2 diabetes: a prospective study and meta-analysis. Diabetologia. 2014 Abstract Full text (link to original source) Full text (in our servers)
  15. Chapman T, Pincombe J, Harris M. Antenatal breast expression: a critical review of the literature. Midwifery. 2013 Abstract
  16. Lawrence RM. Circumstances when breastfeeding is contraindicated. Pediatr Clin North Am. 2013 Feb;60(1):295-318. Abstract
  17. Soltani H, Scott AM. Antenatal breast expression in women with diabetes: outcomes from a retrospective cohort study. International Breastfeeding Journal. 2012 Abstract Full text (link to original source) Full text (in our servers)
  18. Forster DA, McEgan K, Ford R, Moorhead A, Opie G, Walker S, McNamara C. Diabetes and antenatal milk expressing: a pilot project to inform the development of a randomised controlled trial. Midwifery. 2011 Abstract
  19. Sparud-Lundin C, Wennergren M, Elfvin A, Berg M. Breastfeeding in women with type 1 diabetes: exploration of predictive factors. Diabetes Care. 2011 Abstract Full text (link to original source)
  20. Sorkio S, Cuthbertson D, Bärlund S, Reunanen A, Nucci AM, Berseth CL, Koski K, Ormisson A, Savilahti E, Uusitalo U, Ludvigsson J, Becker DJ, Dupré J, Krischer JP, Knip M, Akerblom HK, Virtanen SM; TRIGR Study Group. Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial. Diabetes Metab Res Rev. 2010 Abstract Full text (link to original source)
  21. Maayan-Metzger A, Lubin D, Kuint J. Hypoglycemia rates in the first days of life among term infants born to diabetic mothers. Neonatology. 2009 Abstract
  22. Bentley-Lewis R, Levkoff S, Stuebe A, Seely EW. Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab. 2008 Abstract Full text (link to original source)
  23. Golbert A, Campos MA. Diabetes Melito Tipo 1 e Gestação. [Type 1 diabetes mellitus and pregnancy]. Arq Bras Endocrinol Metabol. 2008 Abstract Full text (link to original source) Full text (in our servers)
  24. Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. Duration of lactation and incidence of type 2 diabetes. JAMA. 2005 Abstract Full text (link to original source)
  25. Sarkar S, Watman J, Seigel WM, Schaeffer HA. A prospective controlled study of neonatal morbidities in infants born at 36 weeks or more gestation to Women with diet-controlled gestational diabetes (GDM-class Al). J Perinatol. 2003 Abstract
  26. Hartmann P, Cregan M. Lactogenesis and the effects of insulin-dependent diabetes mellitus and prematurity. J Nutr. 2001 Abstract Full text (in our servers)
  27. Cordero L, Treuer SH, Landon MB, Gabbe SG. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med. 1998 Abstract
  28. Gerstein HC. Cow's milk exposure and type I diabetes mellitus. A critical overview of the clinical literature. Diabetes Care. 1994 Abstract
  29. Bitman J, Hamosh M, Hamosh P, Lutes V, Neville MC, Seacat J, Wood DL. Milk composition and volume during the onset of lactation in a diabetic mother. Am J Clin Nutr. 1989 Abstract
  30. Mayer EJ, Hamman RF, Gay EC, Lezotte DC, Savitz DA, Klingensmith GJ. Reduced risk of IDDM among breast-fed children. The Colorado IDDM Registry. Diabetes. 1988 Abstract
  31. Butte NF, Garza C, Burr R, Goldman AS, Kennedy K, Kitzmiller JL. Milk composition of insulin-dependent diabetic women. J Pediatr Gastroenterol Nutr. 1987 Abstract
  32. Asselin BL, Lawrence RA. Maternal disease as a consideration in lactation management. Clin Perinatol. 1987 Abstract
  33. Borch-Johnsen K, Joner G, Mandrup-Poulsen T, Christy M, Zachau-Christiansen B, Kastrup K, Nerup J. Relation between breast-feeding and incidence rates of insulin-dependent diabetes mellitus. A hypothesis. Lancet. 1984 Abstract
  34. Whichelow MJ, Doddridge MC. Lactation in diabetic women. Br Med J (Clin Res Ed). 1983 Abstract Full text (link to original source) Full text (in our servers)

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