Danielle K Longmore1,2,3, Elizabeth L M Barr1,4, Alyce N Wilson1,5, Federica Barzi1, Marie Kirkwood1, Alison Simmonds1, I-Lynn Lee1, Eyvette Hawthorne6, Paula Van Dokkum7, Christine Connors8, Jacqueline A Boyle9, Paul Zimmet10, Kerin O'Dea11, Jeremy Oats5, Harold D McIntyre12, Alex D H Brown13,14, Jonathan E Shaw4, Louise J Maple-Brown15,16. 1. Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. 2. Department of Paediatrics, Western Health, St Albans, VIC, Australia. 3. Department of Paediatrics, Royal Children's Hospital, Melbourne, VIC, Australia. 4. Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia. 5. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia. 6. Midwifery Group Practice, Top End Health Service, Darwin, NT, Australia. 7. Aboriginal Health Domain, Baker Heart and Diabetes Institute, Central Australia, NT, Australia. 8. Darwin Region and Strategic Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, NT, Australia. 9. Monash Centre for Health Research and Implementation, School of Preventative Medicine, Monash University, Melbourne, VIC, Australia. 10. Department of Diabetes, Monash University, Melbourne, VIC, Australia. 11. School of Health Sciences, University of South Australia, Adelaide, SA, Australia. 12. Mater Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. 13. Aboriginal Health Equity Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia. 14. Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia. 15. Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. louise.maple-brown@menzies.edu.au. 16. Department of Endocrinology, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia. louise.maple-brown@menzies.edu.au.
Abstract
AIMS/HYPOTHESIS: Women with gestational diabetes mellitus (GDM) and obesity experience lower rates of breastfeeding. Little is known about breastfeeding among mothers with type 2 diabetes. Australian Indigenous women have a high prevalence of type 2 diabetes in pregnancy. We aimed to evaluate the association of hyperglycaemia, including type 2 diabetes, with breastfeeding outcomes. METHODS: Indigenous (n = 495) and non-Indigenous (n = 555) participants of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort included women without hyperglycaemia in pregnancy (n = 222), with GDM (n = 684) and with type 2 diabetes (n = 144). The associations of hyperglycaemia in pregnancy and breastfeeding at hospital discharge, 6 weeks and 6 months post-partum were evaluated with logistic regression, after adjustment for maternal obesity, ethnicity, maternal and neonatal characteristics. RESULTS: Indigenous women were more likely to predominantly breastfeed at 6 weeks across all levels of hyperglycaemia. Compared with women with no hyperglycaemia in pregnancy, women with type 2 diabetes had lower odds for exclusive breastfeeding at discharge (adjusted OR for exclusive breastfeeding 0.4 [95% CI 0.2, 0.8] p = 0.006). At 6 weeks and 6 months, the relationship between type 2 diabetes and predominant breastfeeding was not statistically significant (6 weeks 0.7 [0.3, 1.6] p = 0.40, 6 months 0.8 [0.4, 1.6] p = 0.60). Women with gestational diabetes were as likely to achieve predominant breastfeeding at 6 weeks and 6 months as women without hyperglycaemia in pregnancy. CONCLUSIONS/ INTERPRETATION: Indigenous women had high rates of breastfeeding. Women with type 2 diabetes had difficulty establishing exclusive breastfeeding at hospital discharge. Further research is needed to assess the impact on long-term breastfeeding outcomes. Graphical abstract.
AIMS/HYPOTHESIS: Women with gestational diabetes mellitus (GDM) and obesity experience lower rates of breastfeeding. Little is known about breastfeeding among mothers with type 2 diabetes. Australian Indigenous women have a high prevalence of type 2 diabetes in pregnancy. We aimed to evaluate the association of hyperglycaemia, including type 2 diabetes, with breastfeeding outcomes. METHODS: Indigenous (n = 495) and non-Indigenous (n = 555) participants of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort included women without hyperglycaemia in pregnancy (n = 222), with GDM (n = 684) and with type 2 diabetes (n = 144). The associations of hyperglycaemia in pregnancy and breastfeeding at hospital discharge, 6 weeks and 6 months post-partum were evaluated with logistic regression, after adjustment for maternal obesity, ethnicity, maternal and neonatal characteristics. RESULTS: Indigenous women were more likely to predominantly breastfeed at 6 weeks across all levels of hyperglycaemia. Compared with women with no hyperglycaemia in pregnancy, women with type 2 diabetes had lower odds for exclusive breastfeeding at discharge (adjusted OR for exclusive breastfeeding 0.4 [95% CI 0.2, 0.8] p = 0.006). At 6 weeks and 6 months, the relationship between type 2 diabetes and predominant breastfeeding was not statistically significant (6 weeks 0.7 [0.3, 1.6] p = 0.40, 6 months 0.8 [0.4, 1.6] p = 0.60). Women with gestational diabetes were as likely to achieve predominant breastfeeding at 6 weeks and 6 months as women without hyperglycaemia in pregnancy. CONCLUSIONS/ INTERPRETATION: Indigenous women had high rates of breastfeeding. Women with type 2 diabetes had difficulty establishing exclusive breastfeeding at hospital discharge. Further research is needed to assess the impact on long-term breastfeeding outcomes. Graphical abstract.