Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus
Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus
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DOI：
10.3945/ajcn.113.073049
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发表时间：
2014-01-01
影响因子：
7.1
通讯作者：
Gunderson, Erica P.
中科院分区：
文献类型：
--
作者：
Matias, Susana L.;Dewey, Kathryn G.;Gunderson, Erica P.
背景：及时进入第二阶段泌乳（OL）对成功母乳喂养和新生儿健康至关重要。有妊娠期糖尿病（GDM）病史的妇女中，延迟OL的几个危险因素很常见，这可能会影响她们成功母乳喂养的机会。目的：我们调查了一个种族和民族多样的近期GDM产后妇女队列中延迟OL的患病率和危险因素。设计：我们分析了GDM妊娠后妇女、婴儿喂养和2型糖尿病研究（SWIFT）中收集的数据，这是2008年至2011年在北方加州Kaiser Permanente医院分娩的诊断为GDM的女性的前瞻性队列。在产后6-9周，通过母亲报告乳房丰满度来评估延迟性OL，并将其定义为产后72小时后发生。我们从电子病历和亲自调查中获得了产前课程和产后婴儿喂养实践的数据。我们使用多变量logistic回归模型来估计延迟OL与产前，分娩和产后characteristics.Results的关联：分析包括883 SWIFT参与者谁开始母乳喂养，并没有糖尿病在产后6-9周。33%的女性报告了延迟性OL，并与孕前肥胖相关（OR：1.56; 95% CI：1.07，2.29），高龄产妇（OR：1.05; 95% CI：1.01，1.08），胰岛素GDM治疗（OR：3.11; 95% CI：1.37，7.05），和次优的院内母乳喂养（OR：1.65; 95% CI：1.20，2.26）。较高的胎龄与延迟OL的几率降低相关，但仅在经产母亲中（OR：0.79; 95%CI：0.67，0.94）。母亲肥胖、胰岛素治疗和不理想的住院母乳喂养是延迟OL的关键危险因素。早期母乳喂养支持GDM妇女与这些危险因素可能需要确保成功哺乳。
Background: The timely onset of stage II lactogenesis (OL) is important for successful breastfeeding and newborn health. Several risk factors for delayed OL are common in women with a history of gestational diabetes mellitus (GDM), which may affect their chances for successful breastfeeding outcomes.Objective: We investigated the prevalence and risk factors associated with delayed OL in a racially and ethnically diverse cohort of postpartum women with recent GDM.Design: We analyzed data collected in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy (SWIFT), which is a prospective cohort of women diagnosed with GDM who delivered at Kaiser Permanente Northern California hospitals from 2008 to 2011. At 6-9 wk postpartum, delayed OL was assessed by maternal report of breast fullness and defined as occurring after 72 h postpartum. We obtained data on prenatal course and postdelivery infant feeding practices from electronic medical records and in-person surveys. We used multivariable logistic regression models to estimate associations of delayed OL with prenatal, delivery, and postnatal characteristics.Results: The analysis included 883 SWIFT participants who initiated breastfeeding and did not have diabetes at 6-9 wk postpartum. Delayed OL was reported by 33% of women and was associated with prepregnancy obesity (OR: 1.56; 95% CI: 1.07, 2.29), older maternal age (OR: 1.05; 95% CI: 1.01, 1.08), insulin GDM treatment (OR: 3.11; 95% CI: 1.37, 7.05), and suboptimal in-hospital breastfeeding (OR: 1.65; 95% CI: 1.20, 2.26). A higher gestational age was associated with decreased odds of delayed OL but only in multiparous mothers (OR: 0.79; 95% CI: 0.67, 0.94).Conclusions: One-third of women with recent GDM experienced delayed OL. Maternal obesity, insulin treatment, and suboptimal in-hospital breastfeeding were key risk factors for delayed OL. Early breastfeeding support for GDM women with these risk factors may be needed to ensure successful lactation.