Lactation and Glucose Tolerance After GDM Pregnancy

描述（由申请方提供）：哺乳对葡萄糖耐量有直接的有利影响，在断奶后可能持续存在，以防止女性发生2型糖尿病（DM）。妊娠期葡萄糖不耐受的发展，称为妊娠期糖尿病（GDM），是随后发展为2型糖尿病的强有力预测因素。在美国，GDM发生在所有妊娠的约3-5%，每年影响135，000名妇女。在分娩后5年内，20%至50%的GDM患者将发展为2型DM。妊娠期糖尿病后发生2型糖尿病的危险因素包括胰腺B细胞功能障碍、妊娠期和产后早期葡萄糖耐受不良的严重程度、糖尿病家族史、母亲肥胖、复发性GDM和体重增加。哺乳期降低母体葡萄糖和胰岛素水平，改善葡萄糖耐量和处置指数，表明更好的细胞功能的胰岛素抵抗程度。哺乳的强度和持续时间是否会降低随后患糖尿病的风险很少被研究。以前的研究受到哺乳期（曾经与从未），当前状态（是与否）或哺乳期的定性测量的限制。没有前瞻性研究评估哺乳强度（补充喂养）和/或持续时间与近期妊娠期糖尿病后发生2型糖尿病的关系。我们提出了一项前瞻性队列研究，将在北方加州的Kaiser Permanente医疗保健系统中招募1,098名最近诊断为GDM的妇女，她们在产后6-8周没有2型糖尿病。女性将每年随访一次，持续两年，以进行2小时75克口服葡萄糖耐量试验。我们将确定是否延长，密集的哺乳期相比，没有哺乳与2型糖尿病的发病率较低，更有利的变化，空腹和2小时后负荷血糖和胰岛素水平，胰岛素抵抗指数，体重，腰围和血浆脂联素。由于随机化是不可行的，严格评估哺乳强度和持续时间控制多种潜在的混杂因素是最有效的研究设计。这些发现对有GDM病史的女性的潜在公共卫生影响是巨大的，因为不到50%的美国女性在四个月内哺乳。哺乳是一种可以改变的行为，可以转化为一种实用的，低成本的干预措施，有可能加强产后干预措施，促进健康的饮食摄入和增加体力活动。

DESCRIPTION (provided by applicant): Lactation has immediate favorable effects on glucose tolerance that may persist after weaning to prevent development of type 2 diabetes mellitus (DM) in women. Development of glucose intolerance during pregnancy, known as gestational diabetes (GDM), is a strong predictor of subsequent development of type 2 DM. In the U.S., GDM occurs in about 3-5% of all pregnancies and affects 135,000 women per year. Within 5 years after delivery, 20 to 50% of women with previous GDM will develop type 2 DM. Risk factors for type 2 DM after GDM pregnancy include pancreatic b-cell dysfunction, severity of glucose intolerance during pregnancy and early postpartum periods, family history of DM, maternal obesity, recurrent GDM and weight gain. Lactation lowers maternal glucose and insulin levels, improves glucose tolerance and the disposition index, indicating better-cell function for their degree of insulin resistance. Whether the intensity and duration of lactation reduces subsequent risk of DM has rarely been examined. Previous studies are limited by qualitative measures of lactation (ever vs. never), current status (yes vs. no), or lifetime months of lactation. No prospective studies have assessed lactation intensity (supplemental feedings) and/or duration in relation to development of type 2 DM after recent GDM pregnancy. We propose a prospective cohort study that will enroll 1,098 women with a recent GDM diagnosis who are free of type 2 DM at 6-8 weeks postpartum in the Kaiser Permanente Health Care System in northern California. Women will be followed annually for two years to administer the 2 hr 75 g oral glucose tolerance test. We will determine whether prolonged, intensive lactation compared with no lactation is associated with a lower incidence of type 2 DM, and more favorable changes in fasting and 2-hr post load plasma glucose and insulin levels, indices of insulin resistance, body weight, waist girth and plasma adiponectin. Because randomization is not feasible, the rigorous assessment of lactation intensity and duration controlling for multiple potential confounders is the most valid study design. The potential public health impact of these findings for women with a history of GDM is substantial given that less than 50% of U.S. women lactate for four months. Lactation is a modifiable behavior that may be translated into a practical, low-cost intervention that has the potential to enhance postpartum interventions that promote healthy dietary intakes and increased physical activity.