A Kaiser Permanente study finds that pre-pregnancy obesity and older maternal age are among the risk factors for delayed lactation for women with gestational diabetes mellitus.

Delayed onset of lactation was reported by 33 percent of the women, and was associated with pre-pregnancy obesity, older maternal age and insulin treatment for GDM (which is indicative of greater severity of gestational diabetes).
"Given the potential for breastfeeding to mitigate the higher risk that women with GDM face for developing type-2 diabetes, skilled lactation support is particularly important for obese women with GDM," said lead author Susana L. Matias, PhD, a postdoctoral researcher at the Kaiser Permanente Division of Research and the University of California, Davis, Department of Nutrition.
Among the study group, the average pre-pregnancy body mass index was 29.3, falling within the "overweight" category. GDM is associated with higher pre-pregnancy weight. However, even in this population, being in the heaviest BMI category (i.e., "obese") increased the risk for delayed onset of lactation. Insulin resistance, also associated with obesity, may be another possible mechanism linking obesity and delayed onset of lactation.
Gestational diabetes mellitus, defined as glucose intolerance with first onset during pregnancy, occurs in 7 percent of all U.S. pregnancies, and affects over 200,000 women annually. A history of GDM confers up to a seven-fold higher risk of diabetes, and almost 50 percent of women with a GDM pregnancy will be diagnosed with type 2 diabetes within five to eight years after pregnancy.
Identification of risk factors for delayed milk production could help target breastfeeding support services and enable women with GDM to experience the benefits of lactation for their own future health and that of their offspring.
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Timely onset of milk production following delivery is important for successful breastfeeding and newborn health. Delayed onset of milk production is usually defined as not occurring until after 72 hours (or three days) postpartum, and its incidence in the U.S. is high, ranging from 23 percent to 44 percent.
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Other studies by the Kaiser Permanente Division of Research have shown that breastfeeding with little or no formula supplementation is associated with lower fasting blood glucose and lower insulin levels in women at 6-9 weeks postpartum. The studies have also shown that exclusive or mostly breastfeeding groups had lower prevalence of pre-diabetes than formula-feeding groups, even among obese women.
Source-Eurekalert