[妊娠期糖尿病女性的母乳喂养]

[Breastfeeding in women with gestational diabetes].

作者信息

Hummel S, Hummel M, Knopff A, Bonifacio E, Ziegler A-G

机构信息

Institut für Diabetesforschung, München.

出版信息

Dtsch Med Wochenschr. 2008 Feb;133(5):180-4. doi: 10.1055/s-2008-1017493.

DOI:10.1055/s-2008-1017493

PMID:18213549

Abstract

BACKGROUND AND OBJECTIVE

Children born to mothers with gestational diabetes are at an increased risk of developing obesity. Breastfeeding is acknowledged as beneficial for child development and it is suggested that breastfeeding protects against becoming obese. The aim of this study was to document breastfeeding habits of women with gestational diabetes and to identify factors that affect breastfeeding habits.

METHODS

Breastfeeding habits (breastfeeding of any duration) were recorded of 257 mothers with gestational diabetes (mean age 31.4 +/- 4.8 years) who participated in a prospective post-partum study between 1989 and 1999 and compared to breastfeeding habits of 527 healthy mothers (mean age 30.3 +/- 4.2 years), all enrolled in the prospective BABYDIAB study between the years 1989 and 2000. Breastfeeding data were prospectively obtained by questionnaire and interview.

RESULTS

Compared to children of healthy mothers, fewer children of mothers with gestational diabetes were breastfed (75% vs 86%; P<0.0001). Among breastfed children the duration of full or any breastfeeding was shorter in children of mothers with gestational diabetes (median for full breastfeeding 9 weeks. [mothers with gestational diabetes] vs. 17 weeks. [healthy mothers]; p<0.0001; median duration of any breastfeeding 16 weeks. vs. 26 weeks.; p<0.0001). After stratification for other risk factors the duration of breastfeeding significantly differed between mothers with gestational DM and those who were healthy (hazard ratio [HR] 1.4; p<0.05 for full breastfeeding; HR 1.5; p<0.0001 for any breastfeeding). Full and any breastfeeding was shorter in women with insulin-dependent gestational diabetes than in those with diet-controlled gestational diabetes (full breast-feeding 4 weeks. vs. 12 weeks.; p<0.01 and any breastfeeding 10 weeks. vs. 20 weeks,; p<0.0001). Fewer women with gestational diabetes and a body weight index (BMI) >30 kg/m2 breastfed (65% vs 80%; p=0.01) and for a shorter duration than women with a BMI <30 kg/m2 (any breastfeeding 12 weeks. vs. 17 weeks; p=0.02). The type of DM therapy independently correlated with reduced breastfeeding duration (HR 1.7; p=0<0.01).

CONCLUSIONS

Mothers with gestational diabetes, especially mothers with insulin-dependent gestational diabetes, and obese mothers breastfed their children significantly less and for a shorter duration than healthy mothers. These findings could explain the higher risk of their children developing obesity later in life and should be considered when counselling women with gestational diabetes.

摘要

背景与目的

患有妊娠期糖尿病的母亲所生子女患肥胖症的风险增加。母乳喂养被认为对儿童发育有益，有人提出母乳喂养可预防肥胖。本研究的目的是记录患有妊娠期糖尿病的女性的母乳喂养习惯，并确定影响母乳喂养习惯的因素。

方法

记录了1989年至1999年间参与一项前瞻性产后研究的257名患有妊娠期糖尿病的母亲（平均年龄31.4±4.8岁）的母乳喂养习惯（任何时长的母乳喂养），并与1989年至2000年间参与前瞻性BABYDIAB研究的527名健康母亲（平均年龄30.3±4.2岁）的母乳喂养习惯进行比较。通过问卷调查和访谈前瞻性地获取母乳喂养数据。

结果

与健康母亲的子女相比，患有妊娠期糖尿病的母亲的子女接受母乳喂养的较少（75%对86%；P<0.0001）。在接受母乳喂养的儿童中，患有妊娠期糖尿病的母亲的子女进行纯母乳喂养或任何时长母乳喂养的时间较短（纯母乳喂养的中位数：患有妊娠期糖尿病的母亲的子女为9周，健康母亲的子女为17周；p<0.0001；任何时长母乳喂养的中位数：16周对26周；p<0.0001）。在对其他风险因素进行分层后，患有妊娠期糖尿病的母亲和健康母亲的母乳喂养时长存在显著差异（风险比[HR]1.4；纯母乳喂养时p<0.05；任何母乳喂养时HR 1.5；p<0.0001）。胰岛素依赖型妊娠期糖尿病女性的纯母乳喂养和任何时长母乳喂养都比饮食控制型妊娠期糖尿病女性短（纯母乳喂养：4周对12周；p<0.01，任何母乳喂养：10周对20周；p<0.0001）。体重指数（BMI）>30 kg/m²的患有妊娠期糖尿病的女性进行母乳喂养的较少（65%对80%；p=0.01），且母乳喂养时长比BMI<30 kg/m²的女性短（任何时长母乳喂养：12周对17周；p=0.02）。糖尿病治疗类型与母乳喂养时长缩短独立相关（HR 1.7；p=0<0.01）。