Division of Research, Kaiser Permanente Northern California, Oakland, CA (SLM, CPQ, and EPG), and the Department of Nutrition, University of California, Davis, Davis, CA (SLM and KGD).
Am J Clin Nutr. 2014 Jan;99(1):115-21. doi: 10.3945/ajcn.113.073049. Epub 2013 Nov 6.
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.
We investigated the prevalence and risk factors associated with delayed OL in a racially and ethnically diverse cohort of postpartum women with recent GDM.
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.
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).
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. This trial was registered at clinicaltrials.gov as NCT01967030.
第二期泌乳启动（OL）的及时发生对成功母乳喂养和新生儿健康很重要。有妊娠期糖尿病（GDM）病史的女性中，OL 延迟的几个风险因素很常见，这可能会影响她们成功母乳喂养的机会。
我们调查了种族和民族多样化的近期 GDM 产后妇女队列中 OL 延迟的发生率和相关风险因素。
我们分析了 2008 年至 2011 年期间在 Kaiser Permanente 北加州医院分娩的 GDM 诊断妇女的前瞻性队列研究“妊娠期糖尿病妇女、婴儿喂养和 2 型糖尿病研究（SWIFT）”中收集的数据。产后 6-9 周时，通过母亲报告乳房饱满程度评估 OL 延迟，并将其定义为产后 72 小时后发生。我们从电子病历和面对面调查中获得了产前病程和产后婴儿喂养方式的数据。我们使用多变量逻辑回归模型来估计 OL 延迟与产前、分娩和产后特征的关联。
分析包括 883 名开始母乳喂养且产后 6-9 周时无糖尿病的 SWIFT 参与者。33%的女性报告 OL 延迟，与孕前肥胖（OR：1.56；95%CI：1.07，2.29）、母亲年龄较大（OR：1.05；95%CI：1.01，1.08）、胰岛素 GDM 治疗（OR：3.11；95%CI：1.37，7.05）和医院内母乳喂养不理想（OR：1.65；95%CI：1.20，2.26）有关。较高的胎龄与 OL 延迟的几率降低有关，但仅在多产妇中（OR：0.79；95%CI：0.67，0.94）。
三分之一的近期 GDM 女性经历了 OL 延迟。母亲肥胖、胰岛素治疗和医院内母乳喂养不理想是 OL 延迟的关键危险因素。对于具有这些危险因素的 GDM 女性，可能需要早期进行母乳喂养支持，以确保成功泌乳。该试验在 clinicaltrials.gov 上注册为 NCT01967030。
