Martens Patricia J, Shafer Leigh Anne, Dean Heather J, Sellers Elizabeth A C, Yamamoto Jennifer, Ludwig Sora, Heaman Maureen, Phillips-Beck Wanda, Prior Heather J, Morris Margaret, McGavock Jonathan, Dart Allison B, Shen Garry X
Manitoba Centre for Health Policy, Department of Community Health Sciences, the Departments of Internal Medicine and Pediatrics and Child Health, College of Nursing, and the Department of Obstetrics, Gynecology & Reproductive Sciences, Rady Faculty of Health Sciences, University of Manitoba, and the Assembly of Manitoba Chiefs, Winnipeg, Manitoba, Canada.
Obstet Gynecol. 2016 Nov;128(5):1095-1104. doi: 10.1097/AOG.0000000000001689.
To examine associations between breastfeeding initiation and subsequent diabetes among First Nations (indigenous people in Canada who are not Métis or Inuit) and non-First Nations mothers and their offspring with and without gestational diabetes mellitus (GDM).
This retrospective database study included 334,553 deliveries (1987-2011) in Manitoba with up to 24 years of follow-up for diabetes using population-based databases. Information of breastfeeding initiation before hospital discharge was obtained from hospital abstracts recorded by nurses in postpartum wards. Cox proportional hazard models were applied to examine the association between breastfeeding initiation and risk of diabetes in mothers and their offspring.
Breastfeeding initiation was recorded in 83% of non-First Nations mothers and 56% of First Nations mothers (P<.001). Breastfeeding initiation was associated with a reduced risk of incident (later developed) diabetes in non-First Nations mothers without GDM (hazard ratio [HR] 0.73 [or -27% of risk], 95% confidence interval [CI] 0.68-0.79), non-First Nations mothers with GDM (HR 0.78 or -22% of risk, CI 0.69-0.89), First Nations mothers without GDM (HR 0.89 or -11% of risk, CI 0.81-0.98), and First Nations mothers with GDM (HR 0.82 or -18% of risk, CI 0.73-0.92) with 24 years of follow-up or less. With 24 years of follow-up or less, breastfeeding initiation was associated with a 17% lower risk of youth-onset type 2 diabetes in offspring (HR 0.83, CI 0.69-0.99, P=.038). The association between breastfeeding initiation and subsequent diabetes in mothers and offspring was independent of family income, rural residence, First Nations status, GDM, parity, gestational hypertension, and age of the mother.
Breastfeeding initiation is associated with a reduced risk of diabetes among women and their offspring in Manitoba. The results suggest that breastfeeding might be a potentially modifiable factor to reduce the risk of diabetes in both First Nations and non-First Nations women and children.
研究加拿大第一民族（加拿大非梅蒂斯或因纽特的原住民）和非第一民族母亲及其后代中，开始母乳喂养与后续患糖尿病之间的关联，这些母亲及其后代患有或未患有妊娠期糖尿病（GDM）。
这项回顾性数据库研究纳入了曼尼托巴省334,553例分娩（1987 - 2011年），利用基于人群的数据库对糖尿病进行长达24年的随访。出院前开始母乳喂养的信息从产后病房护士记录的医院摘要中获取。应用Cox比例风险模型来研究开始母乳喂养与母亲及其后代患糖尿病风险之间的关联。
83%的非第一民族母亲和56%的第一民族母亲记录了开始母乳喂养的情况（P<0.001）。开始母乳喂养与未患GDM的非第一民族母亲患新发（后来患）糖尿病的风险降低相关（风险比[HR]0.73[即风险降低27%]，95%置信区间[CI]0.68 - 0.79），患GDM的非第一民族母亲（HR 0.78或风险降低22%，CI 0.69 - 0.89），未患GDM的第一民族母亲（HR 0.89或风险降低11%，CI 0.81 - 0.98），以及患GDM的第一民族母亲（HR 0.82或风险降低18%，CI 0.73 - 0.92），随访时间为24年及以内。随访时间为24年及以内时，开始母乳喂养与后代患青少年型2型糖尿病的风险降低17%相关（HR 0.83，CI 0.69 - 0.99，P = 0.038）。开始母乳喂养与母亲及其后代后续患糖尿病之间的关联独立于家庭收入、农村居住情况、第一民族身份、GDM、产次、妊娠期高血压和母亲年龄。
在曼尼托巴省，开始母乳喂养与女性及其后代患糖尿病的风险降低相关。结果表明，母乳喂养可能是一个潜在的可改变因素，可降低第一民族和非第一民族妇女及儿童患糖尿病的风险。
