Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel.
Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
Arch Gynecol Obstet. 2020 Apr;301(4):973-979. doi: 10.1007/s00404-020-05497-3. Epub 2020 Mar 18.
To examine the impact of lactation on the recurrence rate of gestational diabetes mellitus (GDM).
Retrospective cohort study performed in a single teaching hospital on data between 2009 and 2016. The study group consisted of women who had a diagnosis of GDM and breastfed exclusively for ≥ 1 month. The control group consisted of women who had a diagnosis of GDM and did not breastfeed or added formula < 1 month postpartum. Data regarding breastfeeding duration, timing and amount of formula supplementation were obtained by a telephone questionnaire. We hypothesized that the recurrence of GDM would be lower in women who breastfed exclusively for ≥ 1 month. Therefore, to detect a decrease from 50 to 30% in the recurrence rate of GDM with alpha (one-sided) of 0.05 and 80% power, a sample size of 168 (84 per group) was needed.
Overall, 229 women were found eligible; 139 and 90 in the study and control groups, respectively. Except for parity, baseline demographic and obstetric variables were not different between the two groups. After adjusting for parity, the incidence of GDM in subsequent pregnancy was significantly lower among the study compared to the control group [48 (34.5%) and 41 (45.6%), respectively; one-tailed p = 0.043; RR 0.56; 95% CI 0.35-0.90)]. The cesarean delivery (CD) rate was significantly lower as well [28 (20.1%) and 31 (34.4%), respectively; two-tailed p = 0.02; RR 0.48, 95% CI 0.26-0.89)].
Exclusive lactation for ≥ 1 month reduced the recurrence rate of GDM and possibly the risk of CD in the subsequent pregnancy.
探讨哺乳期对妊娠期糖尿病（GDM）复发率的影响。
这是一项在单所教学医院进行的回顾性队列研究，数据收集时间为 2009 年至 2016 年。研究组纳入的是确诊 GDM 且纯母乳喂养≥1 个月的女性。对照组纳入的是确诊 GDM 且未母乳喂养或产后 1 个月内添加配方奶<1 个月的女性。通过电话问卷调查获得母乳喂养持续时间、开始时间和配方奶补充量的数据。我们假设纯母乳喂养≥1 个月的女性 GDM 复发率会更低。因此，为了检测 GDM 复发率从 50%降至 30%，设定单侧检验 α 值为 0.05，把握度为 80%，需要纳入 168 名（每组 84 名）女性。
共纳入 229 名符合条件的女性，其中研究组和对照组分别为 139 名和 90 名。除了产次外，两组的基线人口统计学和产科变量无差异。在校正产次后，与对照组相比，研究组后续妊娠发生 GDM 的比例显著更低[48（34.5%）和 41（45.6%）；单侧检验 p=0.043；RR 0.56；95%CI 0.35-0.90]。剖宫产率也显著更低[28（20.1%）和 31（34.4%）；双侧检验 p=0.02；RR 0.48，95%CI 0.26-0.89]。
纯母乳喂养≥1 个月可降低 GDM 的复发率，并可能降低后续妊娠的剖宫产风险。
