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母乳喂养持续时间与妊娠期糖尿病女性发生糖代谢异常的关系:来自 GUSTO 队列研究的证据。

Breastfeeding Duration and Development of Dysglycemia in Women Who Had Gestational Diabetes Mellitus: Evidence from the GUSTO Cohort Study.

机构信息

Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.

Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), 30 Medical Drive, Singapore 117609, Singapore.

出版信息

Nutrients. 2021 Jan 28;13(2):408. doi: 10.3390/nu13020408.

DOI:10.3390/nu13020408
PMID:33525398
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7912373/
Abstract

(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study ( = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.

摘要

(1)背景:母乳喂养已被证明可支持妊娠合并糖尿病(GDM)女性产后的血糖稳态,并可有效降低长期糖尿病风险。(2)方法:分析新加坡成长至健康结局研究(GUSTO)的数据,以了解在指数妊娠中患有 GDM 的女性母乳喂养持续时间对长期糖基化异常(糖尿病前期和糖尿病)风险的影响。GDM 和产后 4 至 7 年的糖基化异常通过口服葡萄糖耐量试验(OGTT)确定。使用具有稳健误差方差的泊松回归模型,根据任何母乳喂养持续时间(<1 个月、≥1 至 <6 个月和≥6 个月)的分组,估计产后 4 至 7 年糖基化异常的发病率比值(IRR)。(3)结果:本研究纳入了在指数妊娠期间患有 GDM 且具有完整母乳喂养信息和产后 4 至 7 年 OGTT 的女性(n=116)。51 名女性(44%)患有产后糖基化异常。未调整的 IRR 显示,与<1 个月的任何母乳喂养相比,糖基化异常风险与≥1 至<6 个月(IRR 0.91;95%置信区间 [CI] 0.57,1.43; = 0.68)和≥6 个月(IRR 0.50;95% CI 0.27,0.91; = 0.02)母乳喂养呈负相关。调整关键混杂因素后,≥6 个月组的 IRR 仍然显著(IRR 0.42;95% CI 0.22,0.80; = 0.008)。(4)结论:我们的结果表明,在亚洲环境中,任何持续 6 个月或更长时间的母乳喂养都可能降低有 GDM 病史的女性的长期糖基化异常风险。母乳喂养对母亲的益处不仅在于减肥,尤其是对患有 GDM 的母亲。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05db/7912373/02c8537f61da/nutrients-13-00408-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05db/7912373/02c8537f61da/nutrients-13-00408-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/05db/7912373/02c8537f61da/nutrients-13-00408-g001.jpg

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Diabetes Metab Res Rev. 2019 Mar;35(3):e3108. doi: 10.1002/dmrr.3108. Epub 2019 Jan 7.
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Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women.美国女性妊娠糖尿病及随后发生 2 型糖尿病的患病率。
Diabetes Res Clin Pract. 2018 Jul;141:200-208. doi: 10.1016/j.diabres.2018.05.010. Epub 2018 May 26.
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Lactation and progression to type 2 diabetes in patients with gestational diabetes mellitus: A systematic review and meta-analysis of cohort studies.
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