Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.
Diabetes Care. 2024 Apr 1;47(4):720-728. doi: 10.2337/dc23-1494.
Breastfeeding duration is inversely associated with risks of cardiovascular disease (CVD) and type 2 diabetes in parous women. However, the association among women at high risk, including women with type 2 diabetes or gestational diabetes mellitus (GDM) is unclear.
We included 15,146 parous women with type 2 diabetes from the Nurses' Health Study I and II (NHS, NHS II) and 4,537 women with a history of GDM from NHS II. Participants reported history of breastfeeding via follow-up questionnaires. Incident CVD by 2017 comprised stroke or coronary heart disease (CHD) (myocardial infarction, coronary revascularization). Adjusted hazard ratios (aHRs) and 95% CIs were estimated using Cox models.
We documented 1,159 incident CVD cases among women with type 2 diabetes in both cohorts during 188,874 person-years of follow-up and 132 incident CVD cases among women with a GDM history during 100,218 person-years of follow-up. Longer lifetime duration of breastfeeding was significantly associated with lower CVD risk among women with type 2 diabetes, with pooled aHR of 0.68 (95% CI 0.54-0.85) for >18 months versus 0 months and 0.94 (0.91-0.98) per 6-month increment in breastfeeding. Similar associations were observed with CHD (pooled aHR 0.93 [0.88-0.97]) but not with stroke (0.96 [0.91-1.02]) per 6-month increment in breastfeeding. Among women with GDM history, >18 months versus 0 months of breastfeeding was associated with an aHR of 0.49 (0.28-0.86) for total CVD.
Longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or GDM.
母乳喂养时长与经产妇女心血管疾病（CVD）和 2 型糖尿病的风险呈负相关。然而，包括患有 2 型糖尿病或妊娠期糖尿病（GDM）的高危女性在内的这些女性之间的关联尚不清楚。
我们纳入了来自护士健康研究 I 期和 II 期（NHS，NHS II）的 15146 名患有 2 型糖尿病的经产妇女和 NHS II 中患有 GDM 病史的 4537 名妇女。参与者通过随访问卷报告母乳喂养史。2017 年发生的 CVD 事件包括中风或冠心病（CHD）（心肌梗死、冠状动脉血运重建）。使用 Cox 模型估计调整后的危险比（aHR）和 95%置信区间。
我们在 NHS 和 NHS II 队列中分别记录了 188874 人年随访期间 1159 例 2 型糖尿病女性和 100218 人年随访期间 132 例 GDM 病史女性的 CVD 事件。一生中母乳喂养时间较长与 2 型糖尿病女性的 CVD 风险降低显著相关，与 0 个月相比，>18 个月和 0 个月的汇总 aHR 分别为 0.68（95%CI0.54-0.85）和 0.94（0.91-0.98）。在 CHD（汇总 aHR0.93[0.88-0.97]）中观察到类似的关联，但在中风（0.96[0.91-1.02]）中则没有。在有 GDM 病史的女性中，与 0 个月相比，>18 个月和 0 个月的母乳喂养与总 CVD 的汇总 aHR 为 0.49（0.28-0.86）相关。
较长时间的母乳喂养与 2 型糖尿病或 GDM 女性的 CVD 风险降低相关。
