前瞻性研究母乳喂养、代谢健康、炎症与既往妊娠糖尿病女性骨密度的关系。
Prospective associations between breast feeding, metabolic health, inflammation and bone density in women with prior gestational diabetes mellitus.
机构信息
Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
University of Lausanne, Lausanne, Switzerland.
出版信息
BMJ Open Diabetes Res Care. 2024 May 21;12(3):e004117. doi: 10.1136/bmjdrc-2024-004117.
INTRODUCTION
The aim of the study is to investigate prospective associations between breastfeeding and metabolic outcomes, inflammation, and bone density in women with prior gestational diabetes mellitus (GDM).
RESEARCH DESIGN AND METHODS
We prospectively included 171 women with GDM from the MySweetheart trial. Women were followed during pregnancy (from 24 up to 32 weeks' gestational age) up to 1 year postpartum. Outcomes included weight, weight retention, body composition, insulin resistance and secretion indices, C reactive protein (CRP), and bone density. We compared differences in the associations between breastfeeding and health outcomes between women who breast fed <6 months vs ≥6 months. Analyses were adjusted for potential medical and sociodemographic confounders.
RESULTS
Breastfeeding initiation was 94.2% (n=161) and mean breastfeeding duration was 6.6 months. Breastfeeding duration was independently associated with lower weight, weight retention, body fat, visceral adipose tissue, lean mass, CRP, insulin resistance (Homeostatic Model Assessment for Insulin Resistance), and insulin secretion (Homeostatic Model Assessment of β-cell index) at 1 year postpartum (all p≤0.04) after adjusting for confounders. Breastfeeding was associated with higher insulin resistance-adjusted insulin secretion (Insulin Secretion-Sensitivity Index-2) in the unadjusted analyses only. There was no association between breastfeeding duration and bone density. Compared with <6 months, breastfeeding duration ≥6 months was associated with lower weight, weight retention, body fat, fat-free mass as well as lower CRP at 1 year postpartum (all p<0.05) after adjusting for confounders.
CONCLUSIONS
Longer breastfeeding duration among women with prior GDM was associated with lower insulin resistance, weight, weight retention, body fat and inflammation, but not lower bone density at 1 year postpartum. Breastfeeding for ≥6 months after GDM can help to improve cardiometabolic health outcomes 1 year after delivery.
简介
本研究旨在探讨既往妊娠期糖尿病（GDM）女性母乳喂养与代谢结局、炎症和骨密度之间的前瞻性关联。
研究设计和方法
我们前瞻性纳入了来自“MySweetheart”试验的 171 例 GDM 女性。从 24 周至 32 周的妊娠期开始，直至产后 1 年对女性进行随访。研究结局包括体重、体重滞留、身体成分、胰岛素抵抗和分泌指数、C 反应蛋白（CRP）和骨密度。我们比较了母乳喂养<6 个月与≥6 个月的女性之间，母乳喂养与健康结局之间的关联差异。分析调整了潜在的医学和社会人口学混杂因素。
结果
母乳喂养的起始率为 94.2%（n=161），平均母乳喂养持续时间为 6.6 个月。调整混杂因素后，母乳喂养持续时间与产后 1 年时的体重、体重滞留、体脂、内脏脂肪组织、瘦体重、CRP、胰岛素抵抗（胰岛素抵抗评估的稳态模型评估）和胰岛素分泌（β细胞功能的稳态模型评估指数）呈独立负相关（所有 p≤0.04）。仅在未调整分析中，母乳喂养与胰岛素抵抗调整后的胰岛素分泌（胰岛素分泌敏感性指数-2）呈正相关。母乳喂养持续时间与骨密度之间无关联。与<6 个月相比，母乳喂养持续时间≥6 个月与产后 1 年时的体重、体重滞留、体脂、去脂体重以及 CRP 降低相关（所有 p<0.05），调整混杂因素后。
结论
既往 GDM 女性母乳喂养持续时间较长与产后 1 年时的胰岛素抵抗、体重、体重滞留、体脂和炎症降低相关，但与骨密度降低无关。GDM 后母乳喂养≥6 个月可帮助改善产后 1 年的心血管代谢健康结局。
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