Sarker Minhazur, Jacobs Marni B, Boggess Kim, Battarbee Ashley N, Refuerzo Jerrie, Zork Noelia, Eichelberger Kacey, Durnwald Celeste, Landon Mark, Aagaard Kjersti, Wallace Kedra, Scifres Christina, Longo Sherri, Stuebe Alison, Ramos Gladys A
University of California San Diego, San Diego, CA USA.
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA.
Pregnancy (Hoboken). 2025 Jan;1(1). doi: 10.1002/pmf2.12040. Epub 2025 Jan 28.
Insulin resistance is associated with decreased milk supply in lactating people. Metformin is hypothesized to increase breast milk production by decreasing insulin resistance, suggesting use may increase breastfeeding success. We aimed to determine the association between metformin use during pregnancy and breastfeeding initiation and continuation.
This was a secondary analysis of the MOMPOD randomized controlled trial of metformin versus placebo in addition to insulin therapy among pregnant people with type 2 diabetes and early diabetes. We included parturients who delivered a living neonate, received at least one dose of study drug or placebo, endorsed an intention to breastfeed, and completed a breastfeeding survey. Breastfeeding intentions and breastfeeding outcomes were collected utilizing a breastfeeding questionnaire at 24-30 weeks and 30-days postpartum respectively. The primary outcome was breastfeeding at 30-days postpartum defined by exclusive or partial breastfeeding. Secondary outcomes included immediate breastfeeding defined as any breastfeeding during the postpartum hospital admission until at least postpartum day 3, onset of lactogenesis (days), breast and bra size, and breastfeeding challenges. Baseline characteristics and outcomes were compared using chi-square, t-test, or Wilcoxon tests, as appropriate.
Among the 794 women randomized and receiving either placebo or metformin in the primary trial, 378 (47.6%) met inclusion criteria with 194 (51.3%) in metformin and 184 (48.7%) in placebo groups. There were no significant differences in baseline characteristics. Immediate breastfeeding was comparable between groups (91.1% vs 88.9%, p=0.53) and there was no difference in onset of lactogenesis. Thirty days postpartum, breastfeeding rates were lower among all parturients and there was no difference between metformin and placebo groups (76.0% vs 66.7%, p=0.11). Also, there were no differences in partial or exclusive breastfeeding, breast cup or bra size, or breastfeeding challenges.
Our data suggest no association between metformin use and breastfeeding patterns in those with type 2 or early diabetes in pregnancy. Antepartum metformin should not be recommended solely to improve breastfeeding success.
胰岛素抵抗与哺乳期女性的乳汁供应减少有关。据推测，二甲双胍可通过降低胰岛素抵抗来增加母乳产量，这表明使用二甲双胍可能会提高母乳喂养的成功率。我们旨在确定孕期使用二甲双胍与母乳喂养开始及持续之间的关联。
这是对MOMPOD随机对照试验的二次分析，该试验在患有2型糖尿病和早期糖尿病的孕妇中，除胰岛素治疗外，对比了二甲双胍与安慰剂的效果。我们纳入了分娩活产新生儿、接受至少一剂研究药物或安慰剂、认可母乳喂养意愿并完成母乳喂养调查的产妇。分别在孕24 - 30周和产后30天时，通过母乳喂养问卷收集母乳喂养意愿和母乳喂养结果。主要结局是产后30天时的母乳喂养情况，定义为纯母乳喂养或部分母乳喂养。次要结局包括即刻母乳喂养，定义为产后住院期间直至至少产后第3天的任何母乳喂养、泌乳开始时间（天数）、乳房和胸罩尺寸以及母乳喂养挑战。根据情况，使用卡方检验、t检验或Wilcoxon检验比较基线特征和结局。
在初次试验中随机接受安慰剂或二甲双胍的794名女性中，378名（47.6%）符合纳入标准，其中二甲双胍组194名（51.3%），安慰剂组184名（48.7%）。基线特征无显著差异。两组之间的即刻母乳喂养情况相当（91.1%对88.9%，p = 0.53），泌乳开始时间也无差异。产后30天时，所有产妇的母乳喂养率均较低，二甲双胍组和安慰剂组之间无差异（76.0%对66.7%，p = 0.11）。此外，在部分或纯母乳喂养、胸罩罩杯或胸罩尺寸或母乳喂养挑战方面也无差异。
我们的数据表明，孕期患有2型糖尿病或早期糖尿病的女性使用二甲双胍与母乳喂养模式之间无关联。不应仅为提高母乳喂养成功率而推荐产前使用二甲双胍。
