Kjos S L, Henry O, Lee R M, Buchanan T A, Mishell D R
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.
Obstet Gynecol. 1993 Sep;82(3):451-5.
To investigate the effect of lactation in the puerperium on glucose and lipid metabolism in women with recent gestational diabetes.
In women with recent gestational diabetes, we examined the effect of 4-12 weeks of lactation on glucose tolerance (2-hour oral glucose tolerance test) and on fasting serum lipids (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglycerides). Of 809 women tested in the puerperium, 404 elected to breast-feed and 405 did not lactate.
The mean (+/- standard deviation) maternal age (31.6 +/- 5.9 versus 30.5 +/- 6.3 years), body mass index (28.8 +/- 5.1 versus 28.8 +/- 4.5 kg/m2), and parity (3.0 +/- 1.6 versus 2.8 + 1.7) were not different between the lactating and nonlactating groups, respectively. Glucose metabolism improved in the lactating group, indicated by a significantly lower total area under the glucose tolerance curve (17.0 +/- 4.2 versus 17.9 +/- 5.0 g.minute/dL; P = .01), mean fasting serum glucose (93 +/- 13 versus 98 +/- 17 mg/dL; P = .0001), and mean 2-hour glucose level (124 +/- 41 versus 134 +/- 49 mg/dL; P < .01). These differences were significant after adjusting for maternal age, body mass index (BMI), and the use of insulin in pregnancy. Nursing had no effect on total cholesterol, LDL cholesterol, or triglyceride levels. However, the mean serum HDL cholesterol was elevated in the lactating group after adjusting for maternal age, BMI, and pregnancy insulin use compared with the nonlactating group (48 +/- 11 versus 44 +/- 10 mg/dL; P < .01).
Lactation, even for a short duration, has a beneficial effect on glucose and lipid metabolism in women with gestational diabetes. Breast-feeding may offer a practical, low-cost intervention that helps reduce or delay the risk of subsequent diabetes in women with prior gestational diabetes.
探讨产褥期哺乳对近期患妊娠期糖尿病女性糖脂代谢的影响。
在近期患妊娠期糖尿病的女性中，我们研究了4 - 12周哺乳对糖耐量（口服葡萄糖耐量试验2小时）和空腹血脂（总胆固醇、高密度脂蛋白[HDL]胆固醇、低密度脂蛋白[LDL]胆固醇和甘油三酯）的影响。在产褥期接受检测的809名女性中，404名选择母乳喂养，405名未进行哺乳。
哺乳组和非哺乳组产妇的平均（±标准差）年龄（分别为31.6 ± 5.9岁和30.5 ± 6.3岁）、体重指数（分别为28.8 ± 5.1 kg/m²和28.8 ± 4.5 kg/m²）以及产次（分别为3.0 ± 1.6和2.8 ± 1.7）无差异。哺乳组的糖代谢得到改善，表现为糖耐量曲线下总面积显著降低（分别为17.0 ± 4.2和17.9 ± 5.0 g·分钟/dL；P = 0.01）、平均空腹血糖（分别为93 ± 13和98 ± 17 mg/dL；P = 0.0001）以及平均2小时血糖水平（分别为124 ± 41和134 ± 49 mg/dL；P < 0.01）。在对产妇年龄、体重指数（BMI）和孕期胰岛素使用情况进行校正后，这些差异仍具有统计学意义。哺乳对总胆固醇、LDL胆固醇或甘油三酯水平无影响。然而，在对产妇年龄、BMI和孕期胰岛素使用情况进行校正后，与非哺乳组相比，哺乳组的平均血清HDL胆固醇升高（分别为48 ± 11和44 ± 10 mg/dL；P < 0.01）。
即使是短期哺乳，对妊娠期糖尿病女性的糖脂代谢也有有益影响。母乳喂养可能提供一种实用、低成本的干预措施，有助于降低或延缓既往患妊娠期糖尿病女性后续患糖尿病的风险。
