Lactation and Changes in Maternal Metabolic Risk Factors

Overview

Journal Obstet Gynecol

Specialty Gynecology & Obstetrics

Date 2007 Mar 3

PMID 17329527

Citations 67

Authors

Erica P Gunderson

Cora E Lewis

Gina S Wei

Rachel A Whitmer

Charles P Quesenberry

Steve Sidney

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the relationship between duration of lactation and changes in maternal metabolic risk factors.

Methods: This 3-year prospective study examined changes in metabolic risk factors among lactating women from preconception to postweaning and among nonlactating women from preconception to postdelivery, in comparison with nongravid women. Of 1,051 (490 black, 561 white) women who attended two consecutive study visits in years 7 (1992-1993) and 10 (1995-1996), 942 were nongravid and 109 had one interim birth. Of parous women, 48 (45%) did not lactate, and 61 (55%) lactated and weaned before year 10. The lactated and weaned women were subdivided by duration of lactation into less than 3 months and 3 months or more. Multiple linear regression models estimated mean 3-year changes in metabolic risk factors adjusted for age, race, parity, education, and behavioral covariates.

Results: Both parous women who did not lactate and parous women who lactated and weaned gained more weight (+5.6, +4.4 kg) and waist girth (+5.3, +4.9 cm) than nongravid women over the 3-year interval; P<.001. Low-density lipoprotein cholesterol (+6.7 mg/dL, P<.05) and fasting insulin (+2.6 microunits, P=.06) increased more for parous women who did not lactate than for nongravid and parous women who lactated and weaned. High-density lipoprotein cholesterol decrements for both parous women who did not lactate and parous women who lactated and weaned were 4.0 mg/dL greater than for nongravid women (P<.001). Among parous, lactated and weaned women, lactation for 3 months or longer was associated with a smaller decrement in high-density lipoprotein cholesterol (-1.3 mg/dL versus -7.3 mg/dL for less than 3 months; P<.01).

Conclusion: Lactation may attenuate unfavorable metabolic risk factor changes that occur with pregnancy, with effects apparent after weaning. As a modifiable behavior, lactation may affect women's future risk of cardiovascular and metabolic diseases.

Level Of Evidence: II.

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References

Qureshi I, Xi X, Limbu Y, Bin H, Chen M . Hyperlipidaemia during normal pregnancy, parturition and lactation. Ann Acad Med Singap. 1999; 28(2):217-21. View

Manson J, Rimm E, Colditz G, Stampfer M, Willett W, Arky R . Parity and incidence of non-insulin-dependent diabetes mellitus. Am J Med. 1992; 93(1):13-8. DOI: 10.1016/0002-9343(92)90674-z. View

Kritz-Silverstein D, Barrett-Connor E, Wingard D, Friedlander N . Relation of pregnancy history to insulin levels in older, nondiabetic women. Am J Epidemiol. 1994; 140(4):375-82. DOI: 10.1093/oxfordjournals.aje.a117260. View

Gotto Jr A . High-density lipoprotein cholesterol and triglycerides as therapeutic targets for preventing and treating coronary artery disease. Am Heart J. 2002; 144(6 Suppl):S33-42. DOI: 10.1067/mhj.2002.130301. View

Smith D, Lewis C, Caveny J, Perkins L, Burke G, Bild D . Longitudinal changes in adiposity associated with pregnancy. The CARDIA Study. Coronary Artery Risk Development in Young Adults Study. JAMA. 1994; 271(22):1747-51. View

Diniz J, da Costa T . Independent of body adiposity, breast-feeding has a protective effect on glucose metabolism in young adult women. Br J Nutr. 2004; 92(6):905-12. DOI: 10.1079/bjn20041288. View

Potter J, Nestel P . The hyperlipidemia of pregnancy in normal and complicated pregnancies. Am J Obstet Gynecol. 1979; 133(2):165-70. DOI: 10.1016/0002-9378(79)90469-1. View

Olson C, Strawderman M, Hinton P, PEARSON T . Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. Int J Obes Relat Metab Disord. 2003; 27(1):117-27. DOI: 10.1038/sj.ijo.0802156. View

Haffner S, Bowsher R, Mykkanen L, Hazuda H, Mitchell B, Valdez R . Proinsulin and specific insulin concentration in high- and low-risk populations for NIDDM. Diabetes. 1994; 43(12):1490-3. DOI: 10.2337/diab.43.12.1490. View

10.

Hubert H, Eaker E, Garrison R, CASTELLI W . Life-style correlates of risk factor change in young adults: an eight-year study of coronary heart disease risk factors in the Framingham offspring. Am J Epidemiol. 1987; 125(5):812-31. DOI: 10.1093/oxfordjournals.aje.a114598. View

11.

Stanley K, Fraser R, Bruce C . Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycaemic clamp technique. Br J Obstet Gynaecol. 1998; 105(7):756-9. DOI: 10.1111/j.1471-0528.1998.tb10207.x. View

12.

Kritz-Silverstein D, Barrett-Connor E, Wingard D . The effect of parity on the later development of non-insulin-dependent diabetes mellitus or impaired glucose tolerance. N Engl J Med. 1989; 321(18):1214-9. DOI: 10.1056/NEJM198911023211802. View

13.

Sichieri R, Field A, Rich-Edwards J, Willett W . Prospective assessment of exclusive breastfeeding in relation to weight change in women. Int J Obes Relat Metab Disord. 2003; 27(7):815-20. DOI: 10.1038/sj.ijo.0802285. View

14.

Gunderson E, Lewis C, Murtaugh M, Quesenberry C, West D, Sidney S . Long-term plasma lipid changes associated with a first birth: the Coronary Artery Risk Development in Young Adults study. Am J Epidemiol. 2004; 159(11):1028-39. PMC: 4107869. DOI: 10.1093/aje/kwh146. View

15.

McManus R, Cunningham I, Watson A, Harker L, Finegood D . Beta-cell function and visceral fat in lactating women with a history of gestational diabetes. Metabolism. 2001; 50(6):715-9. DOI: 10.1053/meta.2001.23304. View

16.

. Breastfeeding and the use of human milk. American Academy of Pediatrics. Work Group on Breastfeeding. Pediatrics. 1997; 100(6):1035-9. DOI: 10.1542/peds.100.6.1035. View

17.

Knopp R, Bergelin R, Wahl P, Walden C, Chapman M, Irvine S . Population-based lipoprotein lipid reference values for pregnant women compared to nonpregnant women classified by sex hormone usage. Am J Obstet Gynecol. 1982; 143(6):626-37. DOI: 10.1016/0002-9378(82)90107-7. View

18.

Kjos S, Henry O, Lee R, Buchanan T, Mishell Jr D . The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes. Obstet Gynecol. 1993; 82(3):451-5. View

19.

Dewey K, Heinig M, Nommsen L . Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr. 1993; 58(2):162-6. DOI: 10.1093/ajcn/58.2.162. View

20.

Van Raaij J, Schonk C, Peek M, Hautvast J . Energy cost of lactation, and energy balances of well-nourished Dutch lactating women: reappraisal of the extra energy requirements of lactation. Am J Clin Nutr. 1991; 53(3):612-9. DOI: 10.1093/ajcn/53.3.612. View