Lifetime Duration of Breastfeeding and Cardiovascular Risk in Women With Type 2 Diabetes or a History of Gestational Diabetes: Findings From Two Large Prospective Cohorts

Overview

Journal Diabetes Care

Specialty Endocrinology

Date 2024 Feb 20

PMID 38377484

Authors

Anna Birukov

Marta Guasch-Ferre

Sylvia H Ley

Deirdre K Tobias

Fenglei Wang

Clemens Wittenbecher

Jiaxi Yang

JoAnn E Manson

Jorge E Chavarro

Frank B Hu

Cuilin Zhang

Affiliations

Soon will be listed here.

Abstract

Objective: 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.

Research Design And Methods: 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.

Results: 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.

Conclusions: Longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or GDM.

Citing Articles

Psychometric Properties of the Lactation Assessment and Comprehensive Intervention Tool (LAT).

Grady J, Blair A, Brimdyr K, Cadwell K Nurs Rep. 2024; 14(4):4119-4128.

PMID: 39728661 PMC: 11678466. DOI: 10.3390/nursrep14040300.

References

Tomeo C, Rich-Edwards J, Michels K, Berkey C, Hunter D, Frazier A . Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology. 1999; 10(6):774-7. View

. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997; 20(7):1183-97. DOI: 10.2337/diacare.20.7.1183. View

Zhang Z, Reinikainen J, Adeleke K, Pieterse M, Groothuis-Oudshoorn C . Time-varying covariates and coefficients in Cox regression models. Ann Transl Med. 2018; 6(7):121. PMC: 6015946. DOI: 10.21037/atm.2018.02.12. View

Reece E, Leguizamon G, Wiznitzer A . Gestational diabetes: the need for a common ground. Lancet. 2009; 373(9677):1789-97. DOI: 10.1016/S0140-6736(09)60515-8. View

Li R, Scanlon K, Serdula M . The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev. 2005; 63(4):103-10. DOI: 10.1111/j.1753-4887.2005.tb00128.x. View

Stuebe A, Rich-Edwards J, Willett W, Manson J, Michels K . Duration of lactation and incidence of type 2 diabetes. JAMA. 2005; 294(20):2601-10. DOI: 10.1001/jama.294.20.2601. View

Gaitskell K, Green J, Pirie K, Barnes I, Hermon C, Reeves G . Histological subtypes of ovarian cancer associated with parity and breastfeeding in the prospective Million Women Study. Int J Cancer. 2017; 142(2):281-289. PMC: 5725697. DOI: 10.1002/ijc.31063. View

. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes. 1979; 28(12):1039-57. DOI: 10.2337/diab.28.12.1039. View

Moon J, Kim H, Kim H, Park J, Choi W, Choi W . Lactation improves pancreatic β cell mass and function through serotonin production. Sci Transl Med. 2020; 12(541). PMC: 8276761. DOI: 10.1126/scitranslmed.aay0455. View

10.

Ramos-Roman M, Syed-Abdul M, Adams-Huet B, Casey B, Parks E . Lactation Versus Formula Feeding: Insulin, Glucose, and Fatty Acid Metabolism During the Postpartum Period. Diabetes. 2020; 69(8):1624-1635. PMC: 7372076. DOI: 10.2337/db19-1226. View

11.

Perez-Escamilla R, Tomori C, Hernandez-Cordero S, Baker P, Barros A, Begin F . Breastfeeding: crucially important, but increasingly challenged in a market-driven world. Lancet. 2023; 401(10375):472-485. DOI: 10.1016/S0140-6736(22)01932-8. View

12.

Pinho-Gomes A, Morelli G, Jones A, Woodward M . Association of lactation with maternal risk of type 2 diabetes: A systematic review and meta-analysis of observational studies. Diabetes Obes Metab. 2021; 23(8):1902-1916. DOI: 10.1111/dom.14417. View

13.

Ley S, Chavarro J, Li M, Bao W, Hinkle S, Wander P . Lactation Duration and Long-term Risk for Incident Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus. Diabetes Care. 2020; 43(4):793-798. PMC: 7085808. DOI: 10.2337/dc19-2237. View

14.

Ley S, Chavarro J, Hinkle S, Li M, Tsai M, Hu F . Lifetime duration of lactation and chronic inflammation among middle-aged women with a history of gestational diabetes. BMJ Open Diabetes Res Care. 2020; 8(2). PMC: 7594200. DOI: 10.1136/bmjdrc-2020-001229. View

15.

Manson J, Rimm E, Stampfer M, Colditz G, Willett W, Krolewski A . Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet. 1991; 338(8770):774-8. DOI: 10.1016/0140-6736(91)90664-b. View

16.

Regensteiner J, Golden S, Huebschmann A, Barrett-Connor E, Chang A, Chyun D . Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus: A Scientific Statement From the American Heart Association. Circulation. 2015; 132(25):2424-47. DOI: 10.1161/CIR.0000000000000343. View

17.

McClure C, Catov J, Ness R, Schwarz E . Lactation and maternal subclinical cardiovascular disease among premenopausal women. Am J Obstet Gynecol. 2012; 207(1):46.e1-8. PMC: 3383628. DOI: 10.1016/j.ajog.2012.04.030. View

18.

Lloyd-Jones D, Albert M, Elkind M . The American Heart Association's Focus on Primordial Prevention. Circulation. 2021; 144(15):e233-e235. DOI: 10.1161/CIRCULATIONAHA.121.057125. View

19.

Rich-Edwards J, Corsano K, Stampfer M . Test of the National Death Index and Equifax Nationwide Death Search. Am J Epidemiol. 1994; 140(11):1016-9. DOI: 10.1093/oxfordjournals.aje.a117191. View

20.

. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258):1160-1203. PMC: 7566045. DOI: 10.1016/S0140-6736(20)30977-6. View