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Abstract
Fewer diabetic women exclusively breastfed their infants at hospital discharge than nondiabetic women. Almost as many diabetic women selected breastfeeding as the general maternity patient (53% vs. 57%). Those who stopped nursing did so primarily in the first week postpartum when hospital protocols interfered with the diabetic being able to establish lactation. Duration of breastfeeding did not differ between groups. Once lactation was established, however, diabetics could nurse as long as nondiabetics.
The diabetics’ ability to continue lactation depended on factors related to the hospital protocol, infant behavior, and diabetic control. Extended maternal-infant separation, baby fussiness and poor sucking ability probably decreased the chances of extended lactation success. Insulin-dependent diabetics did not have more breastfeeding problems, but potential problems with increased maternal infection were implicated.
Medical personnel did not discourage breastfeeding in diabetics. However, insulin-dependent diabetics were found to have less infant-feeding education during pregnancy because they did not attend prenatal classes as often as non diabetics. There was no difference in support given by pediatricians after discharge, even though diabetics and their infants had special problems initiating lactation.
Physicians prescribed higher caloric intakes for diabetic women who were able to continue nursing (31 kcal/kg) than for women who had to stop (25 kcal/kg) The diabetic breastfeeders tried to follow their diets and actually consumed (2317 +. 757 kcal/day) as much as the nondiabetics who breastfed (2144 +. 274 kcal/day). Diabetics who stopped nursing consumed about 600 calories fewer per day than the diabetic who nursed. Postpartum weight loss was also most pronounced in this group.
Infants of diabetics who breastfed lost the most weight in the first week, although their total weight lost was no different from that of the other groups. Insufficient data preclude the comparison of infant growth patterns from mothers who continued or stopped nursing.
Those diabetics who had the least insulin requirement prior to pregnancy and at delivery breastfed for the entire study period. Insulin prescribed during lactation quickly returned to the prepregnancy dose and than slowly decreased to the lowest level of all groups during the 42 days postpartum. The insulin requirements of all other groups continued to increase during the study period. Diabetics who were able to breastfeed monitored their blood sugar more often and had lower stabilized blood sugars by 42 days, al-though the blood glucose was more erratic than the other groups in early lactation.
Diabetic women who chose to breastfeed were older (28.5 vs 24.8 yrs) and more educated (14 vs. 12 yrs of schooling) than the diabetics who bottlefed. They also developed diabetes at a later age although there was no difference in the severity of the disease. In addition, these women had endocrinologists or high risk obstetricians who supported their decision..