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Grand Rounds

The 30-Year CARDIA Study: Does Breast Feeding Reduce the Risk for Diabetes?

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BACKGROUND AND PURPOSE:

  • Longer length of lactation has been weakly linked to lower diabetes incidence in older women, solely through self-reported cases
    • These studies are subject to recall bias and do not provide actual biochemical evidence of diabetes
  • No studies considered gestational diabetes (GDM), which is a major risk factor for type 2 diabetes in young women
  • Gunderson et al. (JAMA Intern. Med., 2018) evaluated the association between lactation and progression to diabetes in older women

METHODS:

  • Multicenter, community-based 30-year prospective cohort study
  • Subjects were derived from the Coronary Artery Risk Development in Young Adults (CARDIA) study
  • Current study was designed to evaluate progression to diabetes among young black and white women through multiple assessments of glucose tolerance and other risk factors through prepregnancy to the postweaning years
  • Participants
    • Aged between 18 and 30 years at baseline
    • Gave birth ≥1 times following baseline
    • Reported lactation duration
    • Underwent screening for diabetes up to 7 times during 30 years after baseline
  • Lactation duration categories
    • None
    • >0 to 6 months
    • >6 to <12 months
    • ≥12 months
  • Primary outcome
    • Diabetes incidence rates per 1000 person-years and adjusted relative hazard ratio (RH)
  • Proportional hazards regression models were adjusted for confounding variables such as biochemical and reproductive risk factors

RESULTS:

  • 1,238 women were included in analyses
    • mean [SD] age was 24.2 [3.7] years
  • Overall diabetes incidence rate of 6.6 cases per 1000 person-years (95% CI, 5.6-7.6)
  • Rates were significantly different when taking in to consideration GDM (P for difference < .001)
    • With GDM: 18.0 (95% CI, 13.3-22.8)
    • Without GDM: 5.1 (95% CI, 4.2-6.0)
  • Lactation duration was inversely related to diabetes incidence with the following RH values compared to 0 days lactation (Pfor trend = .01)
    • 0.75 for > 0 to 6 months (95% CI, 0.51-1.09)
    • 0.52 for > 6 months to < 12 months (95% CI, 0.31-0.87)
    • 0.53 (0.29-0.98) for ≥12 months (0.29-0.98)
  • There was no evidence of effect modification by race, GD, or parity

CONCLUSION:

  • This study demonstrated a strong, graded inverse association between lactation duration and diabetes incidence
  • The authors state that this study provides evidence that lactation may lower risk of diabetes and lead to further research into glucose intolerance

Learn More – Primary Sources:

Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years The 30-Year CARDIA Study

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Related ObG Topics:

Updated ACOG Guidance on Gestational Diabetes
Results of the DiRECT Trial: Can Weight Loss in a Primary Care Setting Achieve Remission of Type 2 Diabetes?
Practical obstetrics info for your women's healthcare practice
GDM and Postpartum Followup – The ‘When and How’ of Screening
Does Gestational Hypertension Increase Risk of Type 2 Diabetes in Adult Offspring?

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