ABSTRACT
This study compared the course of lactation from days 2 to 84 postpartum in 33 women with insulin-dependent diabetes mellitus (IDDM); 33 women without diabetes selected by using gestational age of the infant, method of delivery, sex of the infant, and prior lactation experience as a means of ensuring similar patterns in factors known to influence success (control subjects); and 11 healthy reference subjects who delivered vaginally. Nutritionists visited the mothers on days 2, 3, 7, 14, 42, and 84 postpartum; obtained prenatal and perinatal medical information; and questioned the mothers on their breast-feeding experience. Women with IDDM were able to establish lactation despite postpartum separation from their infants, delays in the start of breast-feeding, reduced frequency of feeding, increased use of supplemental feedings, and the high rate of cesarean section. Clinicians must recognize the need to provide appropriate counseling so that mothers with IDDM will not be discouraged by problems with breast-feeding.
Subject(s)
Diabetes Mellitus, Type 1/physiopathology , Lactation , Breast Feeding , Diabetes Mellitus, Type 1/metabolism , Female , Humans , Infant Nutritional Physiological Phenomena , Infant, Newborn/growth & development , Infant, Newborn/metabolism , Milk, Human/chemistry , Mother-Child RelationsABSTRACT
Breast milk lactose, total nitrogen, conductivity, osmolality, and intake by infants of 33 women with insulin-dependent diabetes mellitus (IDDM), 33 control women without diabetes, and 11 reference women were determined in a 3-mo study of lactation. Milk of women with IDDM had significantly lower lactose and higher total nitrogen (2-3 d postpartum), and their infants had significantly less milk intake (7-14 d postpartum) than did control or reference women. Total nitrogen was negatively correlated with milk lactose for women with IDDM at all times and for control women through day 14 postpartum. The data indicate delayed lactogenesis for women with IDDM, which was more likely to occur with poor metabolic control. Differences in milk composition of women with IDDM do not preclude them from breast-feeding their infants.
Subject(s)
Diabetes Mellitus, Type 1/physiopathology , Lactation , Eating , Female , Humans , Infant Nutritional Physiological Phenomena , Infant, Newborn , Lactose/analysis , Milk, Human/chemistry , Nitrogen/analysis , Osmolar ConcentrationABSTRACT
The ability of insulin-dependent diabetic (IDDM) women to breast-feed has been documented, however, there is little information concerning milk composition or factors that influence successful breastfeeding. Placental lactogen and prolactin levels can be normalized during pregnancy with good metabolic control. These hormones affect the readiness of the mammary gland for lactation. Prolactin maintains mammary gland insulin receptors to ensure anabolism. Lactation in IDDM women may be influenced by hyper- or hypoglycemia as women balance their insulin needs. Milk from diabetic animals has decreased lactose, fat, protein and volume and these effects can be reversed with insulin administration. Mature breast milk of IDDM women has increased glucose and sodium and mammary gland lipid metabolism may be impaired. Milk lactose and citrate, markers of lactogenesis II, suggest delayed lactation occurs in diabetic women. Many factors may influence lactation success and breast milk composition of IDDM women. Some of these include: method of delivery, feeding frequency, fetal condition, gestational age, mastitis incidence, metabolic control and maternal dietary intake. Lactation management of the IDDM woman must address these factors.
