Low prevalence of long-term breastfeeding among women with type 2 diabetes.

OBJECTIVE: To investigate the prevalence of long-term breastfeeding among women with type 2 diabetes compared to women with type 1 diabetes and to identify predictors of long-term breastfeeding for women with pre-gestational diabetes. METHODS: In total, 149 women with diabetes were interviewed about long-term breastfeeding, defined as any breastfeeding 4 months postpartum. RESULTS: Ninety-eight percent of the women aimed to breastfeed. At time of discharge, any breastfeeding was frequent for both groups of women (86% versus 93%, p = 0.17). However, 4 months postpartum, the 44 women with type 2 diabetes showed significantly lower prevalence of breastfeeding than the 105 women with type 1 diabetes (34% versus 61%, p < 0.01). Number of feedings in the first 24 h was an independent positive predictor, whereas pre-pregnancy body mass index (BMI) and smoking were independent negative predictors of long-term breastfeeding. CONCLUSION: The prevalence of long-term breastfeeding among women with type 2 diabetes was considerably lower than in women with type 1 diabetes. Number of feedings in the first 24 h was positive and BMI and smoking were negative predictors of long-term breastfeeding in women with pre-gestational diabetes.

Insulin requirements in type 1 diabetic pregnancy: do twin pregnant women require twice as much insulin as singleton pregnant women?

OBJECTIVE: To evaluate the insulin requirements in women with type 1 diabetes during twin pregnancy compared with singleton pregnancy. RESEARCH DESIGN AND METHODS: At 8, 14, 21, 27, and 33 gestational weeks, insulin requirements and HbA(1c) were compared between 15 twin pregnant women from 2000 to 2011 and 108 singleton pregnant women from 2004 to 2006. RESULTS: In twin pregnancies, the weekly increase in daily insulin dose between 14 and 27 weeks was higher than in singleton pregnancies (median 3.0 international units [IU] [range 0.9-4.9] versus 1.5 IU [-1.5 to 5.9]; P = 0.008) and remained stable from 27 to 33 weeks. The increment in total insulin requirement from before pregnancy until 33 weeks tended to be higher in twin pregnancies (103% [36-257%] versus 71% [-20 to 276%]; P = 0.07). Throughout pregnancy, HbA(1c) was similar in twin and singleton pregnancies. CONCLUSIONS: In twin pregnancies, the weekly increase in insulin dose between 14 and 27 weeks was doubled compared with singleton pregnancies.

High maternal HbA1c is associated with overweight in neonates.

INTRODUCTION: The aims of this study were to determine the prevalence of women with gestational diabetes mellitus (GDM) not obtaining HbA1c within the normal range (≤ 5.6%) before delivery and to examine whether elevated HbA1c values are associated with an increased risk of large for gestational age (LGA) infants. MATERIAL AND METHODS: A population of 148 women with singleton pregnancies who had been diagnosed with GDM < 34 weeks, and who had a minimum of two HbA1c tests with a ≥ 3 week interval. They were divided into those obtaining a HbA1c ≤ 5.6%, and those who did not before delivery and further stratified according to baseline HbA1c ≤ or > 5.6%. The primary outcome was LGA infants. RESULTS: A total of 51 (34%) women did not obtain a HbA1c ≤ 5.6% before delivery. The median HbA1c before delivery was 5.9% versus 5.3% in the two groups. At baseline, body mass index and HbA1c were higher in the women not obtaining the goal (30.9 versus 27.8 kg/m², 5.9% versus 5.1%, both p < 0.01). Women with an elevated HbA1c before delivery had a higher prevalence of LGA infants (adjusted odds ratio (OR) 3.1 (95% confidence interval (CI) 1.3-7.6) and neonatal hypoglycaemia (adjusted OR 6.2 (95% CI 1.3-29.0). Other pregnancy outcomes were similar in the two groups. Stratification according to baseline HbA1c did not seem to change the result. CONCLUSION: Women with GDM not obtaining HbA1c within the normal range before delivery had a threefold increased risk of having an LGA infant and a sixfold increased risk of neonatal hypoglycaemia. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Long-term breast-feeding in women with type 1 diabetes.

OBJECTIVE: Breast-feeding may be more difficult in women with diabetes because of neonatal morbidity and fluctuating maternal blood glucose values. The frequency of long-term breast-feeding and the possible predictors for successful breast-feeding were investigated. RESEARCH DESIGN AND METHODS: One hundred two consecutive women with type 1 diabetes were interviewed about breast-feeding using a semistructured questionnaire 5 days and 4 months after delivery. Clinical data were collected from the medical records. RESULTS: Five days after delivery, 86% of the women were breast-feeding. Four months after delivery, 55 (54%) women were exclusively, 14 (14%) were partly, and 33 (32%) were not breast-feeding compared with 50, 26, and 24% in the background population (NS). Mothers exclusively breast-feeding at 4 months were characterized by previous experience with breast-feeding, a higher educational level, and vaginal delivery and included a high proportion of nonsmokers, whereas there were no associations with diabetes-related parameters such as white classes, duration of diabetes, HbA(1c), and insulin dose at conception. Breast-fed offspring had a significantly higher birth weight and gestational age and were less often receiving glucose intravenously compared with the remaining offspring. Independent predictors of exclusive breast-feeding at 4 months were previous experience with breast-feeding (odds ratio 6.3 [95% CI 2.4-17]) and higher educational level (7.1 [2.4-21]). Cessation of breast-feeding was mainly due to common nursing problems, such as perceived milk supply, and not related to maternal diabetes status. CONCLUSIONS: The majority of the women with type 1 diabetes initiated breast-feeding, and the prevalence of breast-feeding at 4 months was comparable to that in the background population. Independent predictors of exclusive breast-feeding at 4 months were previous experience with breast-feeding and higher educational level.

Insulin dose during glucocorticoid treatment for fetal lung maturation in diabetic pregnancy: test of an algorithm [correction of analgoritm].

OBJECTIVE: Poor glycemic control is often a serious clinical problem during glucocorticoid treatment for fetal lung maturation in pregnant women with diabetes. An algorithm for improved subcutaneous insulin treatment during glucocorticoid treatment in insulin-dependent diabetic women was developed and tested. STUDY DESIGN: The sample, divided into two cohorts, consisted of all insulin-dependent diabetic women (n=16) receiving glucocorticoid treatment (betamethasone 12 mg i.m., repeated after 24 h) from 1996 to 1999. In the first cohort the increments of insulin dose were based on the level of blood glucose obtained. Based on the first cohort an algorithm to determine increments of insulin dose was developed. In the second cohort (n = 8) the insulin dose was increased by up to 40%, according to the algorithm, starting immediately after glucocorticoid treatment; prior to a detectable increase in blood glucose. RESULTS: After betamethasone, the daily insulin dose for the following 5 days was increased by 6, 38, 36, 27 and 17% in the first cohort vs. 27, 45, 40, 31 and 11% in the second cohort. The algorithm was used in the second cohort. The median blood glucose was 6.7, 14.3, 12.3, 7.7 and 7.7 vs. 7.7, 8.2, 9.6, 7.0 and 7.4 mmol/l (p<0.05 for day 2 and 3) in the two cohorts, respectively. None developed ketoacidosis or severe hypoglycemia. CONCLUSION: An algorithm with an increasing insulin dose of up to 40% shortly after glucocorticoid treatment for fetal lung maturation in diabetic women prevents severe dysregulation of metabolic control.