Diabetic Mother and Breastfeeding - An Overview

Introduction

Diabetes is a metabolic disorder that is characterized by the body’s inefficiency to utilize the blood sugar levels obtained from the consumed food for proper energy production. Different types of diabetes exist and it affects all age groups of people ranging from infants to teenagers and young adults to elderly people. Women are also equally affected by all types of diabetes. It is of prime concern, particularly when a diabetic woman is lactating and breastfeeding because of increased energy demand.

Controversial advice was more prevalent regarding breastfeeding by diabetic mothers in the past decades. In recent years, there is an increasing trend toward practicing breastfeeding among diabetic women. This raised awareness demands more information about breastfeeding by diabetic mothers. Breastfeeding is a natural process that helps provide the baby with a healthier life and any related misconceptions should be solved by appropriate interventions and scientific evidence.

Who Is a Diabetic Mother?

Diabetic mothers include lactating or breastfeeding women who became pregnant with already existing diabetic conditions or developed diabetes during the progression of pregnancy. The three main forms of diabetes that are commonly seen in diabetic mothers are as follows -

• Type 1 Diabetes - In this condition the body does not produce adequate insulin (a hormone that maintains blood sugar levels) and thereby leading to increased glucose levels in the blood.

• Type 2 Diabetes - In this type, the body produces sufficient insulin but is not efficiently used for energy metabolism, causing elevated blood sugar levels.

• Gestational Diabetes - It is a unique type of diabetes that occurs only in women as they develop it during pregnancy.

• Usually, it is a temporary condition that is characterized by decreased insulin levels when compared to the extra energy needed during pregnancy. This insulin imbalance usually develops during the fourth month of pregnancy leading to gestational diabetes.

• The elevated blood sugar levels seen during gestational diabetes generally return to normal following the childbirth. However, in some women, the diabetic condition could persist and eventually lead to the development of type 2 diabetes.

Glycemic Control

An important parameter for assessing the diabetic status in an individual is glycemic control. It helps in the accurate monitoring of blood sugar levels by estimating glycated hemoglobin (HbA1c) in the blood. The recommended HbA1c value for good glycemic control is not more than 6.5 or 7 % (approximately 53 mmol/mol). Depending on the glycemic status diabetes is further classified into -

• Controlled Diabetes - HbA1c less than or equal to 6.5 or 7 %

• Uncontrolled Diabetes - HbA1c more than 7.5 %

Maintaining a good glycemic status is an essential criterion for diabetic mothers. Breastfeeding mothers with excellent glycemic control experience healthier life and are able to breastfeed just like non-diabetic mothers. Good glycemic control also helps in reducing the risk of diabetic-related complications. On the other hand, high blood sugar levels and poor glycemic control increase the risk of developing infections and other related problems in diabetic mothers.

Also, it affects the duration of breastfeeding. In the case of gestational diabetes, good glycemic status is foremost important for the healthy development of the fetus and also it reduces the risk of developing type-2 diabetes in later life. Quality lifestyle interventions, adequate physical exercise, and a proper diet with appropriate medications help in achieving good glycemic control and also prevent diabetic complications such as nephropathy, neuropathy, retinopathy, and cardiovascular disorders in diabetic mothers.

What Are the Benefits of Breastfeeding in Diabetic Mothers?

All breastfeeding mothers experience both metabolic as well as hormonal changes following childbirth and subsequent lactation. These changes are beneficial and mothers with diabetes are equally benefited from breastfeeding and its positive impact. Some of the important benefits of breastfeeding in diabetic mothers are as follows -

• Active breastfeeding of the baby supports both the mother and the child facilitating the management of diabetes much easier in diabetic mothers.

• Breastfeeding increases insulin sensitivity and exhibits a long-term positive influence on glucose metabolism.

• Lactation improves glucose tolerance by enhancing insulin sensitivity.

• In mothers with type-1 diabetes, breastfeeding reduces the amount of insulin required since the blood sugar levels are diverted to an effective lactation process.

• In type-2 diabetes, insulin sensitivity and utilization are regulated by breastfeeding and thereby reducing the severity of diabetic progression.

• Breastfeeding improves glycemic control in mothers with type-2 diabetes.

• In gestational diabetes, breastfeeding effectively reduces glucose intolerance and significantly reduces the risk of developing type 2 diabetes in the later stages of life.

• Breastfeeding regulates hormonal changes and reduces fat accumulation leading to a reduced risk of diabetic complications.

• Gradual weaning helps to establish good glycemic status in diabetic mothers even after cessation of breastfeeding.

How Does Diabetes Affect Breastfeeding?

Generally, breastfeeding creates high energy needs for milk production and diabetes significantly influences lactation. A positive correlation is observed during breastfeeding by diabetic mothers with good glycemic control. It is evident that breastfeeding is affected by uncontrolled diabetes. Some of the potential risk factors that affect breastfeeding in diabetic mothers are as follows-

• Delayed lactogenesis (production of milk).

• Complicated childbirths in gestational diabetes and associated with potentially poor pregnancy outcomes.

• Frequent hospitalization and prolonged stay at intensive or special neonatal care units because neonates and newborns sometimes develop low blood sugar levels (newborn hypoglycemia).

• Increased risk of acquiring infections.

• Decreased breastfeeding capacity in diabetic mothers.

• Reduced duration of breastfeeding episodes.

• Premature cessation of breastfeeding due to inadequate production of milk.

• Increased dryness or soreness of the nipples decreases breastfeeding frequency.

What Are the Recent Breastfeeding Recommendations for Diabetic Mothers?

The WHO (world health organization) guidelines currently suggest exclusive breastfeeding for at least the first six months by diabetic mothers. In the initial few days following childbirth, diabetic mothers experience delayed milk production. With good glycemic control milk production increases by the third and fourth day. Fluctuating insulin levels influence milk production and breastfeeding efficacy. The following guidelines and recommendations ensure an easy and happy breastfeeding experience among diabetic mothers.

• Diabetic mothers should start breastfeeding at the earliest because nursing the baby and associated suckling reflexes from the newborn initiates milk production sooner.

• Diabetic mothers and newborns should not be separated as it enables the mothers to attach their babies to the breast in the correct position. Also, diabetic mothers are encouraged to hand-express their milk as it increases milk production.

• Newborns of diabetic mothers would sometimes experience low blood sugar levels (neonatal hypoglycemia) hence skin-to-skin contact between mother and child is encouraged.

• In some cases, fluctuation of insulin levels decreases milk production. In such situations, babies need to be fed supplements only temporarily.

• Developing skilled breastfeeding practices help to reduce the requirements for supplement feds.

• The newborn’s feeding should be well established and its blood glucose levels to be maintained optimally before leaving the healthcare facilities following delivery.

• Neonatal hypoglycemia is identified by screening tests and is promptly managed.

• Insulin therapy and most oral hypoglycemics are not expressed in lactating milk. Hence breastfeeding could be continued effectively. However, a doctor should be consulted and also regular monitoring of blood sugar levels is needed to ensure good glycemic control.

Conclusion

Breastfeeding improves glucose regulation in diabetic mothers. It reduces the risk of diabetic complications in them as well as prevents the occurrence of type 2 diabetes in women who developed gestational diabetes. Breastfeeding should be strongly supported and encouraged among diabetic mothers.