Background: Preexisting diabetes and gestational diabetes mellitus (GDM) may increase the risk of adverse pregnancy outcomes and require specialised management. After the birth breastfeeding provides multiple benefits for both the mother and baby. In particular, longer durations of breastfeeding are associated with lower risk of developing type 2 diabetes in diabetic mothers. However, limited evidence suggests that diabetic women are more likely to experience delayed secretory activation (initiation of lactation) and shorter breastfeeding duration.
Methods: Delayed secretory activation has been linked to poorer breastfeeding outcomes and our laboratory has developed human milk biochemical markers of secretory activation (lactose, citrate, sodium, protein) that indicate the transition to copious milk production. We are also able to measure both infant intake of human milk and maternal milk production using the test weigh method. This method also provides important additional information regarding feed practices.
Results: Evidence from our laboratory suggests that women with pre-existing type 2 diabetes experience a slower transition to secretory activation post-partum. Further, women that experience GDM are at increased risk of both delayed secretory activation and low milk production despite support and excellent early feeding practices.
Conclusions: Breastfeeding complications in women with pre-existing diabetes or GDM may be due to altered endocrine pathways implicated in breast development and milk production. Further research is required to identify which mothers with diabetes are at risk of delayed secretory activation and low milk production.