Diabetes and Breastfeeding the Newborn

Sara Corder, RD, MPH

Breastfeeding Trivia

“If all babies were breastfed exclusively for their first six months of life and then given nutritious complementary food with continued breastfeeding up to two years of age, the lives of an additional ________ children under five would be saved every year.”

Dr Elizabeth Mason, Director of WHO's Department of Maternal, Newborn, Child and Adolescent Health and Development

American Academy of PediatricsHuman milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.

Exclusive breastfeeding for the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child.

The World Health Organization Recommends continued breastfeeding up to 2 years of age or beyond.

Water Water

Protein Protein

Carbohydrates Carbohydrates

Fats Fats

Vitamins Vitamins

Minerals Minerals

Fatty Acids: DHA / ARA Fatty Acids: DHA / ARA

Enzymes

Growth Factors

Hormones

Antibacterial Factors

Antiviral Factors

Antiparasitic Factors

Antiallergenic Factors

Human Milk Is Adaptable!!

During a feeding, breast milk changes from low fat to higher fat.

In cold climates breast milk has increased fat for energy, in hot climates, more water to prevent dehydration.

During gradual weaning, breast milk volume decreases, but the antibodies in the milk increase.

Mothers of premature babies make milk that is higher in growth factors, protein and fats.

Mothers who are malnourished produce slightly less milk,

but the milk is equal in fat, protein and carbohydrate.

Benefits of Breastfeeding- Tip of the IcebergMother

Enhances bonding

Mobilizes fat store

Reduce risk of pre-menopausal breast/ovarian caner

Protective role against chronic diseases

HDL increased

Economical

No preparation

InfantEnhances bonding

Reduce incidence/severity ear infections

Reduces incidence of respiratory infections

Decrease risk tooth decay

Reduces incidence of diarrhea

Reduces risk of obesity

Reduces risk of SIDS

Breastfeeding & Diabetes

Why is breastfeeding particularly good for the mother with DM and particularly good for the infant from a mother with Diabetes? (IDM)

Good for the Mother

Improved Glucose MetabolismNon-insulin mediated use of glucose by mammary gland to synthesize lactose.

Increased insulin sensitivity due to increased prolactin and decreased estradial

Improved B cell function with 3 months of breastfeeding in women with GDM

Good for the Mother

Improved Lipid Metabolism

Women who have breastfeed for at least 3 months

LDL levels increase less

HDL levels decrease less

Good for the Mother

Improved Weight LossProspective studies using measured weight change reported lower postpartum weight retention in lactating women

Rate of metabolic syndrome is sig lower with increasing lifetime duration of breastfeeding

Good for the Mother

Lower rate of DM2 in Women who lactated

Duration of lactation inversely associated with risk of DM2 in young and middle aged women

Non-lactating women developed DM2 at a 2 fold higher rate than lactating women after GDM.

Good for the IDM

Breastfed Infants are LeanerInverse relationship between breastfeeding and development of obesity

Formula fed infants produce more insulin

Hyperinsulinemia retards lipolysis and enhances fat deposit.

Good for the IDM

Less Overfeeding: changes in breast milk composition during feeding provide satiety signals to the infant

Breast milk contains leptin- early leptin intake can influence later eating behavior.

Fetal Origins of Adult Disease

The b-cells of the fetal pancreas become more responsive to glucose late in gestation and b-cell mass increase in the last trimester of pregnancy

Theory:A high availability of glucose programs pancreatic islet development irreversibly influencing the metabolic response to glucose later in life and predisposing to certain patterns of adult disease.

What is newborn Hypoglycemia?

Refers to a reduction in the glucose concentration of circulating blood.

Still controversial-no consensus on cut off values (30-50mg/dL)

Avoiding Newborn Hypoglycemia in the IDM

Achieve normoglycemia during pregnancy and LABOR

Terbutaline and ephedrine can cause maternal hyperglycemia and subsequent fetal hyperinsulinemia.

Avoiding Newborn Hypoglycemia

Breastfeed Immediately or within 30 minutes after birth, 10-12x/24hr

Cold wet babies use more glucose- Dry thoroughly and place skin to skin ASAP

Encourage frequent feeds until BG > 45mg/dL BEFORE feedings.

Monitor infant BG for at least 24hrs or until stable for at least 3 consecutive feedings.

Medically Necessary Separation

Provide EXTRA Support for establishing breastfeeding

Use Pump within first 12 hrs

Modern Pumps Are Amazing!

Avoiding Maternal Hypoglycemia

Glucose preferentially shunted towards production of milk

DM1(rarely DM2) prone to hypoglycemia especially at night

May have to adjust evening dose of basal insulin- Bedtime Snack Necessary

Avoiding Maternal Hypoglycemia

If BG <100 BEFORE feeding take 15g If BG <100 BEFORE feeding take 15g CHO and 7 g protein.CHO and 7 g protein.

If BG < 100 AFTER feeding consider 15 g If BG < 100 AFTER feeding consider 15 g snack if insulin on board.snack if insulin on board.

Hypoglycemia causes release of Hypoglycemia causes release of epinephrine which can cause temporary epinephrine which can cause temporary decrease in milk productiondecrease in milk production. .

Healthy Eating During Lactation

No surprises- Follow GDM meal plan!May add fruit/milk at breakfast

May add cereal to breakfast

May add: 2 fat servings, 1 fruit and 1 starch to support extra calorie needs during breastfeeding

Drink Plenty of WATER

Avoid Juices and Sweetened Drinks

Challenges to Breastfeeding

Women with DM less likely to breastfeed

Difficult laborObesity interfering with body mechanicsFear of giving diabetes through breastNeed to continue insulin and “tight” control of BGLack of supportLack of Societal AcceptanceSocietal Barriers

What would happen to this mother in the USA?

Best for Babes-www.BestforBabes.org

Endorsed by American Academy of PediatricsGive breastfeeding a makeover

Market it, Brand it, Mainstream it

Foster a cultural changeUsing positive social pressure stemming from the power of celebrities, foundations, fashion, advertising, the medical community and the media

Identify barriersAt home, in public and workplace

Breaking Societal Barriers….?A Start…

New Look of Breastfeeding

New Look of Breastfeeding

New Look of Breastfeeding

New Look of Breastfeeding

Gabrielle Reece

“Quite frankly I sort of thought, oh god, if I can get through these six months, because I was really committed to the health idea, and then it turned out that I breastfed my first child for 23 months.”

Jenna Elfman

If I was on a plane,  I would just say to the person next to me, “I have to feed my kid because I want his ears to pop, so if you don’t like it, look the other way.”  

Salma Hayek

"her left breast has now done more for humanity in a few minutes than I've done in roughly my life.“

Breastfeeding Supporter

DEBATE

“The debate is over, the science of breastfeeding is strong, now…how do we help moms get it done?”

“As physicians, many of us have a lot to learn about business, marketing ourselves, marketing our product and our passion.”