Breastfeeding May Correct Metabolic Abnormalities Linked To Diabetes Interview with:
Dr. Sandra Hummel and Dr. Daniela Much
Institute of Diabetes Research
Helmholtz Center Munich
German Research Center for Environmental Health
Munich What is the background for this study? What are the main findings?

Response: Gestational diabetes mellitus is associated with a seven-fold increased risk of developing type 2 diabetes postpartum. In 2012, we published that type 2 diabetes risk was markedly reduced up to 15 years after delivery in women with gestational diabetes if they breastfed for more than 3 months. However the underlying biological mechanisms are still unclear to date.

Aim of this biomarker study was to identify the mechanism underlying the protective effect of prolonged lactation. At our study site in Munich, we enrolled 197 women with previous gestational diabetes participating in a postpartum assessment of glucose tolerance at a median time of 3.6 years after delivery. By using a targeted metabolomics approach (including a broad spectrum of lipids and amino acids), we identified lactation-associated biochemical changes in maternal plasma samples. Most interestingly, these metabolite signatures have been described with decreased risk for type 2 diabetes previously. Our results indicate that lactation-associated alterations persisted up to 11 years post-lactation. What should readers take away from your report?

Response: Breastfeeding for > 3 months in women with gestational diabetes may correct several metabolic abnormalities associated with the early pathogenesis of type 2 diabetes, specifically disturbances in the phospholipid and branched-chain amino acid (BCAA) pathways. By that our results further strengthen lactations´ potential as a safe feasible low-cost intervention strategy to prevent type 2 diabetes development in women with a history of gestational diabetes. This is of major relevance as we have shown that mothers with gestational diabetes breastfeed to a lesser extent compared to non-diabetic mothers and further efforts are needed to increase breastfeeding frequency and duration in women with gestational diabetes. What recommendations do you have for future research as a result of this study?

Response: More longitudinal studies that investigate lactation-associated changes in biomarkers from early postpartum to postweaning periods are required to underpin the biological plausibility for lactation’s protection against type 2 diabetes after a pregnancy with gestational diabetes. Recognizing lactation barriers and subsequent modification of lactation behaviors (i.e. to increase lactation intensity and duration) should be considered as high priority for pregnant and postpartum women with gestational diabetes because of lactations lasting metabolic benefits for maternal metabolism. Is there anything else you would like to add?

Response: Breastfeeding failure or early cessation of breastfeeding is a lost opportunity to prevent early onset of type 2 diabetes. Unfortunately, many women with a previous GDM pregnancy hold a faulty low risk perception of their future diabetes risk. Greater allocation of health care resources to promote and support exclusive and extended breastfeeding may be highly beneficial for these women to reduce their high risk for midlife progression to a chronic disease. Thank you for your contribution to the community.

Diabetologia. 2016 Jul 16. [Epub ahead of print]
Lactation is associated with altered metabolomic signatures in women with gestational diabetes.
Much D, Beyerlein A, Kindt A, Krumsiek J, Stückler F, Rossbauer M1,2,3, Hofelich A, Wiesenäcker D, Hivner S, Herbst M,Römisch-Margl W7, Prehn C, Adamski J Kastenmüller G4 Theis F4,5, Ziegler AGHummel

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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