Information taken from Breastfeeding and Chronic Medical Conditions available on Amazon.

Gestational Diabetes is described as impaired glucose tolerance in pregnancy. It is also increasing in prevalence due to obesity rates and now affects some 7% of pregnancies. Most women will need oral metformin to reduce blood glucose or insulin if changes in diet and exercise do not control gestational diabetes effectively. Risk factors for gestational diabetes are.

•             BMI above 30 kg/m2

•             previous macrosomic baby weighing 4.5 kg or above

•             previous gestational diabetes

•             family history of diabetes (first‑degree relative with diabetes

•             minority ethnic family origin with a high prevalence of diabetes.

Kjos (1993) recommended that delivery should be contemplated at 38 weeks and, if not pursued, careful monitoring of foetal growth should be performed to reduce the risk of large for gestational age babies and shoulder dystocia.

Medication is normally discontinued after delivery although a proportion of mothers will go on to develop Type 2 diabetes. Women with gestational diabetes who do not breastfeed are twice as likely to develop future diabetes (Kjos 1993).

Gunderson (2012) studied 522 women diagnosed with gestational diabetes 6-9 weeks after delivery. Exclusive or mostly breastfeeding was associated with improved fasting glucose and lower insulin levels at this time. Lactation was seen to have favourable effects on glucose metabolism and insulin sensitivity that may reduce the risk of diabetes after delivery. These findings continued for 2 years after delivery (Gunderson 2015).

Infants born to diabetic mothers have a 25-40% incidence of hypoglycaemia in the first one to two hours after delivery. This is transient and resolves spontaneously.  Mothers with diabetes have delayed lactogenesis 2. This raises the risk if babies being supplemented which as Perez-Bravo reported increases the risk of future diabetes for the baby. To reduce the risk, it has become increasingly common to suggest that mothers express and store colostrum from 36 weeks gestation. The DAME trial studied 635 women with diabetes. The primary outcome of the trial was the proportion of infants admitted to the NICU post-natally. The results showed that there was no difference between groups (antenatal expression or normal care). They concluded that there was no harm in encouraging antenatal expression of colostrum twice a day in mothers with uncomplicated pregnancies.

References

• Brown A. Jones W A guide to supporting breastfeeding for professionals. Routledge 2019
• Davies HA, Clark J. D., Dalton K. J., and Edwards O. M.    Insulin requirements of diabetic women who breast feed. BMJ. 1989 May 20; 298(6684): 1357–1358.
• Forster, D A,  Moorhead AM, Jacobs SE, , Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C,  Aylward A, East C,  Ford R, Amir LH, Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. The Lancet 2017;389: 2204 – 2213
• Gunderson EP, Hedderson MM, Chiang V, Crites Y, Walton D, Azevedo RA, Fox G, Elmasian C, Young S, Salvador N, Lum M, Quesenberry CP, Lo JC, Sternfeld B, Ferrara A, Selby JV. Lactation intensity and postpartum maternal glucose tolerance and insulin resistance in women with recent GDM: the SWIFT cohort. Diabetes Care. 2012 Jan;35(1):50-6.
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• Jones W Breastfeeding and Medication 2nd Ed 2018 Routledge UK
• Kjos SL, Henry OA, Montoro M, Buchanan TA, Mestman JH. Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labour and expectant management. Am J Obstet Gynecol. 1993 Sep;169(3):611-5.
• Liu B, Jorm L, Banks E Parity, breastfeeding, and the subsequent risk of maternal type 2 diabetes. Diabetes Care, 2010; 33(6): 1239-41.
• Milne N Managing diabetes in women during preconception and pregnancy Clinical Pharmacist 2017; 9 (9)
• NICE Diabetes in pregnancy: management from preconception to the postnatal period NG3
• NICE Hypertension in pregnancy: diagnosis and management CG107
• Pérez-Bravo F. Carrasco E Gutierrez-López M. D. Martínez M. T. López G. García de los Rios M.  Genetic predisposition and environmental factors leading to the development of insulin-dependent diabetes mellitus in Chilean children Journal of Molecular Medicine 1996;74(2):105-109
• Whichelow MJ, Doddridge MC. Lactation in diabetic women. Br Med J (Clin Res Ed) 1983; 3;287(6393):649–650).