1. Is benefit of breast feeding in diabetic pregnancies
over estimated? An audit at Tameside Hospital,
Manchester, UK.
Dr R Peart, Dr P Gondane
Introduction
Results
Current evidence suggests breastfeeding offers benefits to mother and neonate, both long-term and short-term. Benefits to mothers include; weight loss, better glycaemic control, reduced risk of developing breast and ovarian cancer (UNICEF, 2014). Reported benefits to the child include; reduced obesity and therefore reduced risk of developing diabetes later in life, higher IQ, better glycaemic control 24 hours after birth and therefore a reduction NICU admission (Chertok, 2009).
Breastfeeding is less likely to be initiated and continued by people with diabetes for multiple reasons:
delayed lactogenosis (Matias, 2014)
Obesity
Lower socio economic status.
Increased likelihood of admission to NICU for other diabetes associated complications which include:
Prematurity
fetal hypoxia
caesarean section
Sepsis
Hypoglycaemia.
Current hospital policy is to promote breastfeeding, and diabetic patients are advised to milk harvest antenatal to overcome the afore mentioned barriers to breastfeeding. Breastfeeding support services offer help antenatally and postnatally and in the community for 6 weeks.
44% of IDDM mothers were exclusively breastfeeding at delivery to discharge, 22% were combined feeding; 2 neonates were pre-term; 4 required admission to NICU; 4 babies suffered hypoglycaemia. Uptake of breast feeding in NIDDM and IGT mothers was less (22% exclusive and 44% combined); compared with 44% exclusive in non diabetic mothers. 55% of IGT mothers still breast feeding at 6/52 where as 11% IDDM mothers did. .
Materials and Methods
Aims: Asses neonatal outcomes in breastfeeding diabetic mothers compared to breastfeeding non-diabetic mothers
Method: From January to December 2014 all type 1 diabetics that became pregnant and booked with Tameside General Hospital were included : 13 type 1 diabetic patients were identified, comparative arms of type 2, gestational diabetics and non diabetics were reviewed. 44 sets of data were assessed in total. Neonatal outcomes were reviewed using the NICU admission database, Badger.
Conclusions
Despite education and intense support long term breast feeding in mothers with longstanding diabetes is poor compared to gestational diabetics and non-diabetics. Neonatal admissions to NICU remain high despite high levels of breastfeeding support and high numbers of mothers desiring to breast feed at birth.
Further studies need to be performed on the long term health outcomes for both mother and child following breast feeding and quality of support to diabetic mothers who are wanting to breast feed.
References
1) The Baby Friendly Initiative | Health Professionals. February
2) Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes. Chertok IR; Raz I; Shoham I; Haddad H; Wiznitzer. A Journal of Human Nutrition & Dietetics, April 2009, vol./is. 22/2(166-9), ; X (2009 Apr)
3) . Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. Matias SL; Dewey KG; Quesenberry CP Jr; Gunderson American Journal of Clinical Nutrition, January 2014, vol./is. 99/1(115-21), ; (2014 Jan)
4). Guidelines for management of Diabetes mellitus during pregnancy and the postnatal period. Erica Thompson and Dr P Gondane, Tameside General Hospital, February 2014.