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Breastfeeding Rates and Related Factors at 1 Year Postpartum in Women With Gestational Diabetes Initially Recruited for a Diabetes Prevention Program

  • Kadhija Abrahim Cherubini
    Affiliations
    Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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  • Maria Inês Schmidt
    Affiliations
    Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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  • Alvaro Vigo
    Affiliations
    Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Department of Statistics, Institute of Mathematics and Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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  • Michele Drehmer
    Correspondence
    Address for correspondence: Michele Drehmer PhD, Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, 2400 Ramiro Barcelos Street, 2nd Floor, Porto Alegre, RS 90035-003, Brazil.
    Affiliations
    Postgraduate Studies Program in Epidemiology, Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Postgraduate Studies Program in Food, Nutrition and Health, Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Published:January 28, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.01.005

      Abstract

      Objectives

      Our aim in this study was to evaluate breastfeeding up to 1 year postpartum and factors related to weaning in women with recent gestational diabetes mellitus (GDM).

      Methods

      We assembled a cohort study of women with GDM enrolled in prenatal clinics of the Brazilian National Health System as possible candidates for the Lifestyle Intervention for Diabetes Prevention After Pregnancy (LINDA-Brasil) postpartum trial (N=2,220). Sociodemographics and clinical and nutritional information, including breastfeeding, were obtained by interview or chart review. Follow-up by telephone was done at specific intervals during the first year postpartum.

      Results

      The probability of breastfeeding at 1 year postpartum, estimated from Kaplan–Meier survival analysis, was 53.5%. Cox regression models showed increased risk of weaning for those introducing milk or formula before 6 months (hazard ratio [HR], 2.55; 95% confidence interval [CI], 2.10 to 3.09); reporting problems in breastfeeding (HR, 1.49; 95% CI, 1.22 to 1.82); being Caucasian (HR, 1.46; 95% CI, 1.21 to 1.76); smoking during pregnancy (HR, 1.68; 95% CI, 1.28 to 2.20); and living in 2 southern cities of Brazil (HR, 1.58; 95% CI, 1.16 to 2.16; and HR, 1.76; 95% CI, 1.20 to 2.58).

      Conclusions

      About half of the women with GDM ceased breastfeeding before 1 year postpartum, a rate matching that of the general population in Brazil. The main risk factor was not exclusively breastfeeding up to 6 months. Given the possibility of curbing diabetes risk by maintaining longer breastfeeding, further promotion of exclusive breastfeeding up to 6 months for these high-risk women is much needed.

      Résumé

      Objectifs

      L’objectif de notre étude était d’évaluer l’allaitement jusqu’à 1 an après l’accouchement et les facteurs associés au sevrage chez les femmes récemment atteintes d’un diabète sucré gestationnel (DSG).

      Méthodes

      Nous avons réalisé une étude de cohorte composée de femmes atteintes du DSG inscrites dans des cliniques de prénatalité du système national de santé brésilien et considérées comme des candidates potentielles pour participer à l’étude sur le post-partum Lifestyle Intervention for Diabetes Prevention After Pregnancy (LINDA-Brésil) (N = 2220). Nous avons obtenu par entrevue ou revue des dossiers les données sociodémographiques, et les informations cliniques et nutritionnelles, notamment sur l’allaitement. Le suivi par téléphone a été effectué à des intervalles précis durant la première année après l’accouchement.

      Résultats

      La probabilité d’allaitement 1 an après l’accouchement, estimée selon l’analyse de survie de Kaplan–Meier, était de 53,5 %. Les modèles de régression de Cox montraient un risque accru de sevrage chez celles qui introduisaient le lait ou la formule avant 6 mois (rapport de risque [RR], 2,55; intervalle de confiance [IC] à 95 %, de 2,10 à 3,09); qui signalaient des problèmes d’allaitement (RR, 1,49; IC à 95 %, de 1,22 à 1,82); qui étaient caucasiennes (RR, 1,46; IC à 95 %, de 1,21 à 1,76); qui fumaient durant la grossesse (RR, 1,68; IC à 95 %, de 1,28 à 2,20); qui vivaient dans les villes du sud du Brésil (RR, 1,58; IC à 95 %, de 1,16 à 2,16; RR, 1,76; IC à 95 %, de 1,20 à 2,58).

      Conclusions

      Environ la moitié des femmes atteintes du DSG cessaient l’allaitement avant 1 an après l’accouchement, soit un taux qui correspondait à la population générale du Brésil. Le principal facteur de risque n’était pas exclusivement l’allaitement jusqu’à 6 mois. Puisqu’il est possible de limiter le risque de diabète en prolongeant l’allaitement, il est plus que nécessaire d’encourager davantage l’allaitement exclusif jusqu’à 6 mois chez ces femmes exposées à un risque élevé.

      Keywords

      Mots clés

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