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Higher intensity and duration of lactation may reduce the incidence of type 2 diabetes in women after gestational diabetes mellitus (GDM), a new study has suggested.

"We saw 36% to 57% relative reductions in the 2-year [diabetes mellitus] incidence with higher intensity of lactation at 6 to 9 weeks postpartum as well as for longer periods (>2 months through >10 months), independent of obesity, gestational glucose tolerance, and perinatal outcomes that can delay lactogenesis and thereby shorten lactation duration," Erica P. Gunderson, PhD, MPH, RD, an epidemiologist and senior research assistant at Kaiser Permanente, Oakland, California, and colleagues write.

The results of the prospective cohort study were published online November 23 in the Annals of Internal Medicine.

Growing evidence indicates that mothers who breast-feed have improved glucose and lipid metabolism, and that the favorable metabolic effects persist postweaning. However, evidence is limited and conflicting about whether lactation reduces future risk for type 2 diabetes among women with GDM. In addition, previous studies did not account for perinatal outcomes, subsequent pregnancies, or postpartum lifestyle behaviors.

Dr Gunderson and colleagues therefore conducted the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy (SWIFT) to evaluate the effect of exposure to prolonged, intensive lactation compared with that of formula feeding on the 2-year incidence of type 2 diabetes among women with a recent GDM pregnancy.

The study enrolled 1010 women with GDM who delivered singletons at 35 weeks' gestation or later. It excluded women who reported mixed feeding (formula supplementation of 7 - 13 oz per 24 hours) or inconsistent feeding (transition to ≥14 oz of formula per 24 hours after 3 weeks of lactation).

Enrollees underwent three in-person research examinations: at baseline (6 - 9 weeks after delivery) and then annually for 2 years of follow-up. During examinations, the researchers classified participants' infant feeding behaviors (including lactation intensity and duration) and performed oral glucose tolerance tests on the women. The primary study outcome was the development of incident type 2 diabetes during follow-up.

Overall, 959 (95%) of the women without diabetes at baseline were evaluated at lea