The effect of immediate treatment of early gestational diabetes mellitus on breastfeeding outcomes: Findings from the TOBOGM study — ASN Events
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The effect of immediate treatment of early gestational diabetes mellitus on breastfeeding outcomes: Findings from the TOBOGM study (#62)

Canaan Negash Seifu 1 , Jincy Immanuel 1 , William M Hague 2 , Helena Teede 3 , N Wah Cheung 4 , Emily J Hibber 5 , Christopher Nolan 6 7 , Michael J Peek 7 , Vincent Wong 8 , Jeff Flack 9 , Mark Mclean 10 , Arianne Sweeting 11 , Alexandra Kautzky-Willer 12 , Jürgen Harreiter 12 , Emily Gianatti 13 , Visvanathan Mohan 14 , Helena Backman 15 , David Simmons on behalf of the TOBOGM consortium 1
  1. School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
  2. Robinson Research Institute, The University of Adelaide, SA, Australia
  3. Monash Health and Monash University, Melbourne, VIC, Australia
  4. Westmead Hospital, Westmead, NSW, Australia
  5. Nepean Clinical School, University of Sydney and Nepean Hospital, Nepean, NSW, Australia
  6. Canberra Hospital, Canberra, ACT, Australia
  7. Australian National University, Canberra, ACT, Australia
  8. Liverpool Hospital, Liverpool, NSW, Australia
  9. Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  10. Blacktown Hospital, Blacktown, NSW, Australia
  11. Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  12. Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
  13. Department of Endocrinology, Fiona Stanley Hospital, Murdoch, WA, Australia
  14. Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
  15. Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Sweden

BACKGROUND

Breastfeeding has health benefits for both mother and baby. Women with gestational diabetes mellitus (GDM) face several challenges in relation to breastfeeding, including delayed lactogenesis and increased dependency on formula milk. It is unclear whether early GDM (eGDM) diagnosis affects breastfeeding uptake. We compared the uptake of breastfeeding among women with treated eGDM, GDM diagnosed at 24-28 weeks’ gestation (lGDM) and women with no GDM (noGDM).

METHODS

The Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) study recruited women before 20 weeks’ gestation, with overt diabetes in pregnancy (ODIP) risk factors, for a randomised controlled trial of early versus deferred treatment of eGDM. All recruited women had data relating to breastfeeding collected through chart review prior to hospital discharge.  GDM was diagnosed using ADIPS 2014 criteria. Women with ODIP were excluded. The primary outcomes, in this study, were feeding methods and early initiation of breastfeeding (within 1 hour). Comparisons were made using a multivariable logistic regression, adjusting for site, age, marital status, tertiary qualification, smoking, pre-pregnancy body mass index (BMI), parity, and then adding gestation at the time of birth (weeks).

RESULTS

Breastfeeding data were available for 3,323 (85.9%) participants (mean age 31.3±5.1 years, mean pre-pregnancy BMI 28.9±7.5 kg/m2, 41.5% European descent). Postpartum, unadjusted breastfeeding prevalence was higher in the noGDM (1806/2031; 88.9%) than treated eGDM (314/381;82.4%) or lGDM (503/630;79.8%) groups (p<0.001). Adjusting for confounders, compared with the noGDM group (ref=1), the adjusted odds ratio (AOR) was (0.79; 95% confidence interval (CI), 0.57 to 1.11) among women with treated eGDM but less (AOR, 0.56; 95% (CI), 0.43 to 0.74) among women in the lGDM group). Breastfeeding was initiated within one hour of birth in 74.6%, 62.2%, and 65.9% in the noGDM, treated eGDM and lGDM groups, respectively (p= 0.235). Having a university degree and being married were associated with more breastfeeding (AOR, 1.68; 95% CI, 1.28 to 2.22 and AOR, 1.58; 95% CI, 1.11 to 2.25), respectively. Higher parity was associated with initiating breastfeeding within one hour of birth (AOR, 1.35; 95% CI, 1.09 to 1.67).                     

CONCLUSIONS

lGDM, but not treated eGDM, was significantly associated with less breastfeeding at birth, with no difference in initiating breastfeeding within one hour of birth. Further follow-up is required to investigate the influence of breastfeeding uptake on maternal postpartum diabetes and baby outcomes.

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