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Breastfeeding and Maternal Diabetes: The Surprising Truth

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Sometimes, others give us information that we assume to be true. We don’t always hunt up the primary information source, or talk to the author of research studies. I’ve done both! Erica Gunderson, PhD, MPH, RD, is the author of more than 100 research studies, including the renowned CARDIA study and SWIFT study. I had the privilege of interviewing her, and she pointed out some glaring untruths and half-truths about breastfeeding and maternal diabetes. Let me tell you the real truths.

Breastfeeding is protection against maternal diabetes

According to Dr. Gunderson’s studies, breastfeeding for 5-6 months lowers a woman’s future risk of type 2 diabetes by one half. Wow! Maybe you’re wondering how that works. As she explained, the process that makes this possible is not well-understood.

During pregnancy, we see elevation in blood fats, insulin resistance, as well as the accumulation of abdominal (visceral) fat and generalized fat. It may be that breastfeeding helps to reverse those effects.

There’s another theory to explain breastfeeding and maternal diabetes protection. It could be that breastfeeding reduces liver fat deposition, and reduces the load on the pancreatic beta cells that produce insulin. Hence, while the process is not well understood, the outcome has been well documented.

Women with gestational diabetes have a delay in the milk “coming in”

It seems that every expert I talk to and every book I read says, oh, milk “coming in” will be delayed because of the diabetes.

I pushed Dr. Gunderson on this point. She confirmed what I’ve gathered from clinical experience: If the mother’s serum glucose levels are within normal range — i.e., her sugar levels are well controlled — she is unlikely or less likely to have a delay in her milk coming in.

Various reasons account for delays including delayed stimulation of the breast, obesity, hormonal disruptions, preeclampsia, and perhaps even circadian rhythms (and more). So, might the mother with diabetes have a delay in milk production? Yes. But is she doomed to experience delay, or is diabetes the sole explanation for a delay? No. Delay in lactogenesis is about the same whether the mother has gestational diabetes or not. 

Most importantly, as we consider breastfeeding and maternal diabetes, we must acknowledge that labor/birth interventions are more likely among women who are obese or have gestational diabetes.

Such interventions, which often lead to separation of mothers and babies in the early postpartum period, may cause delays. However, it is possible to reduce or eliminate such interventions and practices. (Those of you who have ever listened to me in person have heard me preach, “Early and often! Early and often!”)

Breastfeeding women do not lose substantially more weight than formula-feeding mothers

Thankfully, I have spent my entire career resisting the urge to tell women that they will lose weight better or faster if they are breastfeeding.

Dr. Gunderson says that women who exclusively breastfeed may lose only an additional 2 to 4 pounds compared to those who are using formula. And, the amount of weight lost varies highly from one woman to another, and some breastfeeding mothers may even gain weight! (Remember, the hormones associated with lactation stimulate the mother’s appetite.)

Weight loss of “baby weight” is not associated with protection against diabetes

According to studies, weight loss associated with longer breastfeeding did not vary based on whether women developed diabetes or not later on.

So here’s what you’re wondering about the relationships between breastfeeding and diabetes and weight loss: If breastfeeding protects against developing diabetes later in life, why isn’t it linked to weight loss?

The 50% lowering of diabetes in the women who breastfeed for 5-6 months lose only about 2-4 pounds more than the formula-feeding mothers. The difference in weight-loss is fairly moderate, but the difference in protection against diabetes is fairly dramatic.

Furthermore, Dr. Gunderson’s studies also accounted for any differences in lifestyle factors such as diet and physical activity; these track with weight changes over time, and did not explain the protection against diabetes in women.

Breastfeeding and maternal diabetes: How can we help?

It’s important for mothers with diabetes to breastfeed. Furthermore, it’s important for us to give accurate information and support, and advocate for hospital practices that support early breastfeeding.

Are you surprised about the relationship between breastfeeding and maternal diabetes? Tell me in the comments below!

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