Maternal History of Diabetes in Pregnancy, Health Behaviors, and Exclusive Breastfeeding of Infants: Assessment from an Urban, Racially/ethnically, and Economically Diverse Sample

Background: Breastfeeding confers important health benefits for infants. However, less is known about the relationship between history of diabetes in pregnancy, a condition with unique nutritional and health needs, and infant feeding practice. This study aimed to determine the association among maternal diabetes and related health behaviors during pregnancy and breastfeeding at birth and 6 months.

Methods: A secondary data analysis of a longitudinal study on maternal diabetes and infant development was conducted. Pregnant and postpartum women between 18-50 years-old and their full-term infants were enrolled from an urban academic medical center. The main predictor was maternal history of gestational, Type 1, or Type 2 diabetes mellitus during pregnancy. Secondary predictors were diabetes-related health behaviors: meal plan use, reading nutrition labels, eating out, and exercise before and during pregnancy. Main outcomes were exclusive breastfeeding at birth and 6 months. Covariates included maternal-infant sociodemographic factors, body mass index (BMI), and postpartum depression risk from medical record abstraction and self-reported questionnaires. Bivariate analyses compared maternal diabetes status and outcomes and covariates. Logistic regression models were adjusted for factors significant a priori and on bivariate analyses: maternal age, education, Hispanic ethnicity, and delivery mode.

Results: Of N=108 women at baseline, 44% had diabetes during pregnancy (94% gestational, 6% Type 1 or Type 2) and 52% reported household income < $50,000 (Table 1). Women with diabetes were 10% Black, 81% Hispanic, and older age (34 vs. 31 years, p<0.001). They had higher pre-pregnancy BMI (29.4±5.4 vs. 26.3±7.2 kg/m2, p=0.002), more children in their households (1.7 vs. 1.0, p<0.001), birthed infants of lower gestational age (38.8±0.8 vs. 39.1±1.0, p= 0.02), and had higher 6-month postpartum depression screening scores (3.9 vs. 3.3, p<0.001) compared to women without diabetes. Fifty-four percent of women exclusively breastfed at birth and 29% at 6 months (out of N=70 with complete data at 6 months). Exclusive breastfeeding at birth was associated with lower pre-pregnancy BMI (p=0.013), pre-pregnancy exercise (p=0.038), and meal plan use (p=0.0015). Women with diabetes had 4 times lower odds of exclusive breastfeeding at birth (adjusted odds ratio [AOR]=0.239, 95% confidence interval [CI] 0.092,0.620, p=0.003) compared to women without diabetes. On adjusted models, secondary predictors were not significantly associated with exclusive breastfeeding at birth or 6 months.

Conclusion: In an urban, racially/ethnically, and economically diverse sample, lower pre-pregnancy BMI, exercise before pregnancy, and meal plan utilization were associated with exclusive breastfeeding at birth on unadjusted models. Diabetes in pregnancy remained significantly associated with lower odds of exclusive breastfeeding at birth after controlling for potential confounders. The limited sample size may not have captured small effects from the other potential predictors. Maternal pregnancy diabetes and related health behaviors may impact infant feeding practice and health. Further research in a larger sample is needed.