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"Breastfeeding is the optimal way of providing ideal food for the health, growth, and development of human infants while simultaneously benefiting the lactating mother."
—American Dietetic Association, 1986
A 1996 study of Chilean children concluded that genetic predisposition is an important element in the development of type 1 diabetes in children and that exclusive breastfeeding for at least three months may decrease the level of risk. The study, by Dr. Perez-Bravo and colleagues, was published in the Journal of Molecular Medicine (vol. 74, no. 2).
Another study, published by Gimeno and de Souza in 1997 (Diabetes Care, vol. 20, no. 8), suggested that an even shorter span—more than seven days—had a protective effect. Children who were breastfed for fewer than seven days and those who were given cow's milk in the first week of life were about twice as likely to develop diabetes as those who were breastfed for longer periods.
Research is continuing to explore the reasons why breastfeeding is protective.
"It is not clear whether the increased risk of [type 1 diabetes] among children who were artificially fed as infants is due to the [lack of] protective effects of breastfeeding or to the early introduction of foreign proteins in non-breast-milk foods, or to some combination of the two," states Margaret Davis, MD, MPH, in the February 2001 issue of Pediatric Clinics of North America.
What If the Mother Already Has Diabetes?
Mothers who themselves have diabetes are the most motivated of all to protect their newborns from developing the disease.
Diabetes Health conducted a survey entitled "Questions For Women With Diabetes Who Have Given Birth," which was posted on the Web site www.insulin-pumpers.org as well as on the site www.diabeticmommy.com. (Respondents were not asked specifically how long they had had diabetes or which type of diabetes—type 1, type 2 or gestational—they had.)
Those who breastfed cited encouragement from their obstetrician/gynecologist (OB/GYN), pediatrician and hospital nursing staff as well as support from their endo-crinologist and diabetes educator. Some also had the advantage of receiving the advice of lactation specialists, while others sought out the La Leche League.
"My initial success is due to wonderful nurses and an awesome lactation consultant at my hospital, who came at my request," says Jennifer Serrano, who is still breastfeeding the daughter she had in December 2001.
However, Rebecca Warth-Anderson, who had her baby in 1999, reports that no one—"not my OB/GYN, not his nurse practitioner, nor the lactation consultant at the hospital—promoted breastfeeding as protection from diabetes for my baby at all."
Warth-Anderson had planned on breastfeeding her baby even before she became pregnant. And although the baby was delivered six weeks early by cesarean section, she did breastfeed for about eight weeks. If she has more children, she plans to breastfeed for an entire year. She notes that she will state her wishes in advance by letter to the hospital staff if necessary.
Another mother, Sherry Compton, whose son was born in May 2001, says, "I was never told by anyone that breastfeeding was something people with diabetes should do. I found out from someone later that stopping breastfeeding early could contribute to my son developing diabetes."
Protecting the Newborn
Even with improvements in monitoring and improved control of maternal blood glucose, infants may still be exposed in utero to higher-than-normal levels of glucose. The fetus will produce excessive insulin to balance the high glucose levels. At birth, the extra insulin can result in a rapid drop in blood glucose in the newborn. Therefore, babies are watched carefully and are checked at intervals by means of a heel-stick blood-glucose test. On their own, many newborns quickly adjust. Others require intervention.
When mothers have diabetes, it is common practice in some hospitals to supplement their newborns with formula to ensure against low blood glucose. Additionally, a baby is often removed from the mother's care for observation for eight or more hours. Both practices interfere with the establishment of the baby's sucking reflex. If the baby does exhibit low blood glucose, treatment by intravenous glucose therapy can be started, and the baby can be at breast while the IV is running.
Bottle Feeding Can Interfere With Breastfeeding
Donna Rushing recalls that her lactation nurse never mentioned that once babies are bottle-fed, they often don't learn to breastfeed. Rushing's baby spent 22 days in the neonatal intensive care unit when she was born in May 1991.
"During her time there, she was fed formula, much to my disappointment."
Rushing pumped breast milk and froze it, but once she and her baby returned home, she was not able to transfer the baby from bottle to breast. While she felt unsuccessful at breastfeeding, she continued to pump breast milk, so her daughter did get its benefits, though from a bottle, for her first five weeks.
The Importance of Colostrum
Taking the baby away from the mother also prevents the infant from receiving colostrum—the first milk that appears in the breast at the end of pregnancy and during the early postpartum period.
Colostrum is thicker and more golden than mature breast milk, with a higher content of proteins, many of which are immunoglobins—(also present in mature breast milk). Immunoglobins are proteins with antibody capabilities that aid the infant's immune response. Colostrum is also higher in fat-soluble vitamins (including A, E and K) and some minerals (including sodium and zinc). Colostrum does not stimulate insulin production the way formula does, so it is better for preventing low blood glucose.
Cesarean Sections and Other High-Risk Experiences
When a mother has diabetes, her "high-risk" experience also presents challenges to the success of breastfeeding. Cesarean sections and induced labor are common.
"I had an IV on my right arm, and when I tried to move it a loud alarm would sound. This really hampered things," says Compton. "I was shown by several different people how to start the baby off, but we just couldn't seem to get him latched on. I started feeling like a failure my first day as a mother." Compton did not end up breastfeeding her son.
In 1995, with her first child, Nancy Ludwig—who has had diabetes for 15 years—was given a full meal after her cesarean section. This left her in pain. She found pumping her breasts and breastfeeding in general "difficult and painful" and did not breastfeed either that child or the next, even though she had initially planned to do so.
"I sometimes wish there was more advocacy and support for ‘non-breastfeeders.’ Sometimes it does not work out."
What About the Mother's Own Diabetes Management?
As for their own diabetes management, mothers cited little interference in adjusting their insulin doses post-birth.
Serrano recalls, "One nurse abruptly told me that they recommended that I halve my pump basal rates and go from there. I re-attached my pump and was left to test and monitor on my own. I reported my BGs to the nurse whenever I felt like it. Nobody ever came to see me about my diabetes, but my OB care was great."
Elizabeth Woolley, who had her baby in April 2001 and is still breastfeeding, says doctors were more "cautious" because of her diabetes.
"I was hooked up to an external fetal monitor, an internal fetal monitor, an automatic blood pressure cuff, an IV with antibiotics, and an IV with fluids and some type of glucose solution," she remembers. "I felt tied down. I had hoped to be able to move and have more of a choice in labor and delivery positions."
Regarding the first breastfeeding, Woolley and her husband had to repeatedly ask about starting.
"They kept saying, ‘In a minute,’ as they were still monitoring the baby. Someone on the staff made the comment that he wasn't going to starve because all I had was colostrum."
Jennifer Harkleroad had three successful pregnancies: twins and two more children—all girls.
"I have nursed them all—the twins six months, and the other two, 17 months each."
Harkleroad had read that mothers with diabetes who nursed could give their children immunity from type 1.
"I was determined to do this from the beginning," she says. "Later, I read that you had to nurse at least three months to get the full benefits, but that 12 months was optimal. My endocrinologist worked very closely with my OB. I roomed in with all my babies and gave nurses explicit instructions that they got no formula."
As Harkleroad says: "I was obsessed with giving my children every opportunity not to have diabetes. I worry every day, but I know I did all I could to help them avoid my situation."
Peggy Tague seconds this. She breastfed her first child for three years, and the second for four.
"Both are healthy, diabetes-free—for now and forever, I hope. Breastfeeding is so easy once you get started."
Most would say that breastfeeding was not easy for these mothers. However, it can be successful, beneficial for the mother and protective for the baby.
Clinical adviser's note: Research continues to explore the relationship of breastfeeding to protection from diabetes. This article mentions the possibility that it is exposure of the infant to cow's milk protein that may trigger a later autoimmune type 1 diabetes in those already at risk genetically. Another theory takes a different perspective—that it may be the infant's lack of exposure to breast milk that contains human insulin that sets up the possibility of autoimmune diabetes later on. The insulin in human breast milk does not regulate blood glucose in the infant. Oral insulin may, however, during a critical time in early life, offer a protection from autoimmune diabetes that is still not understood. There is no reason to wait for more scientific conclusions about the very positive association of breastfeeding and healthy offspring. The good news is that breastfeeding offers the very best in life for all babies.
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