Mothers with diabetes should be reassured that their breast-feeding experiences should be like those of non-diabetic mothers: insulin will not harm the baby and breast milk has much the same composition in women whether or not they have diabetes.
During breast-feeding, the hormones released and the extra energy used for milk production may reduce the mother’s insulin requirement.1 Therefore, the mother should be seen by a BDA-registered dietitian to ensure that she is receiving the right balance of nutrients. Glibenclamide and metformin are permitted for lactating women, but the baby should be monitored for hypoglycaemia.2It is extremely important for mothers with diabetes to breast-feed within 30 minutes postpartum, to prevent neonatal hypoglycaemia. Breast-feeding may take longer to become established in mothers with diabetes, due to an initially low milk supply:3 in addition, their babies (particularly if macrosomic) are at increased risk of hypoglycaemia in the early postnatal period. Diabetic mothers may be more predisposed to mastitis due to elevated blood glucose levels,3.4 therefore regular feeding – always emptying the breast – should be emphasised as a preventative measure. Given the higher prevalence of candidiasis in people with diabetes and young babies,5 it is important that breast-feeding mothers are alert to the signs of infection and keep their nipples clean and dry between feeds.
Breast-feeding may reduce the mother’s risk of developing several chronic and serious diseases,6 and may stabilise or reduce the baby’s risk of developing diabetes (likely due to the slower, healthier growth pattern7 found in many breast-fed babies, although more research is needed).
If the mother decides to stop breast-feeding this must be undertaken gradually, to maintain good diabetic control. All health care professionals involved in the mother’s care should be aware that she is breast-feeding, to optimise the experience for her.
1. Riviello C et al. Breastfeeding and the basal insulin requirement in type 1 diabetic women. Endocr Pract 2009; 15: 187 193.
2. Glatstein MM et al. Use of hypoglycemic drugs during lactation. Can Fam Physician 2009; 55: 371–373.
3. Ferris AM et al. Lactation outcome in insulin-dependent diabetic women. J Am Diet Assoc 1988; 88: 317–322.
4. Neubauer SH. Lactation in insulin-dependent diabetes. Prog Food Nutr Sci 1990; 14: 333–370.
5. Pankhurst CL. Candidiasis (oropharyngeal). Clin Evid (Online) 2009; Mar 18: pii: 1304.
6. Stuebe AM, Schwarz EB. The risks and benefits of infant feeding practices for women and their children. J Perinatol 2009; Jul 16. [Epub ahead of print]
7. Viner RM et al. Childhood body mass index (BMI), breastfeeding and risk of Type 1 diabetes: findings from a longitudinal national birth cohort. Diabet Med 2008; 25: 1056–1061.
ResourcePregnancy and Diabetes. Copies can be ordered at www.diabetes.org.uk. Information for professionals is available at http://www.diabetes.org.uk/Professionals/Post.aspx. Accessed 24 Sep 2009.
From: Journal of Family Health Care Bulletin. Directory of Breast-Feeding Advice. December