Women who have diabetes during pregnancy are more likely to have a lower supply of milk for breastfeeding, says research published online in the journal Breastfeeding Medicine.

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Women with diabetes may find they have less milk during lactation.

Previous studies have associated obesity in women with insulin resistance, and obesity also appears to lead to difficulties with lactation. Now, it seems that maternal glucose intolerance, too, may make breastfeeding harder.

The benefits of breastfeeding for both mother and baby are well-documented, and all mothers are encouraged to breastfeed their infants, including mothers with diabetes. However, many women stop earlier, and the most commonly cited reason is low milk supply.

Mothers with diabetes have special considerations; research has shown that it can take longer for mothers with diabetes to start breastfeeding, possibly because of the role played by insulin in lactation.

In addition, breastfeeding can lower the need for insulin by up to 25%, because breast milk contains lactose, which is a sugar. Feeding the baby means a loss of sugar and a fall in blood glucose levels. Lactating mothers with diabetes should be aware of the potential change in blood sugar levels to prevent hypoglycemia.

The current study, thought to be the first to investigate the association between maternal diabetes and low milk supply, could hold clues for future therapy options to increase milk supply.

Dr. Sarah Riddle, a pediatrician at the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital Medical Center and colleagues studied electronic medical records of 641 women who first visited the center between June 2011 and May 2013.

All the participants had given birth within the previous 90 days, and they were all keen to breastfeed.

The team compared results for mothers with diabetes, mothers with low milk supply and no other breastfeeding problem, and mothers who were experiencing breastfeeding problems, such as latching onto the breast, but with a plentiful milk supply.

Lead author Dr. Riddle explained to Medical News Today that since the researchers were interested in any indication of abnormal glucose metabolism during pregnancy, they did not differentiate between types of diabetes. She noted that some mothers with gestational diabetes may have had undiagnosed abnormal glucose metabolism before they became pregnant.

Results showed that nearly 15% of those with low milk supply had had diabetes during pregnancy. Just over 6% of mothers who had lactation problems unrelated to milk supply had maternal diabetes.

When MNT asked Dr. Riddle why she thought this might happen, she speculated that abnormal insulin action/glucose metabolism may cause difficulties in establishing and sustaining robust milk production, but she emphasized that far more research is needed to confirm a cause.

The study notes that there are currently few evidence-based strategies to help mothers to increase milk supply.

However, Dr. Riddle told MNT:

We are hopeful that with a better understanding of the underlying physiology, targeted therapy may be designed to treat or perhaps prevent this problem. We are currently engaged in a small randomized controlled trial of metformin to treat low milk supply.”

MNT recently reported that the gut microbiome may be able to predict type 2 diabetes before symptoms show.