Last update: Jan. 15, 2019
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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This entry can be applied in whole or in part, to type 1, type 2 diabetes and gestational diabetes.
Given the benefits of breastfeeding to mothers and infants, especially in the case of maternal diabetes, it is necessary to encourage breastfeeding and provide as much effective support as possible. Prestigious scientific institutions and various authors recommend it (ADA 2108, Serrano 2015, Cordero 1998).
Breastfeeding decreases the risk of developing type 2 diabetes (Martens 2016, Serrano 2015, Jäger 2014, Stuebe 2005) especially in women who have had gestational diabetes (Gunderson 2015, Bentley 2008) and has a protective effect delaying the onset of diabetes and decreasing its frequency in childhood (Martens 2016, Gerstein 1994, Mayer 1988, Borch 1984).
Occasionally, maternal diabetes mellitus remits during breastfeeding, for prolonged periods, lasting months or years (Lawrence 2016 p 581).
Maternal diabetes is associated with delayed milk production (lactogenesis II) (Matias 2014, Hartmann 2001), low levels of prolactin (Butte 1987) and lack of adequate milk supply (Riddle 2016).
There are usually more difficulties for breastfeeding due to maternal complications (frequent cesarean section) and those related to the newborn (macrosomia, prematurity, early hypoglycemia, hypocalcemia, respiratory problems, jaundice, polyglobulia and malformations) with early separation of mother-baby (Lawrence 2016 p 578, Serrano 2015, Sorkio 2010, Maayan 2009, Cordero 1998).
Therefore, there is a risk of lower prevalence and duration of breastfeeding in maternal diabetes (Oza 2015, Sparud 2011).
Intensive control of glycemia during pregnancy (Golbert 2008), effective support and early initiation of breastfeeding is required (Matias 2014, Sparud 2011, Whichelow 1983), avoiding unnecessary separation and resorting if necessary to the early expression of milk manually or via breastpump (Asselin 1987, Whichelow 1983).
The most important factor for the success of breastfeeding is its early establishment (Whichelow 1983).
Hypoglycaemia in the first few hours can be prevented and treated with frequent oral feeding (Sarkar 2003).
Although there has been much debate about the lack of evidence regarding the benefits and risks of antenatal expression of colostrum to administer to newborns, avoiding the administration of milk formula (Forster 2017 and 2011, East 2014, Chapman 2013, Soltani 2012), the benefits are so great, especially when neonatal problems are anticipated (maternal diabetes, scheduled cesarean section, twins, premature babies, malformations, etc.) that is has become a practice which is recommended by health institutions and several authors (NHS 2018, Wszolek 2015), and is accepted by mothers and improves their self-confidence (Brisbane 2015).
Mothers with diabetes are at greater risk of nipple cracking, mastitis and candidiasis; this must be prevented with frequent breastfeeding, correct positioning, avoiding washes, disinfectants and ointments and energetic antibiotic treatment of mastitis (Lawrence 2016 p 581).
Breastmilk of mothers with diabetes has more glucose (0.7mg/cc) than that of women without diabetes (0.3mg/cc) (Butte 1987) but the total caloric content is not affected because glucose is a very minor sugar in breastmilk. Some authors have found a higher sodium concentration (Butte 1987) but not others (Bitman 1989).
Maternal glucose is used to form lactose (glucose + galactose) in the mother's breast. It is necessary to increase the self-control of the mother due to the risk of hypoglycemia, especially during or after breastfeeding.
Hypoglycemia inhibits (via adrenaline) milk production and ejection.
The need for insulin or oral antidiabetics usually decreases by up to 30% and there is a need for daily caloric increase (Serrano 2015, Whichelow 1983). Adjustments of diet and insulin are also necessary during the introduction of complementary feeding and weaning (Serrano 2015).
During breastfeeding, urine glucose tests using reactive strips are unreliable due to the existence of lactosuria. In all women, the lactose that is reabsorbed from the breast and passes to plasma, is eliminated by urine (Lawrence 2016 p 579, Serrano 2015).
Oral antidiabetics are not useful in type 1 diabetes.
Diet, exercise and breastfeeding improve blood glucose levels.
Insulin, acarbose, glibenclamide or glyburide, glipizide, metformin, miglitol, tolbutamide, exenatide and liraglutide are considered to be safe drugs during breastfeeding (Serrano 2015).
Maternal diet does not cause problems for breastfeeding or the infant.
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.
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