Diabetes

Will having diabetes affect my milk supply?

Mothers with diabetes have lower breastfeeding rates and poorer breastfeeding outcomes. Studies suggest that diabetes can reduce milk supply and can cause the milk to come in late.  Mothers with diabetes may have other health problems that contribute to breastfeeding problems. Diabetes is not, however, a reason to avoid breastfeeding as breastfeeding benefits both mother and baby.

A) Describing diabetes

Diabetes is a disease that results in excess amounts of sugar in the blood. There are three main of types of diabetes:

  • Type 1: caused by the body attacking insulin-producing cells
  • Type 2: caused by resistance to insulin
  • Gestational diabetes: develops during pregnancy

Diabetes in a mother is not a reason to avoid breastfeeding. It has specific benefits for both diabetic mothers and their babies. Diabetes medication, including insulin, is generally safe for use by breastfeeding mothers.

B) Effect of diabetes on breastfeeding

Mothers with diabetes have lower breastfeeding rates and poorer breastfeeding outcomes (Finkelstein 2013; Verd 2016). Mothers with type 2 diabetes appear to have less success breastfeeding than mothers with type 1 (Herskin 2016). Mothers who have had gestational diabetes are less likely to exclusively breastfeed and to breastfeed for a shorter amount of time when compared to mothers without diabetes (Manerkar 2020; Nguyen 2018; Nguyen 2019).

The reason for this is unknown. Having diabetes may affect a mother's ability to breastfeed or there may be other factors related to diabetes that cause problems:  

  • Diabetes can cause the milk to come in late (Achong 2012; Matias 2014).
  • Mothers who have diabetes of any type during pregnancy are more likely to have a low milk supply (Riddle 2016).
  • Mothers with higher blood sugar levels have lower prolactin levels in their blood and milk (Ostrom 1993).
  • Mothers with Type 1 diabetes are more likely to require a Caesarean delivery (Sorkio 2010).
  • Mothers with Type 2 diabetes are more likely to be obese.
  • The babies of diabetic mothers are more likely to have low blood sugar levels (hypoglycaemia) after birth, which may lead to supplementing with milk

References

Achong N, Callaway L, d'Emden M, et al. Insulin requirements in late pregnancy in women with type 1 diabetes mellitus: a retrospective review. Diabetes Res Clin Pract. 2012 Dec;98(3):414-21
 
Finkelstein SA, Keely E, Feig DS, et al. Breastfeeding in women with diabetes: lower rates despite greater rewards. A population-based study. Diabet Med. 2013 Sep;30(9):1094-101
 
Herskin CW, Stage E, Barfred C, et al. Low prevalence of long-term breastfeeding among women with type 2 diabetes. J Matern Fetal Neonatal Med. 2016;29(15):2513-8

Manerkar K, Harding J, Conlon C, et al. Maternal gestational diabetes and infant feeding, nutrition and growth: a systematic review and meta-analysis. Br J Nutr. 2020 Jun 14;123(11):1201-1215 

Matias SL, Dewey KG, Quesenberry CP, et al. Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. The American Journal of Clinical Nutrition. 2014;99(1):115-121
 
Nguyen PTH, Binns CW, Nguyen CL, et al. Gestational Diabetes Mellitus Reduces Breastfeeding Duration: A Prospective Cohort Study. Breastfeed Med. 2018 Nov 1
 
Nguyen PTH, Pham NM, Chu KT, et al. Gestational Diabetes and Breastfeeding Outcomes: A Systematic Review. Asia Pac J Public Health. 2019 Mar 4:1010539519833497
 
Ostrom KM, Ferris AM. Prolactin concentrations in serum and milk of mothers with and without insulin-dependent diabetes mellitus. Am J Clin Nutr. 1993 Jul;58(1):49-53
 
Riddle SW, Nommsen-Rivers LA. A Case Control Study of Diabetes During Pregnancy and Low Milk Supply. Breastfeeding Medicine. 2016;11(2):80-85
 
Sorkio S, Cuthbertson D, Bärlund S, et al. Breastfeeding patterns of mothers with type 1 diabetes: results from an infant feeding trial. Diabetes Metab Res Rev. 2010 Mar;26(3):206-11
 
Verd S, de Sotto D, Fernández C, et al. The Effects of Mild Gestational Hyperglycemia on Exclusive Breastfeeding Cessation. Nutrients. 2016 Nov 19;8(11). pii: E742