Duration of lactation and incidence of the metabolic syndrome in women of reproductive age according to gestational diabetes mellitus status: a 20-Year prospective study in CARDIA (Coronary Artery Risk Development in Young Adults).
OBJECTIVE
The objective of the study was to prospectively assess the association between lactation duration and incidence of the metabolic syndrome among women of reproductive age.


METHODS
Participants were 1,399 women (39% black, aged 18-30 years) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, an ongoing multicenter, population-based, prospective observational cohort study conducted in the U.S. Women were nulliparous and free of the metabolic syndrome at baseline (1985-1986) and before subsequent pregnancies, and reexamined 7, 10, 15, and/or 20 years after baseline. Incident metabolic syndrome case participants were identified according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Complementary log-log models estimated relative hazards of incident metabolic syndrome among time-dependent lactation duration categories by gestational diabetes mellitus (GDM) adjusted for age, race, study center, baseline covariates (BMI, metabolic syndrome components, education, smoking, physical activity), and time-dependent parity.


RESULTS
Among 704 parous women (620 non-GDM, 84 GDM), there were 120 incident metabolic syndrome case participants in 9,993 person-years (overall incidence rate 12.0 per 1,000 person-years; 10.8 for non-GDM, 22.1 for GDM). Increased lactation duration was associated with lower crude metabolic syndrome incidence rates from 0-1 month through >9 months (P < 0.001). Fully adjusted relative hazards showed that risk reductions associated with longer lactation were stronger among GDM (relative hazard range 0.14-0.56; P = 0.03) than non-GDM groups (relative hazard range 0.44-0.61; P = 0.03).


CONCLUSIONS
Longer duration of lactation was associated with lower incidence of the metabolic syndrome years after weaning among women with a history of GDM and without GDM, controlling for preconception measurements, BMI, and sociodemographic and lifestyle traits. Lactation may have persistent favorable effects on women's cardiometabolic health.
Gunderson
Erica P
EP
Division of Research, Epidemiology, and Prevention Section, Kaiser Permanente, Oakland, California, USA. erica.gunderson@kp.org
Jacobs
David R
DR
Chiang
Vicky
V
Lewis
Cora E
CE
Feng
Juanran
J
Quesenberry
Charles P
CP
Sidney
Stephen
S
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood; D007774:Lactation / Q000502:physiology*; D008137:Longitudinal Studies; D024821:Metabolic Syndrome / Q000453:epidemiology*; D015337:Multicenter Studies as Topic; D010298:Parity; D011247:Pregnancy / Q000502:physiology; D011446:Prospective Studies; D044469:Racial Groups; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D001786:Blood Glucose; D007328:Insulin