title: Lactation and maternal risk of type 2 diabetes: a population-based study.
abstract: BACKGROUND
  Lactation has been associated with improvements in maternal glucose metabolism.
  
  
  METHODS
  We explored the relationships between lactation and risk of type 2 diabetes in a well-characterized, population-representative cohort of women, aged 40-78 years, who were members of a large integrated health care delivery organization in California and enrolled in the Reproductive Risk factors for Incontinence Study at Kaiser (RRISK), between 2003 and 2008. Multivariable logistic regression was used to control for age, parity, race, education, hysterectomy, physical activity, tobacco and alcohol use, family history of diabetes, and body mass index while examining the impact of duration, exclusivity, and consistency of lactation on risk of having developed type 2 diabetes.
  
  
  RESULTS
  Of 2233 women studied, 1828 were mothers; 56% had breastfed an infant for > or =1 month. In fully adjusted models, the risk of type 2 diabetes among women who consistently breastfed all of their children for > or =1 month remained similar to that of women who had never given birth (odds ratio [OR] 1.01; 95% confidence interval [CI], 0.56-1.81). In contrast, mothers who had never breastfed an infant were more likely to have developed type 2 diabetes than nulliparous women (OR 1.93; 95% CI, 1.14-3.27) [corrected]. Mothers who never exclusively breastfed were more likely to have developed type 2 diabetes than mothers who exclusively breastfed for 1-3 months (OR 1.52; 95% CI, 1.11-2.10).
  
  
  CONCLUSIONS
  Risk of type 2 diabetes increases when term pregnancy is followed by <1 month of lactation, independent of physical activity and body mass index in later life. Mothers should be encouraged to exclusively breastfeed all of their infants for at least 1 month.
authors.affiliation: Department of Medicine, University of Pittsburgh, PA, USA. schwarzeb@upmc.edu
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.forename: Jeanette S
authors.initials: JS
authors.lastname: Brown
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Creasman
authors.forename: Alison
authors.initials: A
authors.lastname: Stuebe
authors.forename: Candace K
authors.initials: CK
authors.lastname: McClure
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
authors.forename: David
authors.initials: D
authors.lastname: Thom
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D001942:Breast Feeding; D002140:California / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007774:Lactation / Q000378:metabolism*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D013997:Time Factors
chemical_list: D001786:Blood Glucose
references.citation: J Clin Endocrinol Metab. 1998 Jan;83(1):103-6
references.pmid: 9435424
references.citation: Obstet Gynecol. 2009 May;113(5):974-982
references.pmid: 19384111
references.citation: MMWR Morb Mortal Wkly Rep. 2007 Aug 3;56(30):760-3
references.pmid: 17673896
references.citation: Nature. 2001 Dec 13;414(6865):782-7
references.pmid: 11742409
references.citation: Obstet Gynecol. 1993 Sep;82(3):451-5
references.pmid: 8355952
references.citation: J Clin Endocrinol Metab. 2004 Dec;89(12):6239-43
references.pmid: 15579783
references.citation: MMWR Morb Mortal Wkly Rep. 2008 Jun 13;57(23):621-5
references.pmid: 18551096
references.citation: Pediatrics. 2008 Oct;122 Suppl 2:S56-62
references.pmid: 18829832
references.citation: Pediatrics. 2005 Feb;115(2):496-506
references.pmid: 15687461
references.citation: JAMA. 2005 Nov 23;294(20):2601-10
references.pmid: 16304074
references.citation: J Womens Health Gend Based Med. 2001 Sep;10(7):681-7
references.pmid: 11571098
references.citation: Diabetes Care. 1999 Sep;22(9):1471-8
references.pmid: 10480511
references.citation: FEBS Lett. 1986 Jan 6;194(2):292-6
references.pmid: 3079710
references.citation: Gynecol Obstet Invest. 2006;61(2):115-8
references.pmid: 16272815
references.citation: BMJ. 2001 Nov 24;323(7323):1213-7
references.pmid: 11719411
references.citation: Am J Physiol. 1986 Nov;251(5 Pt 1):E537-41
references.pmid: 3535531
references.citation: Metabolism. 2001 Jun;50(6):715-9
references.pmid: 11398150
references.citation: Diabetes Care. 2009 Feb;32(2):287-94
references.pmid: 19017771
references.citation: Evid Rep Technol Assess (Full Rep). 2007 Apr;(153):1-186
references.pmid: 17764214
references.citation: Biochem J. 1984 Jun 1;220(2):455-60
references.pmid: 6146315
references.citation: J Urol. 2006 Jan;175(1):259-64
references.pmid: 16406923
references.citation: Am J Epidemiol. 2005 Feb 1;161(3):289-96
references.pmid: 15671261
references.citation: Diabetes Care. 1995 Jul;18(7):1050-64
references.pmid: 7555542
references.citation: J Nutr. 2001 Nov;131(11):3009S-11S
references.pmid: 11694637
references.citation: Diabetologia. 2008 Feb;51(2):258-66
references.pmid: 18040660