title: Lactation intensity and fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: the SWIFT cohort.
abstract: OBJECTIVE
  Lactation may influence future progression to type 2 diabetes after gestational diabetes mellitus (GDM). However, biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM. This study investigates whether higher lactation intensity is related to more favorable blood lipids, lipoproteins and adipokines after GDM pregnancy independent of obesity, socio-demographics and insulin resistance.
  
  
  METHODS
  The Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT) is a prospective cohort study that recruited 1035 women diagnosed with GDM by the 3-h 100g oral glucose tolerance tests (OGTTs) after delivery of a live birth in 2008-2011. Research staff conducted 2-h 75 g OGTTs, and assessed lactation intensity, anthropometry, lifestyle behaviors and socio-demographics at 6-9 weeks postpartum (baseline). We assayed fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin from stored samples obtained at 6-9 weeks postpartum in 1007 of the SWIFT participants who were free of diabetes at baseline. Mean biomarker concentrations were compared among lactation intensity groups using multivariable linear regression models.
  
  
  RESULTS
  Increasing lactation intensity showed graded monotonic associations with fully adjusted mean biomarkers: 5%-8% higher high-density lipoprotein cholesterol (HDL-cholesterol), 20%-28% lower fasting triglycerides, 15%-21% lower leptin (all trend P-values < 0.01), and with 6% lower adiponectin, but only after adjustment for insulin resistance (trend P-value = 0.04).
  
  
  CONCLUSIONS
  Higher lactation intensity was associated with more favorable biomarkers for type 2 diabetes, except for lower plasma adiponectin, after GDM delivery. Long-term follow-up studies are needed to assess whether these effects of lactation persist to predict progression to glucose intolerance.
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA. Electronic address: Erica.Gunderson@kp.org.
authors.forename: Erica P
authors.initials: EP
authors.lastname: Gunderson
authors.affiliation: The University of Michigan, Ann Arbor, Michigan.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kim
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.affiliation: The University of Washington, Northwest Lipid Metabolism and Diabetes Research Laboratory, Seattle, Washington.
authors.forename: Santica
authors.initials: S
authors.lastname: Marcovina
authors.affiliation: The Kaiser Permanente Northern California Medical Group, Oakland, CA.
authors.forename: David
authors.initials: D
authors.lastname: Walton
authors.affiliation: The Kaiser Permanente Northern California Medical Group, Oakland, CA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Azevedo
authors.affiliation: The Kaiser Permanente Northern California Medical Group, Oakland, CA.
authors.forename: Gary
authors.initials: G
authors.lastname: Fox
authors.affiliation: The Kaiser Permanente Northern California Medical Group, Oakland, CA.
authors.forename: Cathie
authors.initials: C
authors.lastname: Elmasian
authors.affiliation: The Kaiser Permanente Northern California Medical Group, Oakland, CA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Young
authors.affiliation: The Kaiser Permanente Northern California Medical Group, Oakland, CA.
authors.forename: Nora
authors.initials: N
authors.lastname: Salvador
authors.affiliation: The Kaiser Permanente Northern California Medical Group, Oakland, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lum
authors.affiliation: The Kaiser Permanente Northern California Medical Group, Oakland, CA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Crites
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA.
authors.forename: Joan C
authors.initials: JC
authors.lastname: Lo
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA.
authors.forename: Xian
authors.initials: X
authors.lastname: Ning
authors.affiliation: Department of Nutrition, University of California, Davis, One Shields Ave., Davis, CA 95616.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000503:physiopathology*; D018450:Disease Progression; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D007774:Lactation; D020738:Leptin / Q000097:blood*; D008055:Lipids / Q000097:blood*; D008074:Lipoproteins / Q000097:blood; D008875:Middle Aged; D049590:Postpartum Period; D011236:Prediabetic State / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D011247:Pregnancy; D055815:Young Adult
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; D005230:Fatty Acids, Nonesterified; D020738:Leptin; D008055:Lipids; D008074:Lipoproteins
keywords: Adipokines; Breastfeeding; Diabetes Mellitus; Gestational Diabetes Mellitus (GDM); Lipids