title: Is onset of lactation delayed in women with diabetes in pregnancy? A systematic review.
abstract: OBJECTIVE
  To determine if women with diabetes in pregnancy have a delayed onset of lactation through a systematic review of the literature.
  
  
  METHODS
  We searched databases including MEDLINE, Web of Science, PubMed, CINAHL Plus and PsychINFO for articles assessing diabetes in pregnancy and lactogenesis. Thirty-one articles were screened and 10 articles were included in the systematic review. We extracted data on diabetes in pregnancy and onset of lactation (secretory activation or lactogenesis II).
  
  
  RESULTS
  The 10 studies examining the association between women with diabetes in pregnancy and delayed onset of lactation reported a significant delay in women with diabetes compared with women without diabetes. Two studies assessed the impact of metabolic control on lactogenesis, and found an association between poorer metabolic control and delayed onset of lactation.
  
  
  CONCLUSIONS
  Although this review has found evidence of an association between women experiencing diabetes during pregnancy and delayed onset of lactation, the presence of many potential confounding factors need to be acknowledged.
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: De Bortoli
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne, Australia.|Breastfeeding Service, Royal Women's Hospital, Melbourne, Australia.
authors.forename: L H
authors.identifier: http://orcid.org/0000-0002-2510-1399
authors.initials: LH
authors.lastname: Amir
mesh_terms: D000328:Adult; D015986:Confounding Factors, Epidemiologic; D016640:Diabetes, Gestational / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007774:Lactation; D007775:Lactation Disorders / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors