diabetes and breastfeeding the newborn sara corder, rd, mph
TRANSCRIPT
Diabetes and Breastfeeding the Newborn
Sara Corder, RD, MPH
Breastfeeding Trivia
“If all babies were breastfed exclusively for their first six months of life and then given nutritious complementary food with continued breastfeeding up to two years of age, the lives of an additional ________ children under five would be saved every year.”
Dr Elizabeth Mason, Director of WHO's Department of Maternal, Newborn, Child and Adolescent Health and Development
American Academy of PediatricsHuman milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.
Exclusive breastfeeding for the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child.
The World Health Organization Recommends continued breastfeeding up to 2 years of age or beyond.
Water Water
Protein Protein
Carbohydrates Carbohydrates
Fats Fats
Vitamins Vitamins
Minerals Minerals
Fatty Acids: DHA / ARA Fatty Acids: DHA / ARA
Enzymes
Growth Factors
Hormones
Antibacterial Factors
Antiviral Factors
Antiparasitic Factors
Antiallergenic Factors
Human Milk Is Adaptable!!
During a feeding, breast milk changes from low fat to higher fat.
In cold climates breast milk has increased fat for energy, in hot climates, more water to prevent dehydration.
During gradual weaning, breast milk volume decreases, but the antibodies in the milk increase.
Mothers of premature babies make milk that is higher in growth factors, protein and fats.
Mothers who are malnourished produce slightly less milk,
but the milk is equal in fat, protein and carbohydrate.
Benefits of Breastfeeding- Tip of the IcebergMother
Enhances bonding
Mobilizes fat store
Reduce risk of pre-menopausal breast/ovarian caner
Protective role against chronic diseases
HDL increased
Economical
No preparation
InfantEnhances bonding
Reduce incidence/severity ear infections
Reduces incidence of respiratory infections
Decrease risk tooth decay
Reduces incidence of diarrhea
Reduces risk of obesity
Reduces risk of SIDS
Breastfeeding & Diabetes
Why is breastfeeding particularly good for the mother with DM and particularly good for the infant from a mother with Diabetes? (IDM)
Good for the Mother
Improved Glucose MetabolismNon-insulin mediated use of glucose by mammary gland to synthesize lactose.
Increased insulin sensitivity due to increased prolactin and decreased estradial
Improved B cell function with 3 months of breastfeeding in women with GDM
Good for the Mother
Improved Lipid Metabolism
Women who have breastfeed for at least 3 months
LDL levels increase less
HDL levels decrease less
Good for the Mother
Improved Weight LossProspective studies using measured weight change reported lower postpartum weight retention in lactating women
Rate of metabolic syndrome is sig lower with increasing lifetime duration of breastfeeding
Good for the Mother
Lower rate of DM2 in Women who lactated
Duration of lactation inversely associated with risk of DM2 in young and middle aged women
Non-lactating women developed DM2 at a 2 fold higher rate than lactating women after GDM.
Good for the IDM
Breastfed Infants are LeanerInverse relationship between breastfeeding and development of obesity
Formula fed infants produce more insulin
Hyperinsulinemia retards lipolysis and enhances fat deposit.
Good for the IDM
Less Overfeeding: changes in breast milk composition during feeding provide satiety signals to the infant
Breast milk contains leptin- early leptin intake can influence later eating behavior.
Fetal Origins of Adult Disease
The b-cells of the fetal pancreas become more responsive to glucose late in gestation and b-cell mass increase in the last trimester of pregnancy
Theory:A high availability of glucose programs pancreatic islet development irreversibly influencing the metabolic response to glucose later in life and predisposing to certain patterns of adult disease.
What is newborn Hypoglycemia?
Refers to a reduction in the glucose concentration of circulating blood.
Still controversial-no consensus on cut off values (30-50mg/dL)
Avoiding Newborn Hypoglycemia in the IDM
Achieve normoglycemia during pregnancy and LABOR
Terbutaline and ephedrine can cause maternal hyperglycemia and subsequent fetal hyperinsulinemia.
Avoiding Newborn Hypoglycemia
Breastfeed Immediately or within 30 minutes after birth, 10-12x/24hr
Cold wet babies use more glucose- Dry thoroughly and place skin to skin ASAP
Encourage frequent feeds until BG > 45mg/dL BEFORE feedings.
Monitor infant BG for at least 24hrs or until stable for at least 3 consecutive feedings.
Medically Necessary Separation
Provide EXTRA Support for establishing breastfeeding
Use Pump within first 12 hrs
Modern Pumps Are Amazing!
Avoiding Maternal Hypoglycemia
Glucose preferentially shunted towards production of milk
DM1(rarely DM2) prone to hypoglycemia especially at night
May have to adjust evening dose of basal insulin- Bedtime Snack Necessary
Avoiding Maternal Hypoglycemia
If BG <100 BEFORE feeding take 15g If BG <100 BEFORE feeding take 15g CHO and 7 g protein.CHO and 7 g protein.
If BG < 100 AFTER feeding consider 15 g If BG < 100 AFTER feeding consider 15 g snack if insulin on board.snack if insulin on board.
Hypoglycemia causes release of Hypoglycemia causes release of epinephrine which can cause temporary epinephrine which can cause temporary decrease in milk productiondecrease in milk production. .
Healthy Eating During Lactation
No surprises- Follow GDM meal plan!May add fruit/milk at breakfast
May add cereal to breakfast
May add: 2 fat servings, 1 fruit and 1 starch to support extra calorie needs during breastfeeding
Drink Plenty of WATER
Avoid Juices and Sweetened Drinks
Challenges to Breastfeeding
Women with DM less likely to breastfeed
Difficult laborObesity interfering with body mechanicsFear of giving diabetes through breastNeed to continue insulin and “tight” control of BGLack of supportLack of Societal AcceptanceSocietal Barriers
What would happen to this mother in the USA?
Best for Babes-www.BestforBabes.org
Endorsed by American Academy of PediatricsGive breastfeeding a makeover
Market it, Brand it, Mainstream it
Foster a cultural changeUsing positive social pressure stemming from the power of celebrities, foundations, fashion, advertising, the medical community and the media
Identify barriersAt home, in public and workplace
Breaking Societal Barriers….?A Start…
New Look of Breastfeeding
New Look of Breastfeeding
New Look of Breastfeeding
New Look of Breastfeeding
Gabrielle Reece
“Quite frankly I sort of thought, oh god, if I can get through these six months, because I was really committed to the health idea, and then it turned out that I breastfed my first child for 23 months.”
Jenna Elfman
If I was on a plane, I would just say to the person next to me, “I have to feed my kid because I want his ears to pop, so if you don’t like it, look the other way.”
Salma Hayek
"her left breast has now done more for humanity in a few minutes than I've done in roughly my life.“
Breastfeeding Supporter
DEBATE
“The debate is over, the science of breastfeeding is strong, now…how do we help moms get it done?”
“As physicians, many of us have a lot to learn about business, marketing ourselves, marketing our product and our passion.”