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Cited by 164Breastfeeding Practices and InfluencesGestational Diabetes Research and ManagementBirth, Development, and Health

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Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years: The 30-Year CARDIA Study

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Gunderson, Erica P., Lewis, Cora E., Lin, Ying, Sorel, Mike, Gross, Myron, Sidney, Stephen, Jacobs, David R., Shikany, James M., Quesenberry, Charles P.·2018·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2017.7978PMC PMC5885916
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Abstract

Importance: Lactation duration has shown weak protective associations with incident diabetes (3%-15% lower incidence per year of lactation) in older women based solely on self-report of diabetes, studies initiated beyond the reproductive period are vulnerable to unmeasured confounding or reverse causation from antecedent biochemical risk status, perinatal outcomes, and behaviors across the childbearing years. Objective: To evaluate the association between lactation and progression to diabetes using biochemical testing both before and after pregnancy and accounting for prepregnancy cardiometabolic measures, gestational diabetes (GD), and lifestyle behaviors. Design, Setting, and Participants: For this US multicenter, community-based 30-year prospective cohort study, there were 1238 women from the Coronary Artery Risk Development in Young Adults (CARDIA) study of young black and white women ages 18 to 30 years without diabetes at baseline (1985-1986) who had 1 or more live births after baseline, reported lactation duration, and were screened for diabetes up to 7 times during 30 years after baseline (1986-2016). Exposures: Time-dependent lactation duration categories (none, >0 to 6 months, >6 to <12 months, and ≥12 months) across all births since baseline through 30 years. Main Outcomes and Measures: Diabetes incidence rates per 1000 person-years and adjusted relative hazards (RH) with corresponding 95% CIs, as well as proportional hazards regression models adjusted for biochemical, sociodemographic, and reproductive risk factors, as well as family history of diabetes, lifestyle, and weight change during follow-up. Results: Overall 1238 women were included in this analysis (mean [SD] age, 24.2 [3.7] years; 615 black women). There were 182 incident diabetes cases during 27 598 person-years for an overall incidence rate of 6.6 cases per 1000 person-years (95% CI, 5.6-7.6); and rates for women with GD and without GD were 18.0 (95% CI, 13.3-22.8) and 5.1 (95% CI, 4.2-6.0), respectively (P for difference < .001). Lactation duration showed a strong, graded inverse association with diabetes incidence: adjusted RH for more than 0 to 6 months, 0.75 (95% CI, 0.51-1.09); more than 6 months to less than 12 months, 0.52 (95% CI, 0.31-0.87), and 12 months or more 0.53 (0.29-0.98) vs none (0 days) (P for trend = .01). There was no evidence of effect modification by race, GD, or parity. Conclusions and Relevance: This study provides longitudinal biochemical evidence that lactation duration is independently associated with lower incidence of diabetes. Further investigation is required to elucidate mechanisms that may explain this relationship.

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Metadata

Authors
Gunderson, E. P., Lewis, C. E., Lin, Y., Sorel, M., Gross, M., Sidney, S., Jacobs, D. R., Shikany, J. M., & Quesenberry, C. P.
Affiliations
  • Kaiser Permanente (US)
  • University of Alabama at Birmingham (US)
  • University of Minnesota (US)
Corresponding author
Gunderson, Erica P.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2018-03-01
Volume
178
Issue
3
Pages
328
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2017.7978
PMC
PMC5885916
OpenAlex
W2783725520
Cited by
164
References
63
Citations by year
2026: 10 · 2025: 16 · 2024: 27 · 2023: 18 · 2022: 23 · 2021: 20 · 2020: 19 · 2019: 15 · 2018: 16
FWCI
13.65
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Heart, Lung, and Blood Institute
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK090047, K01DK059944, R01DK106201, P30DK079626)
Topics
  • Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
lactation length, type 2 diabetes incidence, gestational diabetes mellitus, postpartum diabetes, women of reproductive age, Black women, cardiometabolic risk, reverse causality, unmeasured confounding, lifestyle habits, weight change, CARDIA cohort, diabetes prevention, young women, family history of diabetes
MeSH terms
Adult, Analysis of Variance, Black or African American, Breast Feeding, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Health Status, Humans, Lactation, Longitudinal Studies, Middle Aged, Prospective Studies, United States, Multicenter Studies as Topic, Incidence, Black People, White People, Young Adult

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