Motherhood comes with a million questions: How much should my baby sleep? How often should I change their diaper? To mothers with type 1 diabetes, however, motherhood comes with the additional question of: If I breastfeed my baby, does it affect my blood glucose levels and health? DDA-funded PhDs Gitte Øskov Skajaa and Ulla Kampmann set out to answer this question with their new study ‘Breastfeeding and insulin requirements in women with type 1 diabetes in the first year postpartum’.

For growth and long-term health, the Danish Health Authority recommends that all infants be exclusively breastfed for the first six months of their lives. At the same time, breastfeeding may affect insulin requirements and the wellbeing of mothers with type 1 diabetes (T1D). Thus, the decision of whether or not to breastfeed is important when it comes to the health of both mother and baby. Therefore, Danish Diabetes Academy-funded (DDA) PhD’s Gitte Øskov Skajaa and Ulla Kampmann, together with colleagues Jens Fuglsang and Per G. Ovesen, set out to investigate breastfeeding and insulin requirements in women with type 1 diabetes (T1D) in the first year postpartum.

– When breastfeeding, glucose from the blood is absorbed by the mammary gland and is transported into the breastmilk. Therefore, mothers with T1D might worry that breastfeeding will result in low blood glucose, posing a danger to both mother and baby. This could make the women think that they should lower their insulin dosages in order to stay within normal range of blood glucose and thus avoid potential serious episodes, including dizziness and unconsciousness, caused by hypoglycemia. This could consequently result in higher blood glucose levels than necessary, says Gitte Øskov Skajaa and Ulla Kampmann.

The sparse amount of existing research within this field does not reflect the large number of mothers who are concerned about the pros and cons of breastfeeding, especially when suffering from T1D. Therefore, they set out to study whether the fear of low blood glucose during breastfeeding leads to lower doses of insulin and higher levels of HbA1c.

One thing less to worry about

In order to explore the effects of breastfeeding, Gitte Øskov Skajaa and Ulla Kampmann followed 66 women with T1D for one year after pregnancy. They gathered information about their insulin needs, their HbA1c, their current weight and asked whether they were breastfeeding.

– The data from the study indicate that mothers with T1D do not have to worry about breastfeeding having an effect on insulin requirements, says Gitte Øskov Skajaa and Ulla Kampmann.

They found that if mothers with T1D start to breastfeed it does not affect their blood glucose levels significantly and that the amount of insulin they need to maintain good blood glucose control does not seem to change substantially. They also found that breastfeeding does not affect how fast or how much weight the women lose after pregnancy. In addition, HbA1c was not affected majorly by the breastfeeding status.

Pros and cons of breastfeeding

The hope is that the knowledge from the study will improve the guidance of women with T1D given by health care providers regarding breastfeeding.

– We wanted to help new mothers to be able to make an informed decision by contributing with research-based knowledge on this topic, says Gitte Øskov Skajaa and Ulla Kampmann.

To improve the guidance of women with diabetes who want to breastfeed for longer than six months, there is a need for more research about the breastfeeding periods of mothers with T1D. Future studies should include more women, contain more detailed information on the length of breastfeeding and examine whether there is a difference in insulin needs between women with T2D and T1D, respectively. This would fill out important knowledge gaps.

Aims: To explore whether breastfeeding affects postpartum insulin requirements, HbA1c levels, and pregnancy weight retention in women with Type 1 Diabetes Mellitus (T1DM).

Methods: This prospective study included 66 women with T1DM. The women were divided into two groups based on whether they were breastfeeding (BF) at 6 months postpartum (BF_yes, n = 32) or not (BF_no, n = 34). Mean daily insulin requirement (MDIR), HbA1c levels, and pregnancy weight retention at 5 time-points from discharge to 12 months postpartum were compared.

Conclusion: In women with T1DM, breastfeeding did not significantly affect postpartum insulin requirements, HbA1c levels or pregnancy weight retention in the first year after delivery.

Breastfeeding and insulin requirements in women with Type 1 diabetes mellitus in the first year postpartum. Acta Diabetol. 2023 Mar 29. doi: 10.1007/s00592-023-02068-1. (Gitte Øskov Skajaa, Ulla Kampmann , Per Glud Ovesen, Jens Fuglsang)

Contact Information

Gitte Øskov Skajaa, MD, PhD
Department of Obstetrics and Gynecology, Aarhus University Hospital.
E-mail: gitteoskajaa@gmail.com
LinkedIn: Gitte Øskov Skajaa

Ulla Kampmann, PhD
Associate Professor, consultant
Steno Diabetes Centre Aarhus, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University
E-mail: ulla.kampmann@clin.au.dk
LinkedIn: Ulla Kampmann Opstrup