Duration of lactation and incidence of the metabolic syndrome in women of reproductive age according to gestational diabetes mellitus status: a 20-Year prospective study in CARDIA (Coronary Artery Risk Development in Young Adults)

Erica P Gunderson, David R Jacobs Jr, Vicky Chiang, Cora E Lewis, Juanran Feng, Charles P Quesenberry Jr, Stephen Sidney, Erica P Gunderson, David R Jacobs Jr, Vicky Chiang, Cora E Lewis, Juanran Feng, Charles P Quesenberry Jr, Stephen Sidney

Abstract

Objective: The objective of the study was to prospectively assess the association between lactation duration and incidence of the metabolic syndrome among women of reproductive age.

Research design and methods: Participants were 1,399 women (39% black, aged 18-30 years) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, an ongoing multicenter, population-based, prospective observational cohort study conducted in the U.S. Women were nulliparous and free of the metabolic syndrome at baseline (1985-1986) and before subsequent pregnancies, and reexamined 7, 10, 15, and/or 20 years after baseline. Incident metabolic syndrome case participants were identified according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Complementary log-log models estimated relative hazards of incident metabolic syndrome among time-dependent lactation duration categories by gestational diabetes mellitus (GDM) adjusted for age, race, study center, baseline covariates (BMI, metabolic syndrome components, education, smoking, physical activity), and time-dependent parity.

Results: Among 704 parous women (620 non-GDM, 84 GDM), there were 120 incident metabolic syndrome case participants in 9,993 person-years (overall incidence rate 12.0 per 1,000 person-years; 10.8 for non-GDM, 22.1 for GDM). Increased lactation duration was associated with lower crude metabolic syndrome incidence rates from 0-1 month through >9 months (P < 0.001). Fully adjusted relative hazards showed that risk reductions associated with longer lactation were stronger among GDM (relative hazard range 0.14-0.56; P = 0.03) than non-GDM groups (relative hazard range 0.44-0.61; P = 0.03).

Conclusions: Longer duration of lactation was associated with lower incidence of the metabolic syndrome years after weaning among women with a history of GDM and without GDM, controlling for preconception measurements, BMI, and sociodemographic and lifestyle traits. Lactation may have persistent favorable effects on women's cardiometabolic health.

Figures

FIG. 1.
FIG. 1.
Flow diagram for analytic sample selection: 704 women who were nulliparous, free of the metabolic syndrome, and aged 18–30 years at baseline (1985–1986) who delivered at least one singleton live birth during the 20-year follow-up period.
FIG. 2.
FIG. 2.
Crude incidence rates (95% CIs) of the metabolic syndrome during 20 years of follow-up for lactation categories by GDM status.
FIG. 3.
FIG. 3.
Crude incidence rates (95% CIs) of the metabolic syndrome during 20 years of follow-up for lactation categories by GDM status (1986–2006) and race (black and white).

References

    1. Gunderson EP, Lewis CE, Tsai AL, Chiang V, Carnethon M, Quesenberry CP, Jr, Sidney S: A 20-year prospective study of childbearing and incidence of diabetes mellitus in young women controlling for glycemia before conception: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Diabetes 2007;56:2990–2996
    1. Kim C, Newton KM, Knopp RH: Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002;25:1862–1868
    1. Gunderson EP, Jacobs DR, Jr, Chiang V, Lewis CE, Tsai A, Quesenberry CP, Jr, Sidney S: Childbearing is associated with higher incidence of the metabolic syndrome among women of reproductive age controlling for measurements before pregnancy: the CARDIA study. Am J Obstet Gynecol 2009;201:177.e1–9
    1. Knopp RH, Walden CE, Wahl PW, Bergelin R, Chapman M, Irvine S, Albers JJ: Effect of postpartum lactation on lipoprotein lipids and apoproteins. J Clin Endocrinol Metab 1985;60:542–547
    1. Tigas S, Sunehag A, Haymond MW: Metabolic adaptation to feeding and fasting during lactation in humans. J Clin Endocrinol Metab 2002;87:302–307
    1. Kjos SL, Henry O, Lee RM, Buchanan TA, Mishell DR, Jr: The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes. Obstet Gynecol 1993;82:451–455
    1. Lenz S, Kuhl C, Hornnes PJ, Hagen C: Influence of lactation on oral glucose tolerance in the puerperium. Acta Endocrinol (Copenh) 1993;98:428–431
    1. Gunderson EP, Lewis CE, Wei GS, Whitmer RA, Quesenberry CP, Sidney S: Lactation and changes in maternal metabolic risk factors. Obstet Gynecol 2007;109:729–738
    1. Cohen A, Pieper CF, Brown AJ, Bastian LA: Number of children and risk of metabolic syndrome in women. J Womens Health (Larchmt) 2006;15:763–773
    1. Ram KT, Bobby P, Hailpern SM, Lo JC, Schocken M, Skurnick J, Santoro N: Duration of lactation is associated with lower prevalence of the metabolic syndrome in midlife—SWAN, the study of women's health across the nation. Am J Obstet Gynecol 2008;198:268–266
    1. Schwarz EB, Ray RM, Stuebe AM, Allison MA, Ness RB, Freiberg MS, Cauley JA: Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol 2009;113:974–982
    1. Stuebe AM, Michels KB, Willett WC, Manson JE, Rexrode K, Rich-Edwards JW: Duration of lactation and incidence of myocardial infarction in middle to late adulthood. Am J Obstet Gynecol 2009;200:138.e1–8
    1. Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB: Duration of lactation and incidence of type 2 diabetes. JAMA 2005;294:2601–2610
    1. Cutter GR, Burke GL, Dyer AR, Friedman GD, Hilner JE, Hughes GH, Hulley SB, Jacobs DR, Jr, Liu K, Manolio TA: Cardiovascular risk factors in young adults: the CARDIA baseline monograph. Control Clin Trials 1991;12:1S–77S
    1. Friedman GD, Cutter GR, Donahue RP, Hughes GH, Hulley SB, Jacobs DR, Jr, Liu K, Savage PJ: CARDIA: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol. 1988;41:1105–1116
    1. Lewis CE, Jacobs DR, Jr, McCreath H, Kiefe CI, Schreiner PJ, Smith DE, Williams OD: Weight gain continues in the 1990s: 10-year trends in weight and overweight from the CARDIA study: Coronary Artery Risk Development in Young Adults. Am J Epidemiol 2000;151:1172–1181
    1. Steffen LM, Kroenke CH, Yu X, Pereira MA, Slattery ML, Van Horn L, Gross MD, Jacobs DR, Jr: Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2005;82:1169–1177
    1. Bild DE, Jacobs DR, Liu K, Williams OD, Hilner JE, Perkins LL, Marcovina SM, Hulley SB: Seven-year trends in plasma low-density-lipoprotein-cholesterol in young adults: the CARDIA Study. Ann Epidemiol. 1996;6:235–245
    1. Lewis CE, Funkhouser E, Raczynski JM, Sidney S, Bild DE, Howard BV: Adverse effect of pregnancy on high density lipoprotein (HDL) cholesterol in young adult women: The CARDIA Study: Coronary Artery Risk Development in Young Adults. Am J Epidemiol 1996;144:247–254
    1. Lewis CE, Smith DE, Wallace DD, Williams OD, Bild DE, Jacobs DR, Jr: Seven-year trends in body weight and associations with lifestyle and behavioral characteristics in black and white young adults: the CARDIA study. Am J Public Health 1997;87:635–642
    1. Smith DE, Lewis CE, Caveny JL, Perkins LL, Burke GL, Bild DE: Longitudinal changes in adiposity associated with pregnancy: The CARDIA Study: Coronary Artery Risk Development in Young Adults Study. JAMA 1994;271:1747–1751
    1. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285:2486–2497
    1. Anderssen N, Jacobs DR, Jr, Sidney S, Bild DE, Sternfeld B, Slattery ML, Hannan P: Change and secular trends in physical activity patterns in young adults: a seven-year longitudinal follow-up in the Coronary Artery Risk Development in Young Adults Study (CARDIA). Am J Epidemiol 1996; 143: 351– 362
    1. Sidney S, Haskell WL, Crow R, Sternfeld B, Oberman A, Armstrong MA, Cutter GR, Jacobs DR, Savage PJ, Van Horn L: Symptom-limited graded treadmill exercise testing in young adults in the CARDIA study. Med Sci Sports Exerc 1992;24:177–183
    1. Prentice RL, Gloeckler LA: Regression analysis of grouped survival data with application to breast cancer data. Biometrics 1978;34:57–67
    1. Gunderson EP: Breastfeeding after gestational diabetes pregnancy: subsequent obesity and type 2 diabetes in women and their offspring. Diabetes Care 2007;30(Suppl. 2):S161– S168
    1. Dewey KG: Energy and protein requirements during lactation. Annu Rev Nutr 1997;17:19–36
    1. Butte NF, Hopkinson JM, Mehta N, Moon JK, Smith EO: Adjustments in energy expenditure and substrate utilization during late pregnancy and lactation. Am J Clin Nutr 1999;69:299–307
    1. Fraser AB, Grimes DA: Effect of lactation on maternal body weight: a systematic review. Obstet Gynecol Surv 2003;58:265–269
    1. Janney CA, Zhang D, Sowers M: Lactation and weight retention. Am J Clin Nutr 1997;66:1116–1124
    1. Kramer FM, Stunkard AJ, Marshall KA, McKinney S, Liebschutz J: Breast-feeding reduces maternal lower-body fat. J Am Diet Assoc 1993;93:429–433
    1. Dewey KG, Heinig MJ, Nommsen LA: Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr 1993;58:162–166
    1. Sohlström A, Forsum E: Changes in adipose tissue volume and distribution during reproduction in Swedish women as assessed by magnetic resonance imaging. Am J Clin Nutr 1995;61:287–295
    1. Sadurskis A, Kabir N, Wager J, Forsum E: Energy metabolism, body composition, and milk production in healthy Swedish women during lactation. Am J Clin Nutr 1988;48:44–49
    1. Brewer MM, Bates MR, Vannoy LP: Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating women. Am J Clin Nutr 1989;49:259–265
    1. Butte NF, Hopkinson JM: Body composition changes during lactation are highly variable among women. J Nutr 1998;128:381S–385S
    1. Wosje KS, Kalkwarf HJ: Lactation, weaning, and calcium supplementation: effects on body composition in postpartum women. Am J Clin Nutr 2004;80:423–429
    1. McManus RM, Cunningham I, Watson A, Harker L, Finegood DT: Beta-cell function and visceral fat in lactating women with a history of gestational diabetes. Metabolism 2001;50:715–719
    1. Darmady JM, Postle AD: Lipid metabolism in pregnancy. Br J Obstet Gynaecol 1982;89:211–215
    1. Qureshi IA, Xi XR, Limbu YR, Bin HY, Chen MI: Hyperlipidaemia during normal pregnancy, parturition and lactation. Ann Acad Med Singapore 1999;28:217–221
    1. Erkkola R, Viikari J, Irjala K, Solakivi-Jaakkola T: One-year follow-up of lipoprotein metabolism after pregnancy. Biol Res Pregnancy Perinatol 1986;7:47–51
    1. Knopp RH, Bergelin RO, Wahl PW, Walden CE: Effects of pregnancy, postpartum lactation, and oral contraceptive use on the lipoprotein cholesterol/triglyceride ratio. Metabolism 1985;34:893–899
    1. Kallio MJ, Siimes MA, Perheentupa J, Salmenperä L, Miettinen TA: Serum cholesterol and lipoprotein concentrations in mothers during and after prolonged exclusive lactation. Metabolism 1992;41:1327–1330

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner