Elsevier

Women and Birth

Volume 28, Issue 2, June 2015, Pages 143-147
Women and Birth

Original Research - Quantitative
Factors associated with early cessation of breastfeeding in women with gestational diabetes mellitus

https://doi.org/10.1016/j.wombi.2014.12.002Get rights and content

Abstract

Aim

To determine factors associated with early cessation of breastfeeding (≤3 months) in women with recent gestational diabetes mellitus (GDM).

Methods

A cross-sectional online survey of women aged ≥18 years, diagnosed with GDM in 2010 and registered with the National Diabetes Services Scheme in Australia. The 59 questions examined breastfeeding duration, intention, attitudes, exclusivity and support.

Results

738 women completed the survey (15% response rate). Data was analysed for 729 eligible respondents. Of these 97% reported ‘ever’ breastfeeding and 19% had breastfed for ≤3 months. Cessation of breastfeeding at or before 3 months was associated with breastfeeding problems at home [adjusted odds ratio 8.01, 95% confidence interval (4.57, 14.05)], return to work prior to three months [OR 3.39 (95% CI 1.53, 7.55)], inadequate breastfeeding support [OR 1.88 (95% CI 1.10, 3.22)], caesarean delivery [OR 1.70 (95% CI 1.04, 2.76)], low socioeconomic status (SEIFA 1 unit increase) [OR 0.89 (95% CI 0.81, 0.97)] and BMI (2 unit increase) [OR 1.08 (95% CI 1.01, 1.57)]. Being married or de facto [OR 0.14 (95% CI 0.03, 0.62)] was a protective against early cessation of breastfeeding.

Conclusion

Strategies to improve breastfeeding duration in women with GDM need to address those most at risk of early cessation and provide appropriate postpartum breastfeeding support in this group.

Section snippets

Background

The benefits of breastfeeding for infant and maternal health have been well documented,1 and in the long-term, include a reduction in the risk of future maternal chronic disease, including type 2 diabetes.2 Despite evidence in the general population for the protective effects of breastfeeding on type 2 diabetes risk, there has been a paucity of evidence regarding specific long-term health benefits for women with gestational diabetes mellitus (GDM).3

Recently, two longer term studies reported

Methods

This study was a cross-sectional online survey of women aged ≥18 years, diagnosed with GDM in 2010 and registered with the National Diabetes Services Scheme (NDSS) in Australia. The NDSS is an initiative of the Commonwealth Government and provides subsidised diabetes related products and self management information and support. Registration is free and is open to all Australians with a diagnosis of diabetes confirmed by a health professional. All registrants have the option of consenting to

Results

Of the 15,817 women registered with the NDSS during 2010, invitations were sent to 5057 women who met the inclusion criteria, with 274 women unable to be contacted. Of those invited, 738 consented to participate (15% response rate). Ineligible respondents included 4 women who reported a stillbirth or neonatal death following a GDM pregnancy and 5 incomplete surveys, leaving total of 729 responses.

The age of respondents (mean ± SD) was 32.9 ± 4.8 years, 72.2% were Australian born, 9.7% spoke a

Discussion

This is the first study to examine breastfeeding in a national sample of Australian women with GDM. Breastfeeding problems at home were found to be the strongest predictor of early cessation in women with GDM in the current study. We found that women who reported problems at home were eight times more likely to stop feeding at or before three months. Although breastfeeding problems in hospital were significant in univariate analyses, only problems experienced at home remained significant in the

Limitations

Our study has several limitations, the main one being the low (15%) response rate. Although this was considerably less than that achieved in our previously studies using postal survey methodology with women with GDM,23 it is comparable to that reported in other online health surveys using the NDSS database.24 Despite the fact that data suggests that 72% of Australians have computer and internet access at home25 and the target group being predominately young women, recruitment may have been

Conclusion

In women with GDM, there are a number of factors influencing early cessation of breastfeeding which are consistent with those found in general population based breastfeeding studies. These include breastfeeding problems at home, BMI, caesarean section, SEIFA, marital status, early postpartum return to work and inadequate breastfeeding support. Compared to women without GDM, these risk factors for early cessation are likely to be more important for this group due to a disproportionate number of

Funding source

Australian Postgraduate Scholarship.

Conflict of interest

Nothing to declare.

Acknowledgements

We are grateful to the women with previous gestational diabetes whose participation made this study possible, to Kim Colyvas, Statistician, for statistical assistance and advice; as well as the National Diabetes Services Scheme and the Diabetes NSW for their support. This study was funded by an Australian Postgraduate Scholarship.

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