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