Global guideline on pregnancy and diabetes - International ...

<strong>Global</strong> Guideline on Pregnancy and Diabetes
5. After pregnancy
5.1 Breastfeeding
Unless there is a specific contra-indication or concern,
breastfeeding is the preferred option for all women. This
general recommendation is also applicable to women
whose pregnancy was affected by pre-existing or gestational
diabetes. However, it should be noted that it is
possible for breastfeeding to have an influence on maternal
glycaemic control, and maternal diabetes may in turn
influence the composition of breast milk.
Along with nutritional and immunological advantages,
breastfeeding has been associated in the general population
with a reduction in the rates of childhood obesity.
The breast milk of mothers with diabetes has been shown
to have a higher glucose and energy content than that
of non-diabetic mothers [102,103]. Perhaps because
of this, the potential for breastfeeding to be protective
against subsequent overweight in the children of
women with diabetes has been questioned, and this has
been examined without clear conclusions being drawn
[104]. In the absence of evidence, it seems advisable to
maintain good maternal glycaemic control during the
breastfeeding period.
For women with pre-existing insulin-treated diabetes, in
limited studies, there was no difference in insulin requirements
or in the rate of hypoglycaemia between those
women who breastfed compared with those women who
did not [105,106]. However, there is recent evidence that
type 1 diabetic women have a reduced basal insulin need
during lactation [107].
Transfer of metformin to human milk is minimal, at