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Milk Production in Mothers with and without Signs of Insulin Resistance

by Laurie Nommsen-Rivers, PhD, RD, IBCLC
  • Duration: 540 Mins
  • Credits: 0.25 CERP, 0.25 L-CERP
  • Learning Format: Webinar
  • Handout: No
  • Origin: ABM Conference 2016
Abstract:

Laurie Nommsen-Rivers, PhD; Sarah Riddle1, MD; Amy Thompson2, MD; Laura Ward1, MD; and Erin Wagner1, MS. 1Cincinnati Children’s Hospital Medical Center and 2University of Cincinnati College of Medicine, Cincinnati, Ohio

Background: Maternal obesity is associated with shortened breastfeeding duration. Insulin resistance is a physiologic hallmark of obesity and may underlie lactation difficulties.
Objective: Our objective is to compare 24-hour milk production in mothers with signs of insulin resistance (IR) versus those without.
Methods: We examined baseline data from the MALMS study, a randomized placebo-controlled trial of metformin to augment low milk supply. Baseline eligibility includes: mother 1-8 weeks postpartum, healthy term infant, and currently supplementing, but strong desire to achieve exclusive breastfeeding. At baseline, all women record 24 hour milk production and are evaluated for the following signs of IR: fasting plasma glucose > 95 mg/dL, abdominal obesity, recent gestational diabetes, or polycystic ovary syndrome. We compared baseline 24-hour milk production in IR versus no IR groups, and then in obese versus non-obese groups. Results: 33 (69%) exhibited signs of IR and 15 had no IR signs. Mean age (+SD) of mother (31+5 years) and infant (4+2 weeks) did not differ between groups, but BMI was significantly higher in the IR group (36.9+7.9 versus 25.4+3.6 kg/m2, P<0.001). Relative ranking of milk production was significantly lower in IR versus no-IR: Median [interquartile range], 216[158-332] versus 377[294-598] mL/day, P=0.004; and differences were less pronounced when milk output compared for obese versus non-obese, P=0.05.

Conclusion: While poor lactation management may have contributed to low production in some participants, our results point to an additional deficit associated with IR.
Funding source: NIH 5 K12 HD051953 (PI, Tsevat), Bridging Interdisciplinary Research Careers in Women’s Health (BIRCWH award to LN-R).

Learning Objectives:

Objective 1: insulin plays a direct and significant role in stimulating milk synthesis in the mammary gland
Objective 2: among mothers with low milk supply striving to exclusively breastfeed, mothers with signs of insulin resistance made significantly less milk than mothers without signs of insulin resistance
Objective 3: not all obese mothers have trouble breastfeeding, but those with signs of insulin resistance may be particularly at risk for lactation difficulty
Objective 4: inability to exclusively breastfeed may be more common than previously believed, especially in settings where poor metabolic health is common