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Background:  The incidence of diabetes is rising, and with it, the number of pregnancies affected by diabetes. U.S. black women have a disproportionately high prevalence of diabetes and lower rates of breastfeeding.  Objective:  The objective of this study was to quantify the relationship between diabetes before pregnancy and breastfeeding duration among black women in the United States.  Materials and Methods:  We analyzed women from the Black Women's Health Study ( N  = 59,000) to assess the relationship between prepregnancy diabetes and time to breastfeeding cessation occurring up to 24 months postdelivery using Kaplan-Meier survival curves, log rank tests, and Cox proportional hazards models. The study population included primiparous women with births between 1995 and 2009 ( N  = 3,404). Obesity, hypertension before pregnancy, and family history of diabetes were examined for effect modification.  Results:  Survival curves demonstrated a markedly reduced duration of breastfeeding in women who had been diagnosed with prepregnancy diabetes ( p  &lt; 0.01). The hazard ratio for breastfeeding cessation for women with prepregnancy diabetes was 1.5 (95% confidence interval 1.1-2.0) compared with women without prepregnancy diabetes after control for age, body mass index (BMI) at age 18, prepregnancy BMI, other metabolic factors, demographics, and health behaviors.  Conclusions:  Our results suggest that prepregnancy diabetes is a strong predictor of curtailed breastfeeding duration, even after control for BMI. This underscores the need for targeted lactation support for diabetic women.

Prepregnancy Diabetes and Breastfeeding Cessation Among Black Women in the United States