Premium
Obstetrical practices but not gestational metabolic abnormalities are associated with delayed onset of lactogenesis
Author(s) -
Ley Sylvia H,
Hanley Anthony J,
Zinman Bernard,
O'Connor Deborah L
Publication year - 2013
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.27.1_supplement.122.2
Subject(s) - medicine , gestational diabetes , breastfeeding , obstetrics , pregnancy , insulin resistance , gestation , gestational age , obesity , pediatrics , genetics , biology
Women with pre‐existing diabetes and obesity experience delayed onset of lactogenesis II (DOLac), but the impact of metabolic abnormalities developed during pregnancy on DOLac is unclear. We aimed to investigate the associations of metabolic status assessed during pregnancy with DOLac (onset of lactogenesis II ≥72 h postpartum). Participants (n=177) underwent a 3‐h oral glucose tolerance test at 30 (25 th , 75 th %tile: 29, 32) weeks gestation, and follow‐up interviews were conducted at 1, 3, and 7 d postpartum. Of 177, 98 (55.4%) women experienced DOLac. Gestational metabolic abnormalities, including gestational diabetes, insulin resistance (HOMA‐IR) and lower insulin sensitivity (Matsuda index), were not associated with DOLac. However, risks for DOLac were increased among women who had an unscheduled C‐section (OR 2.24 [95% CI 1.02, 4.92] vs. spontaneous delivery) and delayed initiation of breastfeeding (2.30 [1.09, 4.86] comparing ≤1 vs. >;2 h) with adjustment for age and ethnicity. Further, women who had an unscheduled C‐section put their infant to the breast at 2.0 (25 th , 75 th %tile: 1.0, 5.1) h, while women who had a spontaneous delivery did so at 1.0 (0.8, 2.0) h. In conclusion, gestational metabolic abnormalities are not associated with DOLac, but obstetrical practices including unscheduled C‐section and delayed timing of breastfeeding initiation increase risk for DOLac. Funding: CDA, CFDR, CIHR