Differences in breast-feeding initiation and continuation by maternal diabetes status

Objective To examine (i) the prevalence of and associations between breast-feeding initiation and continuation by maternal diabetes status and (ii) the reasons for not initiating and/or continuing breast-feeding by maternal diabetes status. Design Secondary data analyses of a population-based cross-sectional study were conducting using data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2011. Multivariable logistic regression was used to investigate the associations between breast-feeding initiation and continuation by diabetes status. Setting Thirty states and New York City, USA. Subjects Mothers of recently live-born infants, selected by birth certificate sampling. Results Among 72755 women, 8·8 % had gestational diabetes mellitus (GDM) and 1·7 % had pregestational diabetes mellitus (PDM). Breast-feeding initiation was similar among GDM and no diabetes mellitus (NDM) women (80·8 % v. 82·2 %, respectively, P=0·2), but continuation was lower among GDM (65·7 % v. 68·8 %, respectively, P=0·01). PDM women had lower initiation and continuation compared with NDM (78·2 %, P=0·03 and 60·4 %, P<0·01, respectively). In adjusted analyses, current smoking status was a significant effect modifier for initiation, but not for continuation. Conclusions Differences in breast-feeding initiation and continuation prevalence by maternal diabetes status may reflect differences in prenatal education, indicating the need for increased efforts among PDM women. Additionally, non-smoking women with PDM or GDM would benefit from additional breast-feeding education.