Lifetime Duration of Breastfeeding and Cardiovascular Risk in Women With Type 2 Diabetes or a History of Gestational Diabetes
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
Breastfeeding duration is inversely associated with risks of cardiovascular disease (CVD) and type 2 diabetes in parous women. However, the association among women at high risk, including women with type 2 diabetes or gestational diabetes mellitus (GDM) is unclear.
RESEARCH DESIGN AND METHODS
We included 15,146 parous women with type 2 diabetes from the Nurses' Health Study I and II (NHS, NHS II) and 4,537 women with a history of GDM from NHS II. Participants reported history of breastfeeding via follow-up questionnaires. Incident CVD by 2017 comprised stroke or coronary heart disease (CHD) (myocardial infarction, coronary revascularization). Adjusted hazard ratios (aHRs) and 95% CIs were estimated using Cox models.
RESULTS
We documented 1,159 incident CVD cases among women with type 2 diabetes in both cohorts during 188,874 person-years of follow-up and 132 incident CVD cases among women with a GDM history during 100,218 person-years of follow-up. Longer lifetime duration of breastfeeding was significantly associated with lower CVD risk among women with type 2 diabetes, with pooled aHR of 0.68 (95% CI 0.54-0.85) for >18 months versus 0 months and 0.94 (0.91-0.98) per 6-month increment in breastfeeding. Similar associations were observed with CHD (pooled aHR 0.93 [0.88-0.97]) but not with stroke (0.96 [0.91-1.02]) per 6-month increment in breastfeeding. Among women with GDM history, >18 months versus 0 months of breastfeeding was associated with an aHR of 0.49 (0.28-0.86) for total CVD.
CONCLUSIONS
Longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or GDM.
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Additional Info
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Lifetime Duration of Breastfeeding and Cardiovascular Risk in Women With Type 2 Diabetes or a History of Gestational Diabetes: Findings From Two Large Prospective Cohorts
Diabetes Care 2024 Apr 01;47(4)720-728, A Birukov, M Guasch-Ferré, SH Ley, DK Tobias, F Wang, C Wittenbecher, J Yang, JE Manson, JE Chavarro, FB Hu, C ZhangFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Diabetes-related conditions are associated with increased cardiovascular risk. This is especially true for women, as it has been shown that diabetes is a stronger risk factor for CVD in women compared with men. Moreover, gestational diabetes (GDM) has been related to a higher maternal cardiovascular risk. A better understanding of the modifiable factors related to cardiovascular risk, including female-specific factors, is crucial to gain deeper insight into the development of CVD in women. Previous studies, mainly conducted in the general population, have shown that ever breastfeeding and longer lifetime durations of breastfeeding are linked with a lower risk for CVD events.
Leading on from this, the present study investigated the association between lifetime duration of breastfeeding and risk of CVD in women with type 2 diabetes (T2D) or a history of GDM. The study included 15,146 parous women with T2D and 4537 parous women with GDM from the Nurses' Health Study I and II, of whom 1159 and 132 experienced an incident CVD event, respectively. In women with T2D, a 6-month longer lifetime duration of breastfeeding was related to a 6% lower risk for CVD in multivariable adjusted models. In women with GDM, the corresponding relative risk reduction was 11%. Moreover, when comparing women who breastfed for more than 18 months with parous women who did not breastfeed, the relative risk for CVD was 32% lower in women with T2D and 51% lower in women with GDM. When women with GDM breastfed exclusively, the corresponding relative risk reduction was even higher at 68%.
Overall, this large-scale study highlights a favourable association between breastfeeding and risk of maternal CVD later in life.