Q&A: Breastfeeding has beneficial effects on cardiometabolic health

Key takeaways:

• Breastfeeding improves CV risk factors and may lower risks for type 2 diabetes and heart disease.
• Women should enter prenatal care early and follow all appropriate testing and receive available interventions.

Breastfeeding has lasting beneficial effects on cardiometabolic health, including lowering the risk for type 2 diabetes and cardiovascular disease, for mothers and obesity in their children, according to a life course epidemiologist.

Erica P. Gunderson, PhD, MS, MPH, senior research scientist at Kaiser Permanente Northern California Division of Research and professor at the Kaiser Permanente Bernard J. Tyson School of Medicine, was awarded the 2022-2023 March of Dimes Agnes Higgins Award in Maternal-Fetal Nutrition at the Pediatric Academic Society annual meeting in April. The March of Dimes award was granted in recognition of Gunderson’s lifetime research regarding critical links between breastfeeding, gestational diabetes, and hypertension on future maternal cardiometabolic health and childhood obesity.

Healio spoke with Gunderson about her previous research areas as well as research efforts in maternal-fetal nutrition and cardiometabolic health outcomes that she will be focusing on in the future.

Healio: How are breastfeeding, gestational diabetes and hypertension associated with future maternal cardiometabolic health? How do they affect childhood obesity?

Gunderson: Gestational diabetes and hypertensive disorders of pregnancy are risk factors for less favorable long-term cardiometabolic health. And, of course, they both increase the risk for type 2 diabetes and/or CVD in women. We also have learned that gestational diabetes in their mother can also adversely affect the metabolic health of the children increasing their risk of obesity. Meanwhile breastfeeding seems to have beneficial effects on specific CVD risk factors for women, such as lower blood triglycerides and reduction of fat depositions in the heart, belly and liver. My research has shown that higher intensity and longer breastfeeding are associated with lowering the risk for type 2 diabetes by one half among women with recent gestational diabetes followed since pregnancy in the SWIFT Study. Also, breastfeeding and avoidance of sugary beverages during early life were associated with lower risk for obesity among the SWIFT offspring of mothers with gestational diabetes.

Healio: How long does breastfeeding protect mothers against cardiometabolic diseases?
That is an important question. The short-term beneficial effects of breastfeeding for the growth and health of children are already well known, including protection against infectious diseases. There are also immediate benefits for the mother, such as decreasing blood loss, improving emotional well-being and faster recovery of her earlier metabolic state before pregnancy. Less evidence is available about the lasting effects of breastfeeding on future cardiometabolic health in both women and their children.

In the U.S. multicenter CARDIA study, a 30-year follow-up study of Black and white women, we measured cardiometabolic health before pregnancy and again many years after pregnancy. This study design was novel in measuring cardiometabolic health before pregnancy, social factors and evaluating pregnancy complications that may affect breastfeeding success.

We found a 50% relative risk reduction in new-onset type 2 diabetes over 30 years among CARDIA Black and white women who had breastfed for 5 months or longer overall. This study evaluated social factors, pregnancy complications and measured pre-pregnancy cardiometabolic health, body size and changes in lifestyle behaviors over time that lead to diabetes. We found that longer breastfeeding also conferred the same strong protection against diabetes for both women with and without gestational diabetes. The findings were similar for both white women and Black women.

Healio: What early life behaviors can mothers with gestational diabetes adopt to improve the metabolic profiles of their children?
Mothers with gestational diabetes should follow the American Academy of Pediatrics recommendations for infant feeding and breastfeed, if possible. The American Academy of Pediatrics recommends avoiding giving sugary beverages and fruit juice to infants during the first year of life, and that is important advice. Limiting these sorts of sugary beverages, even natural or added sugar, is important to establishing healthy food habits and preferences. It is especially important for children of mothers with gestational diabetes to avoid excess simple sugars during this early developmental period to prevent childhood overweight or obesity.

Healio: What are some preconception strategies you’ve identified to prevent gestational diabetes?
Preparation for pregnancy is important for all women, and there are some critical steps that are recommended for preconception health. One of the most important is taking prenatal vitamin mineral supplements months ahead of conception, in particular, folic acid. It’s a very important nutrient for fetal development. If you think you’re at risk for gestational diabetes because you have high body weight, a family history of diabetes or you’re over 35, it’s important to consult with your primary care provider about any preexisting health conditions and be screened for blood pressure and glucose tolerance and other health conditions that might predispose to gestational diabetes or other pregnancy complications.

Healio: What are some preventive methods for hypertension during pregnancy?

Gunderson: High blood pressure may be prevented or alleviated by healthy lifestyle behaviors, including good nutrition, physical activity, and healthy sleep patterns. If you have a history of hypertensive disorders in a previous pregnancy, chronic hypertension or a family history of pregnancy hypertension, it is important to plan your pregnancy because entering pregnancy with the best health possible is crucial.

Healio: Is there anything else you would like to add?

Gunderson: Pregnancy complications are potential signals about future health and can be treated and controlled during pregnancy. It’s very important to enter pregnancy in the best health possible, particularly if you have pre-existing health conditions. I recommend starting prenatal care early and following all the appropriate testing. It’s also helpful for all women, no matter their risk factors, to follow healthy lifestyle habits before pregnancy.

If you’d like to breastfeed, reaching out early to obtain education and support is particularly important, especially if you haven’t breastfed before. Support in the hospital as well as at home is important, because breastfeeding can be challenging, especially for mothers with pregnancy complications or higher body weight.

Reference:

• Faith MS, et al. JAMA Pediatr. 2019;doi:10.1001/jamapediatrics.2018.5199.
• Friedman GD, et al. J Clin Epidemiol. 2023;doi:10.1016/0895-4356(88)90080-7.
• Gunderson EP, et al. JAMA Intern Med. 2018;doi:10.1001/jamainternmed.2017.7978.
• Gunderson EP, et al. JAMA Intern Med. 2015;doi:10.7326/M15-0807.
• Gunderson EP, et al. BMC Public Health. 2011;doi:10.1186/1471-2458-11-952.
• Kim C, et al. J Am Heart Assoc. 2023;doi:10.1161/JAHA.122.028132.