Dergiler / KTO Karatay Üniversitesi Sağlık Bilimleri Dergisi / 2026 / Cilt: 4 Sayı: 2

Gestasyonel Diyabetes Mellitusun Emzirme ve Doğum Sonu Dönem Üzerine Etkisi

Effect of Gestational Diabetes Mellitus on Breastfeeding and Postpartum Period

Emine Kınık(BIRUNI UNIVERSITY, FACULTY OF HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY)0000-0002-5701-4046
Tülay Yılmaz(İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA, SAĞLIK BİLİMLERİ FAKÜLTESİ, EBELİK BÖLÜMÜ, EBELİK PR.)0000-0002-3706-3844
Hüsniye Dinç Kaya(İSTANBUL ÜNİVERSİTESİ - CERRAHPAŞA)0000-0002-8461-643X
Sevil Günaydın(İSTANBUL ÜNİVERSİTESİ-CERRAHPAŞA, SAĞLIK BİLİMLERİ FAKÜLTESİ, EBELİK BÖLÜMÜ, EBELİK PR.)0000-0003-2539-8783
Sayfa
139–150
Yayın Tarihi
2023-12-13
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⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Bu çalışmalarda yer alan mevcut kanıtlar doğum sonu anne glukoz düzeyinin normal sınırlarda tutulmasının, annede beden kitle indeksinin azalmasının bebekte Tip 2 Diyabet gelişim riskini azalttığını göstermektedir.

📌 3 Maddede Bu Makale

🎯
Amaç & Hipotez:Gestasyonel Diyabetes Mellitus’un artan prevalansı nedeni ile emzirme ve doğum sonu dönem üzerindeki rolünün belirlenmesi büyük önem taşımaktadır.
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Temel Bulgular & Veri:Bu faktörler arasında annenin emzirme durumunun değerlendirilmesi, bebeğin beslenme durumunun değerlendirilmesi ve doğum sonu dönemde kadınların yakınları (aile, eş, arkadaş gibi) tarafından desteklenmesi oldukça önemlidir.
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Sonuç & Katkı:Bu çalışmalarda yer alan mevcut kanıtlar doğum sonu anne glukoz düzeyinin normal sınırlarda tutulmasının, annede beden kitle indeksinin azalmasının bebekte Tip 2 Diyabet gelişim riskini azalttığını göstermektedir.
🔬Tür:Literatür & Derleme Çalışması
📍Kapsam:Genişletilmiş Akademik Örneklem
⚙️Değişkenler:Gestasyonel Diyabetes Mellitus · anne sütü · emzirme

Özet

Gestasyonel Diyabetes Mellitus’un artan prevalansı nedeni ile emzirme ve doğum sonu dönem üzerindeki rolünün belirlenmesi büyük önem taşımaktadır. Gestasyonel Diyabetes Mellitus (GDM)’lu kadınlarda anne sütünün salınımının geciktiğini ve içeriğinde bulunan bileşenlerin değiştiğini gösteren çalışmalar bulunmaktadır. GDM’li kadınların emzirmeye başlama konusunda daha fazla zorluk yaşadığı, erken doğum sonu dönemde formula mama verme olasılıklarının daha yüksek olduğu ve daha sonraki dönemde sadece emzirme olasılıklarının daha düşük olduğu bildirilmektedir. GDM'li kadınlar için emzirme sonuçlarını iyileştirmeye yönelik potansiyel yöntemler çok faktörlüdür. Bu faktörler arasında annenin emzirme durumunun değerlendirilmesi, bebeğin beslenme durumunun değerlendirilmesi ve doğum sonu dönemde kadınların yakınları (aile, eş, arkadaş gibi) tarafından desteklenmesi oldukça önemlidir. GDM’nin doğum sonu dönem üzerine etkileri açısından glikoz düzeyi, beden kitle indeksi ve Tip 2 Diyabet gelişme riski ile ilgili çalışmalar bulunmaktadır. Bu çalışmalarda yer alan mevcut kanıtlar doğum sonu anne glukoz düzeyinin normal sınırlarda tutulmasının, annede beden kitle indeksinin azalmasının bebekte Tip 2 Diyabet gelişim riskini azalttığını göstermektedir. Bu derlemede gestasyonel diyabetes mellitusun emzirme ve doğum sonu dönemde anne-bebek sağlığı üzerine etkilerinin incelenmesi amaçlanmıştır.

Abstract

Due to the increasing prevalence of Gestational Diabetes Mellitus, it is very important to determine its role on breastfeeding and the postpartum period. There are studies showing that the secretion of breast milk is delayed in women with Gestational Diabetes Mellitus (GDM) and the components in its content change. It has been reported that women with GDM have more difficulties in starting breastfeeding, they are more likely to give formula in the early postpartum period, and they are less likely to breastfeed exclusively in the later period. Potential ways to improve breastfeeding outcomes for women with GDM are multifactorial. Among these factors, the evaluation of the mother's breastfeeding status, the evaluation of the infant's nutritional status and the support of women by their relatives (such as family, spouse, friends) in the postpartum period are very important. In terms of the effects of GDM on the postpartum period, there are studies on glucose level, body mass index and the risk of developing Type 2 Diabetes. The available evidence in these studies shows that keeping maternal glucose levels within normal limits after delivery and a decrease in maternal body mass index reduce the risk of developing Type 2 Diabetes in the baby. In this review, it is aimed to examine the effects of gestational diabetes mellitus on mother-infant health during breastfeeding and postpartum period.

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Bu Makaleye Atıf Yap

Kınık, E., Yılmaz, T., Kaya, H. D., Günaydın, S. (2023). Gestasyonel Diyabetes Mellitusun Emzirme ve Doğum Sonu Dönem Üzerine Etkisi. KTO Karatay Üniversitesi Sağlık Bilimleri Dergisi, Cilt: 4 Sayı: 2, 139–150. https://doi.org/10.59244/ktokusbd.1263478

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Kaynakça (60)

  1. American Diabetes Association (ADA) (2021). 14. Management of diabetes in pregnancy: Standards of medical care in diabetes-2021. Diabetes Care, 44(Suppl 1), S200-S210. https://doi.org/10.2337/dc21-S014
  2. Aroda, V. R., Christophi, C. A., Edelstein, S. L., Zhang, P., Herman, W. H., Barrett-Connor, E.,. & Ratner, R. E. (2015). Diabetes Prevention Program Research Group. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: The Diabetes Prevention Program outcomes study 10-year follow-up. The Journal of Clinical Endocrinology & Metabolism, 100(4), 1646-1653. https://doi.org/10.1210/jc.2014-3761
  3. Aune, D., Norat, T., Romundstad, P., & Vatten, L. J. (2014). Breastfeeding and the maternal risk of type 2 diabetes: A systematic review and dose–response meta-analysis of cohort studies. Nutrition, Metabolism and Cardiovascular Diseases, 24(2), 107-115. https://doi.org/10.1016/j.numecd.2013.10.028
  4. Borgen, I., Småstuen, M. C., Jacobsen, A. F., Garnweidner-Holme, L. M., Fayyad, S., Noll, J., & Lukasse, M. (2019). Effect of the Pregnant+ smartphone application in women with gestational diabetes mellitus: A randomised controlled trial in Norway. BMJ Open, 9(11), e030884. http://dx.doi.org/10.1136/bmjopen-2019-030884
  5. Castillo, W. C., Boggess, K., Stürmer, T., Brookhart, M. A., Benjamin, D. K., & Funk, M. J. (2015). Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes. JAMA pediatrics, 169(5), 452-458. https://doi:10.1001/jamapediatrics.2015.74
  6. Chamberlain, C. R., Wilson, A. N., Amir, L. H., O'Dea, K., Campbell, S., Leonard, D.,. & Wolfe, R. (2017). Low rates of predominant breastfeeding in hospital after gestational diabetes, particularly among Indigenous women in Australia. Australian and New Zealand Journal of Public Health, 41(2), 144-150. https://doi.org/10.1111/1753-6405.12629
  7. Chertok, I. R., Raz, I., Shoham, I., Haddad, H., & Wiznitzer, A. (2009). Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes. Journal of Human Nutrition and Dietetics, 22(2), 166-169. https://doi.org/10.1111/j.1365-277X.2008.00921.x
  8. Cordero, L., Gabbe, S. G., Landon, M. B., & Nankervis, C. A. (2013). Breastfeeding initiation in women with gestational diabetes mellitus. Journal of Neonatal-Perinatal Medicine, 6(4), 303-310. https://doi.org/10.3233/NPM-1372513
  9. Cordero, Y., Mottola, M. F., Vargas, J., Blanco, M., & Barakat, R. (2015). Exercise is associated with a reduction in gestational diabetes mellitus. Medicine and Science in Sports and Exercise, 47(7), 1328. https://doi.org/10.1249/MSS.0000000000000547
  10. Dugas, C., Laberee, L., Perron, J., St-Arnaud, G., Richard, V., Perreault, V.,. & Robitaille, J. (2023). Gestational diabetes mellitus, human milk composition, and infant growth. Breastfeeding Medicine, 18(1), 14-22. https://doi.org/10.1089/bfm.2022.0085
  11. Ehrenthal, D. B., Maiden, K., Rogers, S., & Ball, A. (2014). Postpartum healthcare after gestational diabetes and hypertension. Journal of Women's Health, 23(9), 760-764. https://doi.org/10.1089/jwh.2013.4688
  12. Fenger-Grøn, J., Fenger-Grøn, M., Blunck, C. H., Schønemann-Rigel, H., & Wielandt, H. B. (2015). Low breastfeeding rates and body mass index in Danish children of women with gestational diabetes mellitus. International Breastfeeding Journal, 10(26), 1-12. https://doi.org/10.1186/s13006-015-0051-8
  13. Finkelstein, S. A., Keely, E., Feig, D. S., Tu, X., Yasseen III, A. S., & Walker, M. (2013). Breastfeeding in women with diabetes: lower rates despite greater rewards. A population‐based study. Diabetic Medicine, 30(9), 1094-1101. https://doi.org/10.1111/dme.12238
  14. Fok, D., Aris, I. M., Ho, J., Chan, Y. H., Rauff, M., Lui, J. K.,. & Mattar, C. N. (2019). Early initiation and regular breast milk expression reduces risk of lactogenesis II delay in at-risk Singaporean mothers in a randomised trial. Singapore Medical Journal, 60(2), 80–88. https://doi.org/10.11622/smedj.2018067
  15. Griffith, R. J., Alsweiler, J., Moore, A. E., Brown, S., Middleton, P., Shepherd, E., & Crowther, C. A. (2020). Interventions to prevent women from developing gestational diabetes mellitus: An overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, (6), CD012394 https://doi.org/10.1002/14651858.CD012394.pub3
  16. Gunderson, E. P. (2014). Impact of breastfeeding on maternal metabolism: Implications for women with gestational diabetes. Current diabetes reports, 14, 1-9. https://doi.org/10.1007/s11892-013-0460-2
  17. Haile, Z. T., Oza-Frank, R., Azulay Chertok, I. R., & Passen, N. (2016). Association between history of gestational diabetes and exclusive breastfeeding at hospital discharge. Journal of Human Lactation, 32(3), NP36-NP43. https://doi.org/10.1177/0890334415618936
  18. Horta, B. L., Loret de Mola, C., & Victora, C. G. (2015). Long‐term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta‐analysis. Acta paediatrica, 104, 30-37. https://doi.org/10.1111/apa.13133
  19. Kim, C. (2014). Maternal outcomes and follow‐up after gestational diabetes mellitus. Diabetic Medicine, 31(3), 292-301. https://doi.org/10.1111/dme.12382
  20. King, T. L., Brucker, M. C., Kriebs, J. M., & Fahey, J. O. (2013). Varney's midwifery. Jones & Bartlett Publishers. ISBN: 9781284025422
  21. Korkut, S., Köse Çetinkaya, A., Işık, Ş., Özel, Ş., Gökay, N., Şahin, A., & Alyamaç Dizdar, E. (2022). Macronutrient composition of colostrum in mothers with gestational diabetes mellitus. Breastfeeding Medicine, 17(4), 322-325. https://doi.org/10.1089/bfm.2021.0209
  22. Lessen, R., & Kavanagh, K. (2015). Position of the academy of nutrition and dietetics: Promoting and supporting breastfeeding. Journal of the Academy of Nutrition and Dietetics, 115(3), 444-449. https://doi.org/10.1016/j.jand.2014.12.014
  23. Ley, S. H., Chavarro, J. E., Li, M., Bao, W., Hinkle, S. N., Wander, P. L.,. & Zhang, C. (2020). Lactation duration and long-term risk for incident type 2 diabetes in women with a history of gestational diabetes mellitus. Diabetes Care, 43(4), 793-798. https://doi.org/10.2337/dc19-2237
  24. Li, Z., Cheng, Y., Wang, D., Chen, H., Chen, H., Ming, W. K., & Wang, Z. (2020). Incidence rate of type 2 diabetes mellitus after gestational diabetes mellitus: A systematic review and meta-analysis of 170,139 women. Journal of Diabetes Research, Article ID 3076463, 12 pages https://doi.org/10.1155/2020/3076463
  25. Madazlı, R. (2021). Gebelik ve Sistemik Hastalıklar. İstanbul; Nobel Tıp Kitabevi: 35-54. ISBN: 9786257291033 Martinez, N. G., Niznik, C. M., & Yee, L. M. (2017). Optimizing postpartum care for the patient with gestational diabetes mellitus. American Journal of Obstetrics and Gynecology, 217(3), 314-321. https://doi.org/10.1016/j.ajog.2017.04.033
  26. Matias, S. L., Dewey, K. G., Quesenberry Jr, C. P., & Gunderson, E. P. (2014). Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. The American Journal of Clinical Nutrition, 99(1), 115-121. https://doi.org/10.3945/ajcn.113.073049
  27. Meek, J. Y., & Noble, L. (2022). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 150(1): e2022057988. https://doi.org/10.1542/peds.2022-057988
  28. Much, D., Beyerlein, A., Roßbauer, M., Hummel, S., & Ziegler, A. G. (2014). Beneficial effects of breastfeeding in women with gestational diabetes mellitus. Molecular metabolism, 3(3), 284-292. https://doi.org/10.1016/j.molmet.2014.01.002
  29. Nguyen, P. T. H., Pham, N. M., Chu, K. T., Van Duong, D., & Van Do, D. (2019). Gestational diabetes and breastfeeding outcomes: A systematic review. Asia Pacific Journal of Public Health, 31(3), 183-198. https://doi.org/10.1177/101053951983349
  30. Ogurtsova, K., da Rocha Fernandes, J. D., Huang, Y., Linnenkamp, U., Guariguata, L., Cho, N. H.,. & Makaroff, L. E. (2017). IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Research and Clinical Practice, 128, 40-50. https://doi.org/10.1016/j.diabres.2017.03.024
  31. Oza-Frank, R., & Gunderson, E. P. (2017). In-hospital breastfeeding experiences among women with gestational diabetes. Breastfeeding Medicine, 12(5), 261-268. https://doi.org/10.1089/bfm.2016.0197
  32. Peila, C., Gazzolo, D., Bertino, E., Cresi, F., & Coscia, A. (2020). Influence of diabetes during pregnancy on human milk composition. Nutrients, 12(1), 185. https://doi.org/10.3390/nu12010185
  33. Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018). The pathophysiology of gestational diabetes mellitus. International Journal of Molecular Sciences, 19(11), 3342. https://doi.org/10.3390/ijms19113342
  34. Rayanagoudar, G., Hashi, A. A., Zamora, J., Khan, K. S., Hitman, G. A., & Thangaratinam, S. (2016). Quantification of the type 2 diabetes risk in women with gestational diabetes: A systematic review and meta-analysis of 95,750 women. Diabetologia, 59, 1403-1411. https://doi.org/10.1007/s00125-016-3927-2
  35. Sauder, K. A., Bekelman, T. A., Harrall, K. K., Glueck, D. H., & Dabelea, D. (2019). Gestational diabetes exposure and adiposity outcomes in childhood and adolescence: An analysis of effect modification by breastfeeding, diet quality, and physical activity in the EPOCH study. Pediatric Obesity, 14(12), e12562. https://doi.org/10.1111/ijpo.12562
  36. Shearrer, G. E., Whaley, S. E., Miller, S. J., House, B. T., Held, T., & Davis, J. N. (2015). Association of gestational diabetes and breastfeeding on obesity prevalence in predominately Hispanic low‐income youth. Pediatric Obesity, 10(3), 165-171. https://doi.org/10.1111/ijpo.247
  37. Simon Sarkadi, L., Zhang, M., Muránszky, G., Vass, R. A., Matsyura, O., Benes, E., & Vari, S. G. (2022). Fatty acid composition of milk from mothers with normal weight, obesity, or gestational diabetes. Life, 12(7), 1093. https://doi.org/10.3390/life12071093
  38. Sparud-Lundin, C., Wennergren, M., Elfvin, A., & Berg, M. (2011). Breastfeeding in women with type 1 diabetes: exploration of predictive factors. Diabetes Care, 34(2), 296-301. https://doi.org/10.2337/dc10-1916
  39. Stuebe, A. M. (2015, June). Does breastfeeding prevent the metabolic syndrome, or does the metabolic syndrome prevent breastfeeding?. In Seminars in Perinatology, 39(4), 290-295. https://doi.org/10.1053/j.semperi.2015.05.008
  40. Tarrant, M., Chooniedass, R., Fan, H. S. L., Del Buono, K., & Masina, S. (2020). Breastfeeding and postpartum glucose regulation among women with prior gestational diabetes: A systematic review. Journal of Human Lactation, 36(4), 723-738. https://doi.org/10.1177/0890334420950259
  41. The American College of Obstetricians and Gynecologists (ACOG) (2018). ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstetrics & Gynecology,131, e49–e64. https://doi.org/10.1097/AOG.0000000000002501
  42. The American College of Obstetricians and Gynecologists (ACOG) (2022). ACOG Frequently Asked Questions No.177: Gestational Diabetes Mellitus. https://www.acog.org/womens-health/faqs/gestational-diabetes
  43. TÜRKDİAB Diyabet Tanı ve Tedavi Rehberi 2019. Erişim adresi: https://www.turkdiab.org/admin/PICS/files/Diyabet_Tani_ve_Tedavi_Rehberi_2019.pdf Erişim tarihi: 13.03.2023
  44. Van Ryswyk, E., Middleton, P., Shute, E., Hague, W., & Crowther, C. (2015). Women's views and knowledge regarding healthcare seeking for gestational diabetes in the postpartum period: A systematic review of qualitative/survey studies. Diabetes Research And Clinical Practice, 110(2), 109-122. https://doi.org/10.1016/j.diabres.2015.09.010
  45. Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J.,. & Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490. https://doi.org/10.1016/S0140-6736(15)01024-7
  46. Vounzoulaki, E., Khunti, K., Abner, S. C., Tan, B. K., Davies, M. J., & Gillies, C. L. (2020). Progression to type 2 diabetes in women with a known history of gestational diabetes: Systematic review and meta-analysis. BMJ, 369. https://doi.org/10.1136/bmj.m1361
  47. World Health Organization (WHO) 2022. Erişim adresi: https://www.who.int/news-room/fact-sheets/detail/diabetes Erişim tarihi: 13.03.2023
  48. Wu, J. L., Pang, S. Q., Jiang, X. M., Zheng, Q. X., Han, X. Q., Zhang, X. Y., & Pan, Y. Q. (2021). Gestational diabetes mellitus and risk of delayed onset of lactogenesis: A systematic review and meta-analysis. Breastfeeding Medicine, 16(5), 385-392. https://doi.org/10.1089/bfm.2020.0356
  49. Yasuhi, I., Yamashita, H., Nomiyama, M., Kubo, N., Ogawa, M., Okura, N.,. & Sumitomo, M. (2017). 68: Exclusive breastfeeding improves insulin sensitivity independent of maternal weight change during early postpartum in gestational diabetic women. American Journal of Obstetrics & Gynecology, 216(1), S48-S49. https://doi.org/10.1016/j.ajog.2016.11.954
  50. You, H., Hu, J., Liu, Y., Luo, B., & Lei, A. (2021). Risk of type 2 diabetes mellitus after gestational diabetes mellitus: A systematic review & meta-analysis. The Indian Journal Of Medical Research, 154(1), 62. https://doi.org/10.4103/ijmr.IJMR_852_18
  51. Ziegler, A. G., Wallner, M., Kaiser, I., Rossbauer, M., Harsunen, M. H., Lachmann, L.,. & Hummel, S. (2016). Long-term protective effect of lactation on the development of type 2 diabetes in women with recent gestational diabetes mellitus. Diabetes, 61(12), 3167-3171. https://doi.org/10.2337/db12-0393.
  52. Aroda, V. R., Christophi, C. A., Edelstein, S. L., Zhang, P., Herman, W. H., Barrett-Connor, E.,. & Ratner, R. E. (2015). Diabetes Prevention Program Research Group. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: The Diabetes Prevention Program outcomes study 10-year follow-up. The Journal of Clinical Endocrinology & Metabolism, 100(4), 1646-1653. https://doi.org/10.1210/jc.2014-3761
  53. Chamberlain, C. R., Wilson, A. N., Amir, L. H., O'Dea, K., Campbell, S., Leonard, D.,. & Wolfe, R. (2017). Low rates of predominant breastfeeding in hospital after gestational diabetes, particularly among Indigenous women in Australia. Australian and New Zealand Journal of Public Health, 41(2), 144-150. https://doi.org/10.1111/1753-6405.12629
  54. Dugas, C., Laberee, L., Perron, J., St-Arnaud, G., Richard, V., Perreault, V.,. & Robitaille, J. (2023). Gestational diabetes mellitus, human milk composition, and infant growth. Breastfeeding Medicine, 18(1), 14-22. https://doi.org/10.1089/bfm.2022.0085
  55. Fok, D., Aris, I. M., Ho, J., Chan, Y. H., Rauff, M., Lui, J. K.,. & Mattar, C. N. (2019). Early initiation and regular breast milk expression reduces risk of lactogenesis II delay in at-risk Singaporean mothers in a randomised trial. Singapore Medical Journal, 60(2), 80–88. https://doi.org/10.11622/smedj.2018067
  56. Ley, S. H., Chavarro, J. E., Li, M., Bao, W., Hinkle, S. N., Wander, P. L.,. & Zhang, C. (2020). Lactation duration and long-term risk for incident type 2 diabetes in women with a history of gestational diabetes mellitus. Diabetes Care, 43(4), 793-798. https://doi.org/10.2337/dc19-2237
  57. Ogurtsova, K., da Rocha Fernandes, J. D., Huang, Y., Linnenkamp, U., Guariguata, L., Cho, N. H.,. & Makaroff, L. E. (2017). IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Research and Clinical Practice, 128, 40-50. https://doi.org/10.1016/j.diabres.2017.03.024
  58. Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J.,. & Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490. https://doi.org/10.1016/S0140-6736(15)01024-7
  59. Yasuhi, I., Yamashita, H., Nomiyama, M., Kubo, N., Ogawa, M., Okura, N.,. & Sumitomo, M. (2017). 68: Exclusive breastfeeding improves insulin sensitivity independent of maternal weight change during early postpartum in gestational diabetic women. American Journal of Obstetrics & Gynecology, 216(1), S48-S49. https://doi.org/10.1016/j.ajog.2016.11.954
  60. Ziegler, A. G., Wallner, M., Kaiser, I., Rossbauer, M., Harsunen, M. H., Lachmann, L.,. & Hummel, S. (2016). Long-term protective effect of lactation on the development of type 2 diabetes in women with recent gestational diabetes mellitus. Diabetes, 61(12), 3167-3171. https://doi.org/10.2337/db12-0393.