Breastfeeding with Diabetes: Benefits, Challenges, and Recommendations
By Cheryl Alkon
By Cheryl Alkon
Diabetes can make breastfeeding more challenging, affecting blood sugar levels and milk supply. With all the health benefits of breastfeeding, here’s expert advice for women with diabetes
You could call Jessica Lynn, CNM, DCES, a diabetes, pregnancy and breastfeeding cheerleader.
“Everyone should be breastfeeding,” said Lynn, a nurse, midwife, and perinatal diabetes care and education specialist (DCES) who works for a Brooklyn hospital in the New York City Health and Hospital system. She also runs her own business as The Diabetes Midwife. At the hospital, “I take care of every person with diabetes, from preconception through postpartum,” she told us.
Lynn, who has lived with type 1 diabetes since age three, has worked as a healthcare professional for more than two decades. She stresses the benefits of breastfeeding for everyone, including women with diabetes: “Breastfeeding is an opportunity to improve your health and to improve the health of your baby. Who wouldn’t want that?”
According to Lynn and the Centers for Disease Control and Prevention, breastfeeding has several benefits.
Babies that are breastfed are less likely to:
Have type 1 diabetes
Have ear infections
Have severe lower respiratory disease
Experience sudden infant death syndrome (SIDS)
Have infections that cause diarrhea or vomiting
Mothers who breastfeed are less likely to develop breast or ovarian cancer or high blood pressure. Mothers who breastfeed for six months who had gestational diabetes or no diabetes before pregnancy are less likely to develop type 2 diabetes later on, said Lynn.
Does diabetes affect breastfeeding?
While diabetes can cause potential issues with breastfeeding, “they’re not insurmountable,” said Lynn. Some situations to keep in mind:
Building and maintaining milk supply. Blood sugars that are out of range can contribute to how much milk you produce. “Normalization of blood sugar is super important for maintaining supply, in addition to eating a healthy diet and drinking twice as many fluids as you did during pregnancy,” she said.
Delayed milk production. People with diabetes may be slow to start producing milk after giving birth. To counteract the problem, Lynn recommends storing colostrum (the first milk the body produces that is filled with antibodies for a newborn baby) before giving birth. Talk to a lactation consultant well before you are ready to give birth to ask how to hand express colostrum from your breasts before you deliver, and how to store it safely until your baby arrives.
A baby with a less-developed sucking reflex. People with diabetes are more likely to develop pregnancy problems, such as preterm pre-eclampsia, which can lead to preterm labor and preterm birth, said Lynn. “All these things can make birth less predictable, and a baby who is born early will have a less-developed sucking reflex , which can make it harder to impossible for the baby to breastfeed, and may be more likely to go to the Neonatal Intensive Care Unit (NICU),” she said. It is possible to feed a baby expressed breast milk in the NICU through a tube or a bottle, and it may be possible to breastfeed the baby in the NICU, depending on the medical reasons why the baby is there.
How does breastfeeding affect diabetes management and blood sugar levels?
Breastfeeding is a real workout for your body; it may make your blood sugar numbers drop unless you’re prepared.
“Breastfeeding is as if you are on the treadmill 24-7,” said Lynn. “It has benefits for the mother, because she’ll be losing weight just like she’s on a treadmill. For diabetes, some people may experience low blood sugars during letdown [when the baby first begins nursing], while others may experience lows at other times.”
Prepare for low blood sugars by having a source of glucose nearby while you are breastfeeding, such as fruit juice or glucose tabs. Work with your healthcare team to adjust your medications (insulin or pills) as needed. “You can be proactive about taking less insulin: you may need less insulin, even half as much, as you needed before,” Lynn said. However, every woman is different, so be sure to check in with your healthcare team if you are changing your insulin doses.
Breastfeeding also helps with weight loss, suppresses the return of your period, and is relaxing, Lynn said. “That reduced stress will help your blood sugar and your life after childbirth.”
Is there anything women with diabetes need to know before they decide to breastfeed?
For any new mother—with or without diabetes—learning how to breastfeed takes time, and it doesn’t necessarily come naturally without a lot of help. If you know you want to breastfeed, Lynn recommends the following tips:
See if your hospital has a baby-friendly accreditation. The Baby-Friendly Hospital Initiative shows which hospitals are committed to supporting breastfeeding. This directory can help you find a place near you.
Develop a team of people to support you after giving birth. This can include a lactation consultant to help you while you are in the hospital and while you are at home as you establish breastfeeding, and/or post-partum doulas who help you with infant feeding as well as recovery after birth, newborn care and safety, and related issues.
Learn how to use a breast pump to express milk. You can use a hand pump or a hospital-grade pump to empty your breasts if it takes time for your baby to learn how to latch efficiently, or if you want to pump to establish or maintain your milk supply, or if you want to store your breast milk for feeding your baby from a bottle.
If your milk supply isn’t sufficient, there are different foods and medications that can help increase it. Talk to a lactation consultant or your healthcare professional about what would work best for you.
How long should women with diabetes breastfeed their babies?
The recommendations for breastfeeding apply to all women, regardless of whether or not they have diabetes, Lynn told us.
The American Academy of Pediatrics recommends that women exclusively breastfeed for six months, and continue to breastfeed as other foods are introduced up until the baby is one year old. The World Health Organization and UNICEF echo the six-month exclusive breastfeeding recommendation, but suggest two years or more of breastfeeding along with eating additional foods.
However, as your baby begins eating more solid foods, you will breastfeed less. Doing so will likely make your blood sugars rise until you have enough insulin or oral medication to keep your numbers in range. “Remember to adjust your medication to maintain blood sugar levels,” Lynn said.
Ensuring you are eating and exercising to maintain a healthy weight at this time is also important.
Does COVID-19 affect breastfeeding?
The American Academy of Pediatrics issued the following recommendations on April 2, 2020, about the novel coronavirus and breastfeeding:
Because studies have not detected the virus in breast milk, mothers may express breast milk after carefully cleaning their breasts and hands.
Caregivers who are not infected may feed breast milk to an infant.
Mothers who want to directly breastfeed their baby should use strict precautions, including wearing a mask and maintaining meticulous breast and hand hygiene.
Beginning breastfeeding can be hard, and it can take a commitment to stick to it when learning how to do it. But the health benefits for both the mother and the baby are significant.
“Breastfeeding is challenging, just like everything else in diabetes,” said Lynn.” But we with diabetes are up for the challenge.”