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Breastfeeding and Diabetes

Breastfeeding is the healthiest way for a woman to feed her baby. Women with diabetes should aim to have a normal experience of pregnancy and this includes breast feeding. There are clearly established important health benefits now known to exist for both the mother and her child.

What are the benefits of breastfeeding for my baby?
Breast milk contains antibodies; babies who are breastfed are less likely to have many illnesses including:
• Gastro-intestinal infections (vomiting and diarrhoea)
• Chest infections
• Urine infections
• Ear infections
• Wheeze when breathing/asthma
• Eczema, where this runs in the family
• Diabetes in childhood
• Obesity

What are the benefits of breastfeeding to the mother?
Breastfeeding has benefits for you, too. Breastfeeding helps you return to your pre-pregnancy weight. During pregnancy, your body lays down fat stores in preparation for feeding; when you breast feed you use them up, helping you avoid the long-term health risks associated with being overweight, such as diabetes and heart disease.

Mothers who breastfed have a lower risk of :
• Breast cancer
• Ovarian cancer
• Hip fracture in later life, caused by the osteoporosis (thinning of the bones)

How to get started and what do I need to look out for?
In the majority of women with diabetes, breastfeeding can take place without major issues. In some women with diabetes, breastfeeding may be difficult to establish if early feeding is interrupted by hypoglycaemia (low blood sugar) in the baby, or if there is separation from the baby due to caesarean section or if the baby has been in the special care baby unit (SCBU). If so, the mother is encouraged to express her milk for use by the baby. Any difficulties with insulin and diabetes control whilst breast feeding can usually be easily dealt with.

Is my breast milk the same as milk from a woman who does not have diabetes?
Yes. Even if your diabetes is poorly controlled, your milk will be quite normal.

Do I have to make special changes to my diet or insulin dose?
You may have to increase the amount of food you eat, particularly starchy (carbohydrate) foods, because breast milk is high in a carbohydrate sugar called lactose as well as containing proteins, fats and minerals. As you feed your baby, you will lose that sugar and your blood glucose will drop, which may cause a hypo. As well as adjusting diet, you may need less insulin when breast feeding because baby is using some of your food energy through the breast milk.

Breastfeeding may lower your insulin dose by up to 25% to 30%. Get advice from your antenatal diabetes team for specific tailoring of your doses post-delivery. Test before and after a few feeds so that you know how much to adjust your insulin and food intake by.

What about "skin to skin contact"?
Having high blood sugar can affect the baby's growth in the womb. This can cause the baby to grow larger, which can sometimes make delivery difficult but it can also slow down the baby's growth and both can affect development.

Shortly after birth, the baby may continue to make extra insulin even though high levels of blood sugar are no longer present This may cause the baby to have low blood sugar (hypoglycaemia). About half of all babies born to mothers with diabetes may be hypoglycaemic at birth. If the hypo is more severe, your baby might need a glucose drip into a vein. The hypo generally does not harm the baby.

Ensure that your baby has skin to skin contact with you immediately after birth and that your baby receives the first breast feed within 30 minutes of birth and then receives regular breast feeds. It may be necessary to give your baby extra milk eg. Expressed colostrum if available as necessary (based on his/her individual needs) this will help to prevent low blood sugar. Skin to skin contact also helps your baby maintain temperature control. Your baby's blood glucose will be measured within 4 hours of birth and then 2-3 times within the first day. Women with diabetes are asked to stay in hospital for 24hours following the birth so that baby can be observed for any early signs of hypoglycaemia and women can receive extra support with breast feeding.

After 24 hours your baby's blood sugar levels are unlikely to drop. Please ask the Diabetes Specialist Midiwife about expressing colostrum prior to the birth.

Can I breastfeed if I am taking diabetes tablets?
Some drugs for diabetes cross into the milk and can affect the baby. Metformin is safe for use in pregnancy and breastfeeding. If you are on metformin or insulin you can breastfeed. You may have switched to insulin during pregnancy. If you want to breast feed, and we strongly encourage you to do so, continue with insulin whilst you are breastfeeding. Your doctor, health visitor or diabetes antenatal team will advise you about this.

Will I gain weight due to breastfeeding?
No. Breastfeeding may help you lose weight, even though you are eating more. You can focus on losing weight after you have stopped breastfeeding.

Seeking advice and what care to expect
Your breast feeding plan should have been fully discussed with you during the antenatal period. Get any extra advice as needed from you GP, practice nurse, midwives, health visitors, diabetes team and dietitians.

Your doctor, diabetes specialist nurse and dietician can also help you balance your food and insulin levels at this time especially if you are having any difficulty with hypos.