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BF Early Nutrition Mother DM1 PDF
BF Early Nutrition Mother DM1 PDF
ekahaksari 2016
ekahaksari 2016
• World Breastfeeding
Week
August 2007
• An early start on
breast milk saves
infants’ lives
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• 16% kematian neonatal • 22% kematian neonatal
dapat dicegah jika dapat dicegah pada
menyusu ekslusif sejak inisiasi menyusu dini
hari pertama pada 1 jam pertama
Edmond K et al. Delayed Breastfeeding Initiation Increases Risk
of Neonatal Mortality. Pediatrics,2006. 117:380-386
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DURATION OF BREAST-FEEDING
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DIABETES (AAP 2012)
• Up to a 30% the incidence type 1 diabetes mellitus
is reported for infants who exclusively breastfed
avoiding exposure to cow milk protein or at least 3 months
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Obesity (AAP 2012)
• Rates of obesity are significantly
lower in breastfed infants
National campaigns to prevent obesity
begin with breastfeeding support
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BREASTFEEDING OR BY BOTTLE
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Breastfeeding and development of overweight
Breastfed infants self-regulate intake volume
irrespective of maneuvers that
available milk volume,
& the early programming of self-regulation,
affects adult weight gain
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INFANTS’ RISK FOR EXCESS WEIGHT
DURING LATE INFANCY
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INFANTS FED FROM BOTTLE
LACK SELF REGULATION OF MILK INTAKE
COMPARED WITH DIRECTLY BREASTFED INFANTS
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The American Diabetes Association has recommended
that women with GDM should be encouraged to
breastfed (1986)
• Recommendation from the 4th International
Workshop Conference on Gestational Diabetes
Mellitus encourage women to breastfeed,
although data demonstrating efficacy were lacking
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PRACTICE POINTS
• Maternal diabetes during pregnancy should be
screened & treated to neonatal outcomes
• Maternal obesity/overweight is an additional risk
factor for adverse neonatal outcomes
• Pediatricians should be aware of the neonatal risks
associated with diabetes in pregnancy,
especially RDS & hypoglycemia
• Strategies for screening & managing women with
GDM should be developed in middle & low- income
countries
• Mitanches et al. Best practice & Research Clinical Obstetrics and
Gynecology 2015
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BREAST FEEDING
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Association of breastfeeding & early childhood overweight
in children from mothers with gestational diabetes mellitus
• Children of mothers who had gestational diabetes mellitus (GDM),
have a risk of infant overweight
• Breastfeeding (BF) > 3 months appears negatively associated
with overweight in early childhood
• Prevalence of childhood overweight with increased duration of nursing
• The highest prevalence of 37% was observed in children who were never
breast-fed
• Exclusive BF revealed to be an independent preventive indicator of
childhood overweight after adjustment for confounding factors, such
parental obesity & high birth weight
• The risk of childhood overweight may be 40-50% when BF >3
months
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ASSOCIATION OF BREASTFEEDING &
EARLY CHILDHOOD OVERWEIGHT IN CHILDREN
FROM MOTHERS
WITH GESTATIONAL DIABETES MELLITUS
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Breast-feeding and Diabetes:
Long-term impact on mothers & their infants
• Breast-feeding (BF) is associated with reduced risk offspring
being overweight later in life by 22% to 24% across the age
spectrum,
from preschool children to adults
• A dose-response gradient with increasing duration of
breastfeeding, & lower risk with prolonged exclusive breast
feeding
• BF has been slow infant growth to 2 years of age
• Inconclusive BF protect overweight
• Development of type 2 diabetes among offspring whose
mothers had diabetes during pregnancy
• Lactation protects development of type 2 diabetes later in life
in women with a diabetes history during pregnancy
Gunderson EP. Curr Diab Rep 2008
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Breastfeeding and development of overweight
The general population
• Developed country, BF lower risk overweight during
childhood & adolescent, even after accounting maternal
obesity & family lifestyle behaviors
• Meta-analysis 39 published during the past years,
concluded BF individual were less likely classified
overweight ( OR 0,78, 95%CI) Adjust parenteral
anthropometry, socio- economic status, birth weight did
not abolished
• The overall reduction in overweight BF infant with the
observations the BF infants grow slowly &
are leaner at 1 to 2 years of age than non BF
• The slower of growth persist at least 2 years, &
the protective effects continue through childhood
&adolescent
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Breastfeeding and development of overweight
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Breastfeeding and development of overweight
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Breastfeeding Lowers Risk of
Type 2 Diabetes Following Gestational Diabetes Pregnancy
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Breastfeeding more often & for longer durations
helps mother's health
Gunderson
EP
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Evidence for the general population of developed countries
supports association between breast-feeding & lower risk of
becoming overweight during childhood & adolescence,
even after accounting for maternal obesity & family lifestyle
behaviors.
• However, evidence is inconclusive that breast-feeding confers the
same protection against obesity for offspring of women with
diabetes during pregnancy as for the general population.
• Findings are mixed, with higher, lower, or no difference in risk of
overweight for breast-fed compared with non–breast-fed infants
whose mothers had diabetes during pregnancy.
• Prospective studies of these infants of diabetic mothers are needed
to examine the effect of breast-feeding on infant growth &
development of overweight in childhood controlling for parental
attributes, intrauterine metabolic milieu, maternal postpartum
glucose tolerance, & postnatal behavioral traits.
Gunderson EP Curr Diab Rep 2010
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For the mother, clinical & epidemiologic evidence
• Lactation has immediate favorable effects on maternal glucose
tolerance for the general population & those with a diabetes
history during pregnancy
• The Nurses Health Study, women who lactated for >4 mo had
25% reduction in risk of type 2 diabetes & exclusive lactation
was associated 35% to 40% reduction in diabetes risk.
• In this study, among women with a GDM history,
findings were inconclusive.
• To determine if breast-feeding delays or prevents the onset of
type 2 diabetes in women with a diabetes history during
pregnancy & their offspring, prospective, population based
studies that control for intrauterine & postnatal exposures are
needed.
Gunderson EP. Curr Diab Rep 2010
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The SWIFT Study:
Study of Women, Infant Feeding &
Type 2 Diabetes after GDM Pregnancy
• 12 percent of women in the study developed type 2 diabetes
within 2 years after delivery.
• Those who exclusively formula-fed their babies at 6 to 9
weeks of age were > 2x develop diabetes as women who
exclusively BF their infants.
• There was a graded 35 -57% reduction in the 2year diabetes
incidence associated with greater lactation intensity
from exclusively formula-feeding to exclusively BF,
and with increasing lactation duration
from < 2 to > 10 months of BF
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The Swift study
• A major strength of the study was the ability to control for
numerous influences on breastfeeding &
other diabetes risk factors, including maternal obesity
before pregnancy, gestational weight gain, prenatal
metabolism, treatment for gestational diabetes, C-section
delivery, infant size & birth outcomes, race/ethnicity, &
lifestyle behaviors such as diet, physical activity &
weight change.
• The association between breastfeeding intensity &
duration with lower risk of developing type 2 diabetes
remained after accounting for these variables.
• The highlight the importance of
prioritizing breastfeeding education &
support for women with gestational diabetes as part of
early diabetes prevention efforts by health care systems
Gunderson EP 2007
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The WIFT Study
• The first to measure breastfeeding on a monthly basis during the first year
after delivery & to enroll a statistically significant number of women with
gestational diabetes. It is also the first to evaluate social, behavioral &
prenatal risk factors that influence development of type 2 diabetes, as well
as breastfeeding initiation and success.
• The study enrolled > 1,000 Kaiser Permanente members in Northern
California who were diagnosed with gestational diabetes during pregnancy
between 2008 and 2011. The SWIFT cohort was racially & ethnically
diverse, with 75 percent of the women reporting Hispanic, Asian or
African-American heritage. In-person exams, which included oral glucose
tolerance tests, were conducted at six to nine weeks after delivery as
women enrolled in the study, & again at one year & two years post-delivery
in those who did not have diabetes at baseline.
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Identification of modifiable risk factors that influence postnatal
programming of adiposity, appetite and/or energy regulation
mechanisms among GDM offspring
is necessary to formulate strategies for
prevention of obesity and type2 diabetes mellitus in high-risk group
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Annals of Internal Medicine 2015
Lactation and Progression to Type 2 Diabetes After Gestational Diabetes
• What is the problem and what is known about it so far?
• Breastfeeding has positive effects on the health of infants as well as their
mothers. Some of the positive effects of breastfeeding in mothers include
improved metabolism of glucose and lipids. Whether breastfeeding a child
can prevent women with gestational diabetes (or diabetes during
pregnancy) from developing type 2 diabetes after delivery is unclear.
• Why did the researchers do this particular study?
• To see whether the level and duration of breastfeeding lowered the
mother's future risk for new-onset type 2 diabetes after a pregnancy with
gestational diabetes.
• Who was studied?
• 1035 Hispanic, Asian, black, or white women who had gestational diabetes
and enrolled in the study at 2 months after delivery.
• How was the study done?
• At the time the women were enrolled in the study, they were classified as
either exclusively breastfeeding, mostly breastfeeding, mostly formula or
mixed/inconsistent feeding, or exclusively formula feeding. The women
had an oral glucose tolerance test at 2 months after delivery (baseline),
and those who did not have diabetes at 2 months were tested again every
year for 2 years, in addition to other tests. The investigators determined
how many women developed type 2 diabetes during the follow-up period.
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Annals of Internal Medicine 2015
Lactation & Progression to Type 2 Diabetes
After Gestational Diabetes
• What did the researchers find?
• Higher amounts of breastfeeding (mostly breastfeeding or
breastfeeding only) and breastfeeding for longer periods of
time (>2 months) were both associated with a decreased
risk for type 2 diabetes.
• What were the limitations of the study?
• The women were followed for only 2 years after delivery. It
is possible that some women may have developed type 2
diabetes after the study ended.
• What are the implications of the study?
• Higher intensity of breastfeeding and breastfeeding for
longer periods of time may prevent type 2 diabetes in
women with a history of gestational diabetes.
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Lactation and Progression to Type 2 Diabetes
Mellitus After Gestational Diabetes Mellitus: A
Prospective Cohort Study
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Early neonatal
breast feeding by
diabetic mothers has
beneficial effects on
early psychomotor
development
in their offspring
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Early neonatal
ingestion of
breast milk from
diabetic mothers may
risk of
becoming overweight,
developing impaired
glucose tolerance
beginning early
during childhood
Plageman A et al.
Diabetes Care 2002
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The 1st week of life
appears
to be the critical window
for nutritional programming in
offspring diabetic mothers
by ingestion of maternal
‘diabetic’ breast milk
Rodekamp et al.
Diabetes Care 2005
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Feeding methods and type2 Diabetes
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Breastfeeding in infancy is
associated with reduced risk of type 2 diabetes,
with marginally lower insulin concentrations in later life &
with lower blood glucose & serum insulin concentrations
in infancy.
Owen CG et al. Am J Clin Nutr 2006;84:1043–54.
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A Systematic Review of
Associating Breastfeeding with
Type 2 Diabetes & Gestational Diabetes
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