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Review
. 2016 Mar 15;7(2):407-14.
doi: 10.3945/an.115.011007. Print 2016 Mar.

Does Insulin Explain the Relation between Maternal Obesity and Poor Lactation Outcomes? An Overview of the Literature

Laurie A Nommsen-Rivers  1
Affiliations
Review

Does Insulin Explain the Relation between Maternal Obesity and Poor Lactation Outcomes? An Overview of the Literature

Laurie A Nommsen-Rivers. Adv Nutr. .

Abstract

It is well established that obese women are at increased risk of delayed lactogenesis and short breastfeeding duration, but the underlying causal contributors remain unclear. This review summarizes the literature examining the role of insulin in lactation outcomes. Maternal obesity is a strong risk factor for insulin resistance and prediabetes, but until recently a direct role for insulin in milk production had not been elucidated. Over the past 6 y, studies in both animal models and humans have shown insulin-sensitive gene expression to be dramatically upregulated specifically during the lactation cycle. Insulin is now considered to play a direct role in lactation, including essential roles in secretory differentiation, secretory activation, and mature milk production. At the same time, emerging clinical research suggests an important association between suboptimal glucose tolerance and lactation difficulty. To develop effective interventions to support lactation success in obese women further research is needed to identify how, when, and for whom maternal insulin secretion and sensitivity affect lactation ability.

Keywords: breastfeeding; diabetes; impaired glucose tolerance; insulin; insulin resistance; lactation; maternal; obesity.

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Conflict of interest statement

Author disclosures: LA Nommsen-Rivers, no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Prevalence of delayed lactogenesis (defined as lack of copious milk production symptoms by 72 h postpartum). Sources: rural Ghana (24); rural Guatemala (32); peri-urban Lima, Peru (33); Davis, California (23); Hartford, Connecticut (31); Sacramento, California (9); and Cincinnati, Ohio (17).
See this image and copyright information in PMC

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