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. 2024 Apr 1;47(4):720-728.
doi: 10.2337/dc23-1494.

Lifetime Duration of Breastfeeding and Cardiovascular Risk in Women With Type 2 Diabetes or a History of Gestational Diabetes: Findings From Two Large Prospective Cohorts

Anna Birukov  1   2 , Marta Guasch-Ferré  1   3 , Sylvia H Ley  4 , Deirdre K Tobias  1   5 , Fenglei Wang  1 , Clemens Wittenbecher  1   6 , Jiaxi Yang  7   8   9 , JoAnn E Manson  5   10   11 , Jorge E Chavarro  1   10   11 , Frank B Hu  1   10   11 , Cuilin Zhang  1   7   8   9
Affiliations

Lifetime Duration of Breastfeeding and Cardiovascular Risk in Women With Type 2 Diabetes or a History of Gestational Diabetes: Findings From Two Large Prospective Cohorts

Anna Birukov et al. Diabetes Care. .

Abstract

Objective: Breastfeeding duration is inversely associated with risks of cardiovascular disease (CVD) and type 2 diabetes in parous women. However, the association among women at high risk, including women with type 2 diabetes or gestational diabetes mellitus (GDM) is unclear.

Research design and methods: We included 15,146 parous women with type 2 diabetes from the Nurses' Health Study I and II (NHS, NHS II) and 4,537 women with a history of GDM from NHS II. Participants reported history of breastfeeding via follow-up questionnaires. Incident CVD by 2017 comprised stroke or coronary heart disease (CHD) (myocardial infarction, coronary revascularization). Adjusted hazard ratios (aHRs) and 95% CIs were estimated using Cox models.

Results: We documented 1,159 incident CVD cases among women with type 2 diabetes in both cohorts during 188,874 person-years of follow-up and 132 incident CVD cases among women with a GDM history during 100,218 person-years of follow-up. Longer lifetime duration of breastfeeding was significantly associated with lower CVD risk among women with type 2 diabetes, with pooled aHR of 0.68 (95% CI 0.54-0.85) for >18 months versus 0 months and 0.94 (0.91-0.98) per 6-month increment in breastfeeding. Similar associations were observed with CHD (pooled aHR 0.93 [0.88-0.97]) but not with stroke (0.96 [0.91-1.02]) per 6-month increment in breastfeeding. Among women with GDM history, >18 months versus 0 months of breastfeeding was associated with an aHR of 0.49 (0.28-0.86) for total CVD.

Conclusions: Longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or GDM.

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Conflict of interest statement

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
Associations between lifetime duration of breastfeeding, exclusive breastfeeding, and incident CVD in NHS II participants with a GDM history (n = 4,537). CVD includes MI, stroke, CABG surgery, or PCI. CHD includes MI, CABG surgery, and PCI. Models are adjusted for age (strata), ethnicity, smoking at index GDM, prepregnancy BMI, physical activity at index GDM pregnancy, family history of CVD, age at first birth, and alcohol intake.
Figure 2
Figure 2
Stratified analyses by major CVD risk factors among NHS and NHS II women with type 2 diabetes or prior GDM. Subgroup analyses among NHS and NHS II female participants with type 2 diabetes (pooled HRs with 95% CI from both cohorts) (A) and NHS II participants with prior GDM (B) for the risk of composite CVD in relation to lifetime duration of breastfeeding (dichotomized, <12 months [reference] vs. ≥12 months), stratified by risk factors at baseline or across reproductive life span.
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