Public Health Nutrition

Research Papers

Differences in breast-feeding initiation and continuation by maternal diabetes status

Reena Oza-Franka1 c1, Ilana Chertoka2 and Adam Bartleya3

a1 Center for Perinatal Research, Research Institute at Nationwide Children’s Hospital, Department of Pediatrics, The Ohio State University, 700 Children’s Drive, Research Building 3, Columbus, OH 43205, USA

a2 School of Nursing, West Virginia University, Morgantown, WV, USA

a3 College of Public Health, The Ohio State University, Columbus, OH, USA


Objective To examine (i) the prevalence of and associations between breast-feeding initiation and continuation by maternal diabetes status and (ii) the reasons for not initiating and/or continuing breast-feeding by maternal diabetes status.

Design Secondary data analyses of a population-based cross-sectional study were conducting using data from the US Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS), 2009–2011. Multivariable logistic regression was used to investigate the associations between breast-feeding initiation and continuation by diabetes status.

Setting Thirty states and New York City, USA.

Subjects Mothers of recently live-born infants, selected by birth certificate sampling.

Results Among 72755 women, 8·8 % had gestational diabetes mellitus (GDM) and 1·7 % had pregestational diabetes mellitus (PDM). Breast-feeding initiation was similar among GDM and no diabetes mellitus (NDM) women (80·8 % v. 82·2 %, respectively, P=0·2), but continuation was lower among GDM (65·7 % v. 68·8 %, respectively, P=0·01). PDM women had lower initiation and continuation compared with NDM (78·2 %, P=0·03 and 60·4 %, P<0·01, respectively). In adjusted analyses, current smoking status was a significant effect modifier for initiation, but not for continuation.

Conclusions Differences in breast-feeding initiation and continuation prevalence by maternal diabetes status may reflect differences in prenatal education, indicating the need for increased efforts among PDM women. Additionally, non-smoking women with PDM or GDM would benefit from additional breast-feeding education.

(Received October 01 2013)

(Revised March 05 2014)

(Accepted April 03 2014)

(Online publication May 08 2014)


  • Breast-feeding;
  • Diabetes;
  • Pregnancy


c1 Corresponding author: Email