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[IP] Article in Diabetes Interview

A few months ago, a woman who was writing an article about diabetic mothers
who breastfeed their babies, interviewed several IP'ers from this list.
Yesterday I received this copy of the article written for the May issue.  I
recognize Sherry Compton's name, but not the others, so I'm not sure if they
are also memebers of this list or not.  I was excited to see my name in the
article and would like to share this with all of you.

Donna Rushing

>>>PLEASE keep in mind that this article is copyrighted by Diabetes Interview,
King's Publishing Inc., and any permission to reprint must be obtained from
the magazine (800-382-0808).

Breastfeeding at Birth

Protection From Diabetes for the Baby, Especially if the Mother   Has

By Beverly Morgan, IBCLC, and Tina B. Farrell

9Breastfeeding is the optimal way of providing ideal food for the health,
growth, and development of human infants while simultaneously benefiting the
lactating mother.9

-American Dietetic Association, 1986

As many expectant parents have now heard, introducing a child to cow9s milk
too early in the child9s development has been linked to type 1 diabetes.

A 1996 study of Chilean children concluded that genetic predisposition is an
important element in the development of type 1 diabetes in children and that
exclusive breastfeeding for at least three months may decrease the level of
risk. The study, by Dr. Perez-Bravo and colleagues, was published in the
Journal of Molecular Medicine (vol. 74, no. 2).

Another study, published by Gimeno and de Souza in 1997 (Diabetes Care, vol.
20, no. 8), suggested that an even shorter span -- more than seven days -- had
a protective effect. Children who were breastfed for fewer than seven days and
those who were given cows9 milk in the first week of life were about twice as
likely to develop diabetes as those who were breastfed for longer periods.

Research is continuing to explore the reasons why breastfeeding is protective.

"It is not clear whether the increased risk of [type 1 diabetes] among
children who were artificially fed as infants is due to the [lack of]
protective effects of breastfeeding or to the early introduction of foreign
proteins in non-breast-milk foods, or to some combination of the two," states
Margaret Davis, MD, MPH, in the February 2001 issue of Pediatric Clinics of
North America.

What if the Mother Already Has Diabetes?

Mothers who themselves have diabetes are the most motivated of all to protect
their newborns from developing the disease.

Diabetes Interview conducted a survey entitled "Questions for Women With
Diabetes Who Have Given Birth," which was posted on the Web site
www.insulin-pumpers.org as well as on the site www.diabeticmommy.com.
(Respondents were not asked specifically how long they had had diabetes or
which type of diabetes -- type 1, type 2 or gestational -- they had.)

Those who breastfed cited encouragement from their obstetrician/gynecologist
(OB/GYN), pediatrician and hospital nursing staff as well as support from
their endocrinologist and diabetes educator. Some also have the advantage of
receiving the advice of lactation specialists, while others sought out La
Leche League.

"My initial success is due to wonderful nurses and an awesome lactation
consultant at my hospital, who came at my request," says Jennifer Serrano, who
is still breastfeeding the daughter she had in December 2001.

However, Rebecca Warth-Anderson, who had her baby in 1999, reports that no one
-- "not my OB/GYN, not his nurse practitioner, nor the lactation consultant at
the hospital --  promoted breastfeeding as protection from diabetes for my
baby at all."

Warth-Anderson had planned on breastfeeding her baby even before she became
pregnant. And although the baby was delivered six weeks early by cesarean
section, she did breastfeed for about eight weeks. If she has more children,
she plans to breastfeed for an entire year. She notes that she will state her
wishes in advance by letter to the hospital staff if necessary.

Another mother, Sherry Compton, whose son was born in May 2001, says, "I was
never told by anyone that breastfeeding was something people with diabetes
should do. I found out from someone later that stopping breastfeeding early
could contribute to my son developing diabetes."

Protecting the Newborn

Even with improvements in monitoring and improved control of maternal blood
glucose, infants may still be exposed in utero to higher-than-normal levels of
glucose. The fetus will produce excessive insulin to balance the high glucose
levels. At birth, the extra insulin can result in a rapid drop in blood
glucose in the newborn. Therefore, babies are watched carefully and checked at
intervals by means of a heel-stick blood-glucose test. On their own, many
newborns quickly adjust. Others require intervention.

When mothers have diabetes, it is common practice in some hospitals to
supplement their newborns with formula to ensure against low blood glucose.
Additionally, a baby is often removed from the mother9s care for observation
for eight or more hours. Both practices interfere with establishment of the
baby9s sucking reflex. If the baby does exhibit low blood glucose, treatment
by intravenous glucose therapy can be started, and the baby can be at breast
while the IV is running.

Bottle Feeding Can Interfere With Breastfeeding

Donna Rushing recalls that her lactating nurse never mentioned that once
babies are bottle-fed, they often don't learn to breastfeed. Rushing9s baby
spent 22 days in the neonatal intensive care unit when she was born in May

"During her time there, she was fed formula, much to my disappointment."

Rushing pumped breast milk and froze it, but once she and her baby returned
home, she was not able to transfer the baby from bottle to breast. While she
felt unsuccessful at breastfeeding, she continued to pump breast milk, so her
daughter did get its benefits, though from a bottle, for her first five

The Importance of Colostrum

Taking the baby away from the mother also prevents the infant from receiving
colostrum -- the first milk that appears in the breast at the end of pregnancy
and during the early postpartum period.

Colostrum is thicker and more golden than mature breast milk, with a higher
content of proteins, many of which are immunoglobins -- (also present in
mature breast milk). Immunoglobins are proteins with antibody capabilities
that aid the infant9s immune response. Colostrum is also higher in fat-soluble
vitamins (including A, E and K) and some minerals (including sodium and zinc).
Colostrum does not stimulate insulin production the way formula does, so it is
better for preventing low blood glucose.

Cesarean Sections and Other high-Risk Experiences

When a mother has diabetes, her "high-risk" experience also presents
challenges to the success of breastfeeding. Cesarean sections and induced
labor are common.

"I had an IV on my right arm, and when I tried to move it a loud alarm would
sound. This really hampered things," says Compton. "I was shown by several
different people how to start the baby off, but we just couldn't seem to get
him latched on. I started feeling like a failure my first day as a mother."
Compton did not end up breastfeeding her son.

In 1995, with her first child, Nancy Ludwig -- who has had diabetes for 15
years -- was given a full meal after her cesarean section. This left her in
pain. She found pumping her breasts and breastfeeding in general "difficult
and painful" and did not breastfeed either that child or the next, even though
she had initially planned to do so.

"I sometimes wish there was more advocacy and support for Onon-breastfeeders.9
Sometimes it does not work out."

What About the Mother9s Own Diabetes Management?

As for their own diabetes management, mothers cited little interference in
adjusting their insulin doses post-birth.

Serrano recalls, "One nurse abruptly told me that they recommended that I
halve my pump basal rates and go from there. I re-attached my pump and was
left to test and monitor on my own. I reported my BG's to the nurse whenever I
felt like it. Nobody ever came to see me about my diabetes, but my OB care was

Elizabeth Woolley, who had her baby in April 2001 and is still breastfeeding,
says doctors were more "cautious" because of her diabetes.

"I was hooked up to an external fetal monitor, an internal fetal monitor, an
automatic blood pressure cuff, an IV with antibiotics, and an IV with fluids
and some type of glucose solution," she remembers. "I felt tied down. I had
hoped to be able to move and have more of a choice in labor and delivery

Regarding the first breastfeeding, Woolley and her husband had to repeatedly
ask about starting.

"They kept saying, OIn a minute,9 as they were still monitoring the baby.
Someone on the staff made the comment that he wasn't going to starve because
all I had was colostrum."

Jennifer Harkleroad had three successful pregnancies: twins and two more
children -- all girls. "I have nursed them all -- the twins six months, and
the other two, seventeen months each."

Harkleroad had read that mothers with diabetes who nursed could give their
children immunity from type 1.

"I was determined to do this from the beginning," she says. "Later, I read
that you had to nurse at least three months to get the full benefits, but that
12 months was optimal. My endocrinologist worked very closely with my OB. I
roomed in with all my babies and gave nurses explicit instructions that they
got no formula."

As Harkleroad says: "I was obsessed with giving my children every opportunity
not to have diabetes. I worry every day, but I know I did all I could to help
them avoid my situation."

Peggy Tague seconds this. She breastfed her first child for three years, and
the second for four.

"Both are healthy, diabetes-free -- for  now and forever, I hope.
Breastfeeding is so easy once you get started."

Most would say that breastfeeding was not easy for these mothers. However, it
can be successful, beneficial for the mother and protective for the baby.

Clinical Adviser9s Note: Research continues to explore the relationship of
breastfeeding to protection from diabetes. This article mentions the
possibility that it is exposure of the infant to cow9s milk protein that may
trigger a later autoimmune type 1 diabetes in those already at risk
genetically. Another theory takes a different perspective -- that it may be
the infant9s lack of exposure to breast milk that contains human insulin that
sets up the possibility of autoimmune diabetes later on. The insulin in human
breast milk does not regulate blood glucose in the infant. Oral insulin may,
however, during a critical time in early life, offer a protection from
autoimmune diabetes that is still not understood. There is no reason to wait
for more scientific conclusions about the very positive association of
breastfeeding and healthy offspring. The good news is that breastfeeding
offers the very best in life for all babies.

Beverly Morgan has been working in the breastfeeding field since 1973. She is
the author of two audiobooks about breastfeeding and has authored many
articles on the topic in publications as varied as Sacramento9s Parents
Monthly (CA) and Social Marketing Quarterly. She is in private practice in the
greater San Jose, California area and is on the board of the San Jose Mothers
Milk Bank.

Tina Farrell has published many nonfiction articles. Her articles on diabetes
and other health topics have been published in Diabetes Interview, the
newsletter of the Diabetes Society of Sonoma County (CA), the newsletter of
the Diabetes Society of Santa Clara Valley (CA), the Business Journal of
Silicon Valley (CA), and on the Internet. She has had type 1 diabetes for 10

Tina B. Farrell
Writing, Editing, Design
email @ redacted
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