Lactation intensity and fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: the SWIFT cohort

Metabolism. 2014 Jul;63(7):941-50. doi: 10.1016/j.metabol.2014.04.006. Epub 2014 Apr 13.


Objectives: Lactation may influence future progression to type 2 diabetes after gestational diabetes mellitus (GDM). However, biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM. This study investigates whether higher lactation intensity is related to more favorable blood lipids, lipoproteins and adipokines after GDM pregnancy independent of obesity, socio-demographics and insulin resistance.

Methods: The Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT) is a prospective cohort study that recruited 1035 women diagnosed with GDM by the 3-h 100g oral glucose tolerance tests (OGTTs) after delivery of a live birth in 2008-2011. Research staff conducted 2-h 75 g OGTTs, and assessed lactation intensity, anthropometry, lifestyle behaviors and socio-demographics at 6-9 weeks postpartum (baseline). We assayed fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin from stored samples obtained at 6-9 weeks postpartum in 1007 of the SWIFT participants who were free of diabetes at baseline. Mean biomarker concentrations were compared among lactation intensity groups using multivariable linear regression models.

Results: Increasing lactation intensity showed graded monotonic associations with fully adjusted mean biomarkers: 5%-8% higher high-density lipoprotein cholesterol (HDL-cholesterol), 20%-28% lower fasting triglycerides, 15%-21% lower leptin (all trend P-values < 0.01), and with 6% lower adiponectin, but only after adjustment for insulin resistance (trend P-value = 0.04).

Conclusion: Higher lactation intensity was associated with more favorable biomarkers for type 2 diabetes, except for lower plasma adiponectin, after GDM delivery. Long-term follow-up studies are needed to assess whether these effects of lactation persist to predict progression to glucose intolerance.

Keywords: Adipokines; Breastfeeding; Diabetes Mellitus; Gestational Diabetes Mellitus (GDM); Lipids.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adiponectin / blood*
  • Adult
  • Biomarkers / blood
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Diabetes, Gestational / physiopathology*
  • Disease Progression
  • Fatty Acids, Nonesterified / blood
  • Female
  • Humans
  • Insulin Resistance
  • Lactation*
  • Leptin / blood*
  • Lipids / blood*
  • Lipoproteins / blood
  • Middle Aged
  • Postpartum Period
  • Prediabetic State / blood
  • Prediabetic State / etiology
  • Prediabetic State / physiopathology*
  • Pregnancy
  • Young Adult


  • ADIPOQ protein, human
  • Adiponectin
  • Biomarkers
  • Fatty Acids, Nonesterified
  • Leptin
  • Lipids
  • Lipoproteins