Prepregnancy Diabetes and Breastfeeding Cessation Among Black Women in the United States

Breastfeed Med. 2019 May;14(4):249-255. doi: 10.1089/bfm.2018.0074. Epub 2019 Mar 6.


Background: The incidence of diabetes is rising, and with it, the number of pregnancies affected by diabetes. U.S. black women have a disproportionately high prevalence of diabetes and lower rates of breastfeeding. Objective: The objective of this study was to quantify the relationship between diabetes before pregnancy and breastfeeding duration among black women in the United States. Materials and Methods: We analyzed women from the Black Women's Health Study (N = 59,000) to assess the relationship between prepregnancy diabetes and time to breastfeeding cessation occurring up to 24 months postdelivery using Kaplan-Meier survival curves, log rank tests, and Cox proportional hazards models. The study population included primiparous women with births between 1995 and 2009 (N = 3,404). Obesity, hypertension before pregnancy, and family history of diabetes were examined for effect modification. Results: Survival curves demonstrated a markedly reduced duration of breastfeeding in women who had been diagnosed with prepregnancy diabetes (p < 0.01). The hazard ratio for breastfeeding cessation for women with prepregnancy diabetes was 1.5 (95% confidence interval 1.1-2.0) compared with women without prepregnancy diabetes after control for age, body mass index (BMI) at age 18, prepregnancy BMI, other metabolic factors, demographics, and health behaviors. Conclusions: Our results suggest that prepregnancy diabetes is a strong predictor of curtailed breastfeeding duration, even after control for BMI. This underscores the need for targeted lactation support for diabetic women.

Keywords: African Americans; breastfeeding; diabetes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Black or African American*
  • Body Mass Index
  • Breast Feeding / ethnology*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Obesity / ethnology*
  • Pregnancy
  • Pregnancy in Diabetics / ethnology*
  • Proportional Hazards Models
  • Time Factors
  • United States / epidemiology