The same factors that lead to diabetes also contribute to low milk supply in some new mothers.

Severely obese teens face a higher risk of low iron, low vitamin D and other nutritional deficiencies, whether or not they receive bariatric surgery.

And a surprising proportion of breastfed children in the US are not being introduced quickly enough to a diverse mix of foods once they reach 6 months of age.

These are some of the many new findings from scientists at Cincinnati Children’s that were presented this week at the annual meeting of the Pediatric Academic Societies (PAS) in Vancouver, Canada.

Diabetes and breast milk

A study presented May 5 reports that problems with insulin metabolism can affect a mother’s milk production. The study, which included 561 women with breastfeeding problems, found that women diagnosed with low milk supply were 2.5 times more likely to have experienced gestational diabetes compared to women seen at the clinic solely because their infants were having problems latching onto the breast. 

“We need to better understand how we can identify mothers at risk for low milk supply and how best to support them in meeting their breastfeeding goals,” says Sarah Riddle, MD, a pediatrician at the Center for Breastfeeding Medicine at Cincinnati Children’s and lead author of the study. “We also need to develop targeted therapies to support lactation success in women with a history of glucose intolerance.”

In a separate study presented April 27 at the Experimental Biology annual meeting in San Diego, Laurie Nommsen-Rivers, PhD, a researcher at the Cincinnati Children’s Perinatal Institute, showed that postpartum metabolic health also affects lactation sufficiency – even among women who did not experience diabetes in pregnancy. She found that elevated body mass index, elevated fasting insulin, insulin resistance and, especially, elevated fasting plasma glucose in the pre-diabetic range, were all predictors of insufficient milk supply in women attempting to exclusively breastfeed. 

“One consequence of the obesity epidemic is that nearly one out of every four reproductive-aged women is pre-diabetic. Research to inform how to support lactation success in this vulnerable group of women is urgently needed,” Nommsen-Rivers says.

The next step for Nommsen-Rivers and Riddle will be to conduct a clinical trial of metformin, a drug used to control blood sugar in type 2 diabetes.  They hope to determine whether metformin, by improving insulin action in the mammary gland, will boost milk production in pre-diabetic mothers diagnosed with low milk supply.

Obese teens and poor nutrition

A study of 79 severely obese teens surprised scientists at Cincinnati Children’s when they found higher risks of nutritional deficiencies for the teens whether they received weight loss surgery or not.

The study involved comparing outcomes for teens at least five years after they were offered weight loss surgery. Findings were presented May 4 at the annual PAS meeting in Vancouver.

“We knew there were nutritional difficulties in teens who had undergone bariatric surgery, but everyone thought it was primarily the surgery that caused these problems since gastric bypass excludes the portion of the small intestine where many nutrients, especially iron, are most absorbed,” says co-author Stavra Xanthakos, MD, medical director the Surgical Weight Loss Program for Teens at Cincinnati Children’s. “What this shows us is that nutritional deficiencies occur even in teens who don’t undergo surgery. “

Those who did have surgery experienced “durable and significant” weight loss, of about 28 percent.  Those who did not receive surgery had not lost weight. But nutritional deficiencies continued in both groups. Those receiving surgery had low iron, mild anemia and low vitamin D. Those who did not have surgery had low iron, low vitamin D and low levels of protein in their blood.

“Severely obese patients should be screened for nutritional deficiencies, regardless of whether they’ve undergone weight loss surgery,” Xanthakos says.

Does breastfeeding delay introducing a diverse mix of foods?

According to the World Health Organization, infants who have reached 6 months old should be offered food from at least four food groups every day. But heavily breastfed babies in the US are less likely than breastfed infants in China or Mexico to be receiving a diverse diet.

“Much of the previous work in the area of dietary diversity has focused on developing nations, where access to healthy and sufficient complementary foods may be limited,” says Jessica Woo, PhD, a researcher at Cincinnati Children’s and lead author of the study. “Our research raises some concern about infants in developed nations, particularly the United States, who may not be achieving sufficient dietary diversity by one year of age.”

Findings were presented May 3 at the annual PAS meeting in Vancouver.

The researchers studied 365 breastfed infants in Cincinnati, Shanghai and Mexico City.  Dietary diversity increased between 6 and 12 months, but less than 28 percent of highly breastfed Cincinnati infants received diverse diets between 6 and 12 months – considerably fewer infants than in Shanghai and Mexico City.

The study did not compare the impact of dietary diversity on growth or nutritional status of these infants. But the findings suggest that better education is needed in the US about the importance of introducing at least four food groups a day after six months of age, Woo says.