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Lifetime duration of breastfeeding and cardiovascular risk in women with type 2 diabetes or a history of gestational diabetes: Findings from two large prospective cohorts

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posted on 2024-02-20, 21:27 authored by Anna Birukov, Marta Guasch-Ferré, Sylvia H. Ley, Deirdre K. Tobias, Fenglei Wang, Clemens Wittenbecher, Jiaxi Yang, JoAnn E Manson, Jorge E. Chavarro, Frank B. Hu, Cuilin Zhang

Objective: Breastfeeding duration is inversely associated with risks of cardiovascular disease (CVD) and type 2 diabetes in parous women. However, the association among women at high risk including women with type 2 diabetes or gestational diabetes (GDM) is unclear.

Research Design and Methods: We included 15,146 parous women with type 2 diabetes from Nurses’ Health Study I and II (NHS, NHS2) and 4,537 women with a history of GDM from NHS2. Participants reported history of breastfeeding via follow-up questionnaires. Incident CVD by 2017 comprised stroke or coronary heart disease (CHD: myocardial infarction, coronary revascularization). Adjusted hazard ratios [aHR 95% CI] were estimated using Cox models.

Results: We documented 1,159 incident CVD cases among women with type 2 diabetes in both cohorts during 188,874 person-years of follow-up and 132 incident CVD cases among women with a GDM history during 100,218 person-years of follow-up. Longer lifetime duration of breastfeeding was significantly associated with lower CVD risk among women with type 2 diabetes, pooled aHR 0.68 (95% CI 0.54-0.85) for >18 months vs 0 months and 0.94 (0.91-0.98) per 6 months increment in breastfeeding. Similar associations were observed with CHD (pooled aHR 0.93 [0.88-0.97]), however, not with stroke: 0.96 [0.91-1.02] per 6 months increment in breastfeeding). Among women with GDM history, >18 months vs 0 months of breastfeeding was associated with aHR 0.49 (0.28-0.86) for total CVD.

Conclusions: Longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or GDM.

Funding

This work was supported by research grants UM1 CA186107, U01 CA176726, U01 HL145386, R01 HL034594, R01 HL088521 from the National Institutes of Health. AB was supported by the German Research Foundation (DFG) individual fellowship (BI 2427/1-1). MG-F was supported by Novo Nordisk Research grant NNF18CC0034900. CW was supported by the German Research Foundation (DFG) individual fellowship (#WI5132/1-1) and the SciLifeLab & Wallenberg Data Driven Life Science Program (grant: KAW 2020.0239). The funding sources played no role in the design, collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication.

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