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Lactation in insulin-dependent diabetes.

The ability of insulin-dependent diabetic (IDDM) women to breast-feed has been documented, however, there is little information concerning milk composition or factors that influence successful breastfeeding. Placental lactogen and prolactin levels can be normalized during pregnancy with good metabolic control. These hormones affect the readiness of the mammary gland for lactation. Prolactin maintains mammary gland insulin receptors to ensure anabolism. Lactation in IDDM women may be influenced by hyper- or hypoglycemia as women balance their insulin needs. Milk from diabetic animals has decreased lactose, fat, protein and volume and these effects can be reversed with insulin administration. Mature breast milk of IDDM women has increased glucose and sodium and mammary gland lipid metabolism may be impaired. Milk lactose and citrate, markers of lactogenesis II, suggest delayed lactation occurs in diabetic women. Many factors may influence lactation success and breast milk composition of IDDM women. Some of these include: method of delivery, feeding frequency, fetal condition, gestational age, mastitis incidence, metabolic control and maternal dietary intake. Lactation management of the IDDM woman must address these factors.