A Cluster Randomized Trial of Tailored Breastfeeding Support for Women with Gestational Diabetes

Alison M. Stuebe, Karen Bonuck, Reuben Adatorwovor, Todd A. Schwartz, Diane C. Berry

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background: Women with gestational diabetes mellitus (GDM) and their infants are at increased risk of developing metabolic disease; however, longer breastfeeding is associated with a reduction in these risks. We tested an intervention to increase breastfeeding duration among women with GDM. Materials and Methods: We conducted a cluster randomized trial to determine the efficacy of a breastfeeding education and support program for women with GDM. Women were enrolled between 22 and 36 weeks of pregnancy and cluster randomized to an experimental lifestyle intervention or wait-list control group. Breastfeeding duration and intensity were prespecified secondary outcomes of the trial. Duration of exclusive and any breastfeeding was assessed at 6 weeks and at 4, 7, and 10 months postpartum. We quantified differences in breastfeeding rates using Kaplan-Meier estimates, log-rank tests, and Cox regression models. Results: We enrolled 100 women, of whom 52% were African American, 31% non-Hispanic white, 11% Hispanic, 9% American Indian or Alaskan Native, 2% Asian, 2% other, and 4% more than one race. In models accounting for within-cluster correlation and adjusted for study site, breastfeeding intention, and African American race, women allocated to the intervention group were less likely to stop breastfeeding (adjusted hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.21-0.74) or to introduce formula (adjusted HR 0.50, 95% CI 0.34-0.72). Conclusion: Our results suggest that targeted breastfeeding education for women with GDM is feasible and efficacious.

Original languageEnglish
Pages (from-to)504-513
Number of pages10
JournalBreastfeeding Medicine
Issue number10
StatePublished - Dec 2016

Bibliographical note

Funding Information:
All three individuals were supported by 1R21DK092750-01A1 during the study period. Findings were presented at the Society for Maternal Fetal Medicine, abstract number 97, on February 6, 2016. The trial is funded by the National Institutes of Health: The National Institute of Diabetes and Digestive and Kidney Disease, 1R21DK092750-01A1.

Publisher Copyright:
© 2016, Mary Ann Liebert, Inc.


  • Breastfeeding
  • gestational diabetes
  • lactation

ASJC Scopus subject areas

  • Pediatrics
  • Health Policy
  • Obstetrics and Gynecology
  • Maternity and Midwifery


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