Correlation Between Gestational Diabetes Mellitus(GDM) And Delayed Onset Of Lactogenesis(DOL) And Risk Factors Of DOL Among Gdm Puerperae

BackgroundGestational diabetes mellitus(GDM)is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is one of the most serious and common complications during pregnancy.Occurrence rate of GDM is increasing year by year and has reached up to 19.7%in Beijing.Delayed onset of lactogenesis(DOL)is defined as absence of obvious breast bilges feeling within 72h postpartum.DOL is a difficulty faced with during early breastfeeding and also one of reasons resulting in breastfeeding failure.Owing to increasing risk of earlier cessation of breastfeeding and excess neonatal weight loss,DOL is harmful to the health of mothers and children.Morbidity rate of DOL reported in domestic and foreign literature are different(from 11.7%to 44%)and this may be related to different feature of study population.Foreign literature has reported that type 1 diabetes was associated with DOL,but there are few studies on relationship between GDM and DOL and no one in China at present.Therefore,exploring whether GDM is related to DOL and analysing risk factors of DOL among GDM mothers are necessary to seek preventative measures of DOL.Objective1.To explore the correlation between GDM and DOL by comparing the incidence rate of DOL in two groups.2.To investigate the occurrence of DOL among GDM puerpera and analyse related risk factors of it to provide guidance for its prevention.Materials and Methods1.Among gravidas who went to three tertiary hospitals of Nanjing for antenatal examination from March to September 2016,two hundred and seventy-five gravidas diagnosed with GDM through 75g oral glucose tolerance test(OGTT)were screened as GDM group,meanwhile two hundred and seventy-five gravidas with normal glucose tolerance as non-GDM group.Prospective cohort study was carried out between the two groups.Related materials were collected during perinatal period.Recorded the time of the onset of lactogenesis and judged whether it is delayed.Compared the occurrence rate of DOL in two groups and analysed correlation between GDM and DOL with multiple logistic regression model.Collected 0.2?1ml breast milk during 48?72h after delivery from voluntary gravidas,and preserved at-18??-20? refrigerator.Concentration of lactose in milk was detected and compared in two groups with t-test.Relationship between lactose concentration and time of onset of lactogenesis was analysed with Pearson correlation analysis.2.Three hundred gravidas diagnosed with GDM were included whose antenatal examination were done in three tertiary hospitals in Nanjing from March to October 2016.The time of the onset of lactogenesis and their demographic characteristics,gestational materials,materials about GDM,information on perinatal period and newborn were recorded.Risk factors of DOL was analysed with multiple logistic regression model.Results 1.Results of prospective cohort study After elimiating mothers who lost tofollow-up,experienced maternal separation,gave up breastfeeding and whose information were not complete,four hundred and ninety-seven gravidas were analysed in all.Results were as follows:(1)Gestational weeks,marriage,education level,prenatal BMI and gestational weight gain of gravidas in GDM group had no significant difference with the other group(P>0.05).(2)Pearson correlation analysis demonstrated that lactose concentration was negatively correlated with time of onset of lactogenesis(P<0.05,r=-0.201).The mean lactose concentration was(5.454±2.092)mmol/L in GDM group,and(6.729± 1.718)mmol/L in non-GDM group,the difference was statistically significant(P<0.05).The mean time of onset of lactogenesis reported was(52.725±11.350)h in GDM group,and(49.890±11.901)h in non-GDM group,the difference was statistically significant(P<0.05).(3)Occurrence rate of DOL in GDM group was higher than that in non-GDM group.Multiple logistic regression showed that primiparity(OR=1.558),and GDM(OR=1.639)were risk factors of DOL.2.Results of risk factors analysis After elimiating mothers who lost to follow-up,experienced maternal separation,gave up breastfeeding,two hundred and eighty-four gravidas were analysed in all.Results were as follows:(1)33.8%of GDM gravidas experienced DOL.(2)Multiple logistic regression showed that maternal age?35years old,primiparity and without reexaminating blood glucose regularly after OGTT were independent risk factors of DOL among GDM gravidas,and OR were 2.267,3.261 and 3.666,respectively.Conclusion1.GDM gravidas are high-risk in experiencing DOL.Measures should be taken to prevent GDM.2.Lactose concentration in milk is negatively correlated with timing of onset of lactogenesis(OL).And timing of OL in GDM puerpera later than that in non-GDM puerpera may be related to decreasing synthesis of lactose owing to disturbance of carbohydrate metabolism.3.GDM gravidas who are older and primiparity should be informed importance of glycemic control and regular reexamination of glucose prenatal.More attention and breastfeeding support should be provided postpartum while controlling blood glucose to prevent DOL.