Energy Restriction, Weight Loss, Glycemia, and Breastfeeding Outcomes in Gestational Diabetes: A DiGest Trial Secondary Analysis

• DOI: 10.2337/dc24-2625
• Publication Date: 2025-05-07T16:44:06Z
• Authors: Sarah Dib; Laura C. Kusinski; Danielle L. Jones; Nooria Atta; Suzanne Smith; Emanuella De Luci...; Helen R. Murphy; Roy Taylor; Claire L. Meek

OBJECTIVE We aimed to assess whether energy restriction, weight loss, or maternal glycemia in late pregnancy were associated with breastfeeding outcomes.

RESEARCH DESIGN AND METHODS This is a secondary analysis of the Dietary Intervention in Gestational Diabetes (DiGest) randomized controlled trial, which included 425 participants with gestational diabetes who were randomly assigned to receive a standard-energy (2,000 kcal/day) or reduced-energy (1,200 kcal/day) diet box from 29 weeks until delivery, with masked continuous glucose monitoring. Breastfeeding intentions and outcomes were documented (n = 304 of 425) and analyzed using regression models.

RESULTS Energy restriction in late pregnancy did not affect breastfeeding outcomes. Achieving ≥90% time in range (3.5–6.7 mmol/L; 63–120 mg/dL) with a low glycemic variability (coefficient of variation and SD), but not weight loss, were associated with any breastfeeding at 3 months postnatally.

CONCLUSIONS Improved late pregnancy glycemia and decreased glucose variability, but not weight loss or energy restriction, were associated with breastfeeding after gestational diabetes.