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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded


Month Degree Awarded


First Advisor

Lindiwe Sibeko

Second Advisor

Katherine W. Reeves

Third Advisor

Alayne G. Ronnenberg

Fourth Advisor

Jing Qian

Subject Categories

Nutritional Epidemiology


Research suggests that the trajectory to obesity and its associated metabolic disorders begins early in life. Prenatal exposure to maternal gestational diabetes mellitus (GDM) is associated with increased risk, while breastfeeding is associated with reduced risk. Breastfeeding may influence obesity risk by preventing rapid postnatal weight gain. Mothers with gestational diabetes may not breastfeed as intensely as healthy mothers, potentially exacerbating the risk to their infants. We conducted three distinct investigations related to gestational diabetes, breastfeeding, and infant weight gain. All used data from the U.S. Infant Feeding Practices Study II. Multivariate logistic regression was used to estimate associations between predictor and outcome variables.

In the first study (N=1,225), we found that compared to 100% breast milk feeds, likelihood of rapid weight gain was increased two-to-three-fold for infants fed any other way. In the second study, which used prenatal (N=3,244) and postpartum (N=2,051) data, GDM was associated with a 46% reduced odds of ever EBF. Intention to breastfeed was similar in both groups. Infants of GDM mothers were 78% more likely to receive formula in the hospital. Duration of breastfeeding was similar in both groups. The third study included 3,010 and 1,733 women in prenatal and postnatal analyses, respectively. During pregnancy, GDM women were nearly 40% less likely to report breastfeeding as optimal feeding and 74-78% more likely to indicate formula or mixed feeding as the preferred feeding by the infant’s father. They were nearly three times more likely than NDM women to say their physician preferred formula, and were 30% less likely to report being comfortable breastfeeding in front of women friends. There were no differences in knowledge of breastfeeding benefits or recommendations. Following delivery, infants of GDM women were 45% less likely to room-in with their mother. GDM women were 66% more likely to indicate problems with sucking and twice as likely to say the infant was not interested in breastfeeding.

The results of these studies suggest that high-intensity breastfeeding in early infancy may be necessary to prevent rapid infant weight gain, and that women with GDM may especially need support and encouragement to achieve optimal breastfeeding outcomes.