ABSTRACT
For maternal metabolism, pregnancy ends not with delivery, but with weaning. In several
recent epidemiological studies, authors have reported an association between duration
of breast-feeding and reduced maternal risk of metabolic disease. These findings parallel
data from animal models showing favorable changes in metabolism associated with lactation.
During gestation, visceral fat accumulates, and insulin resistance and lipid and triglyceride
levels increase. These changes appear to reverse more quickly, and more completely,
with lactation. In this article, we review animal and human studies regarding the
effects of lactation on adiposity, lipid, and glucose homeostasis. We hypothesize
that lactation plays an important role in “resetting” maternal metabolism after pregnancy.
KEYWORDS
Lactation - adiposity - glucose homeostasis - hyperlipidemia - diabetes - metabolic
syndrome
REFERENCES
1
Gunderson E P, Murtaugh M A, Lewis C E et al..
Excess gains in weight and waist circumference associated with childbearing: The Coronary
Artery Risk Development in Young Adults Study (CARDIA).
Int J Obes Relat Metab Disord.
2004;
28
525-535
2
Villamor E, Cnattingius S.
Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based
study.
Lancet.
2006;
368
1164-1170
3
Rooney B L, Schauberger C W, Mathiason M A.
Impact of perinatal weight change on long-term obesity and obesity-related illnesses.
Obstet Gynecol.
2005;
106
1349-1356
4
Stuebe A M, Rich-Edwards J W, Willett W C, Manson J E, Michels K B.
Duration of lactation and incidence of type 2 diabetes.
JAMA.
2005;
294
2601-2610
5
Stuebe A M, Michels K B, Willett W C, Manson J E, Rich-Edwards J.
Duration of lactation and incidence of myocardial infarction.
Am J Obstet Gynecol.
, In press
6
Ram K T, Bobby P, Hailpern S M et al..
Duration of lactation is associated with lower prevalence of the metabolic syndrome
in midlife-SWAN, the study of women's health across the nation.
Am J Obstet Gynecol.
2008;
198
268.e261-268.e266
7
Schwarz E B, Stuebe A M, Allison M A et al..
Impact of lactation on risk factors for cardiovascular disease.
J Gen Intern Med.
2008;
23(Suppl 2)
321-322
8 Ellison P T. Metabolizing for Two. In, On Fertile Ground. Cambridge; Harvard University
Press 2001: 94-97
9
Dall S R, Boyd I L.
Evolution of mammals: lactation helps mothers to cope with unreliable food supplies.
Proc Biol Sci.
2004;
271
2049-2057
10
Einstein F H, Fishman S, Muzumdar R H et al..
Accretion of visceral fat and hepatic insulin resistance in pregnant rats.
Am J Physiol Endocrinol Metab.
2008;
294
E451-E455
11
Hamosh M, Clary T R, Chernick S S, Scow R O.
Lipoprotein lipase activity of adipose and mammary tissue and plasma triglyceride
in pregnant and lactating rats.
Biochim Biophys Acta.
1970;
210
473-482
12
Steingrimsdottir L, Brasel J A, Greenwood M R.
Diet, pregnancy, and lactation: effects on adipose tissue, lipoprotein lipase, and
fat cell size.
Metabolism.
1980;
29
837-841
13
Moore B J, Brasel J A.
One cycle of reproduction consisting of pregnancy, lactation or no lactation, and
recovery: effects on carcass composition in ad libitum-fed and food-restricted rats.
J Nutr.
1984;
114
1548-1559
14
Moore B J, Olsen J L, Marks F, Brasel J A.
The effects of high fat feeding during one cycle of reproduction consisting of pregnancy,
lactation and recovery on body composition and fat pad cellularity in the rat.
J Nutr.
1984;
114
1566-1573
15
Zhong S, Almario R, Dubrinsky M et al..
Repeated pregnancy without lactation: effects on maternal glycemic control, pregnancy
outcome, carcass composition, and fat distribution in rats.
Metabolism.
1990;
39
1127-1132
16
Butte N F, Garza C, Stuff J E, Smith E O, Nichols B L.
Effect of maternal diet and body composition on lactational performance.
Am J Clin Nutr.
1984;
39
296-306
17
Goldberg G R, Prentice A M, Coward W A et al..
Longitudinal assessment of the components of energy balance in well-nourished lactating
women.
Am J Clin Nutr.
1991;
54
788-798
18
Butte N F, Hopkinson J M, Mehta N, Moon J K, Smith E O.
Adjustments in energy expenditure and substrate utilization during late pregnancy
and lactation.
Am J Clin Nutr.
1999;
69
299-307
19
van Raaij J M, Schonk C M, Vermaat-Miedema S H, Peek M E, Hautvast J G.
Energy cost of lactation, and energy balances of well-nourished Dutch lactating women:
reappraisal of the extra energy requirements of lactation.
Am J Clin Nutr.
1991;
53
612-619
20
Brewer M M, Bates M R, Vannoy L P.
Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating
women.
Am J Clin Nutr.
1989;
49
259-265
21
Sadurskis A, Kabir N, Wager J, Forsum E.
Energy metabolism, body composition, and milk production in healthy Swedish women
during lactation.
Am J Clin Nutr.
1988;
48
44-49
22
Dewey K G, Heinig M J, Nommsen L A.
Maternal weight-loss patterns during prolonged lactation.
Am J Clin Nutr.
1993;
58
162-166
23
Ohlin A, Rossner S.
Maternal body weight development after pregnancy.
Int J Obes.
1990;
14
159-173
24
Ohlin A, Rossner S.
Factors related to body weight changes during and after pregnancy: the Stockholm Pregnancy
and Weight Development Study.
Obes Res.
1996;
4
271-276
25
Janney C A, Zhang D, Sowers M.
Lactation and weight retention.
Am J Clin Nutr.
1997;
66
1116-1124
26
Valeggia C R, Ellison P T.
Impact of breastfeeding on anthropometric changes in peri-urban Toba women (Argentina).
Am J Hum Biol.
2003;
15
717-724
27
Quandt S A.
Changes in maternal postpartum adiposity and infant feeding patterns.
Am J Phys Anthropol.
1983;
60
455-461
28
Kac G, Benicio M H, Velasquez-Melendez G, Valente J G, Struchiner C J.
Breastfeeding and postpartum weight retention in a cohort of Brazilian women.
Am J Clin Nutr.
2004;
79
487-493
29
Soltani H, Fraser R.
A longitudinal study of maternal anthropometric changes in normal weight, overweight
and obese women during pregnancy and postpartum.
Br J Nutr.
2000;
84
95-101
30
Chou T W, Chan G M, Moyer-Mileur L.
Postpartum body composition changes in lactating and non-lactating primiparas.
Nutrition.
1999;
15
481-484
31
Kramer F M, Stunkard A J, Marshall K A, McKinney S, Liebschutz J.
Breast-feeding reduces maternal lower-body fat.
J Am Diet Assoc.
1993;
93
429-433
32
Martinez H, Allen L H, Lung'aho M, Chavez A, Pelto G H.
Maternal fatness in Mexican women predicts body composition changes in pregnancy and
lactation.
Adv Exp Med Biol.
1994;
352
99-107
33
Forsum E, Sadurskis A, Wager J.
Estimation of body fat in healthy Swedish women during pregnancy and lactation.
Am J Clin Nutr.
1989;
50
465-473
34
Sidebottom A C, Brown J E, Jacobs Jr D R.
Pregnancy-related changes in body fat.
Eur J Obstet Gynecol Reprod Biol.
2001;
94
216-223
35
Sohlstrom A, Forsum E.
Changes in adipose tissue volume and distribution during reproduction in Swedish women
as assessed by magnetic resonance imaging.
Am J Clin Nutr.
1995;
61
287-295
36
Rebuffe-Scrive M, Enk L, Crona N et al..
Fat cell metabolism in different regions in women. Effect of menstrual cycle, pregnancy,
and lactation.
J Clin Invest.
1985;
75
1973-1976
37
Lassek W D, Gaulin S J.
Changes in body fat distribution in relation to parity in American women: a covert
form of maternal depletion.
Am J Phys Anthropol.
2006;
131
295-302
38
Gigante D P, Victora C G, Barros F C.
Breast-feeding has a limited long-term effect on anthropometry and body composition
of Brazilian mothers.
J Nutr.
2001;
131
78-84
39
Sichieri R, Field A E, Rich-Edwards J, Willett W C.
Prospective assessment of exclusive breastfeeding in relation to weight change in
women.
Int J Obes Relat Metab Disord.
2003;
27
815-820
40
Rooney B L, Schauberger C W.
Excess pregnancy weight gain and long-term obesity: one decade later.
Obstet Gynecol.
2002;
100
245-252
41
Rush D, Lumey L H, Ravelli A C, Myers B.
The indirect association of lactation with subsequent perimenopausal body weight.
Eur J Clin Nutr.
1996;
50
12-16
42
Dewey K G, Cohen R J, Brown K H, Rivera L L.
Effects of exclusive breastfeeding for four versus six months on maternal nutritional
status and infant motor development: results of two randomized trials in Honduras.
J Nutr.
2001;
131
262-267
43
Jones R G, Ilic V, Williamson D H.
Physiological significance of altered insulin metabolism in the conscious rat during
lactation.
Biochem J.
1984;
220
455-460
44
Burnol A F, Leturque A, Ferre P, Kande J, Girard J.
Increased insulin sensitivity and responsiveness during lactation in rats.
Am J Physiol.
1986;
251(5 Pt 1)
E537-E541
45
Karnik S K, Chen H, McLean G W et al..
Menin controls growth of pancreatic beta-cells in pregnant mice and promotes gestational
diabetes mellitus.
Science.
2007;
318
806-809
46
Kjos S L, Henry O, Lee R M, Buchanan T A, Mishell Jr D R.
The effect of lactation on glucose and lipid metabolism in women with recent gestational
diabetes.
Obstet Gynecol.
1993;
82
451-455
47
McManus R M, Cunningham I, Watson A, Harker L, Finegood D T.
Beta-cell function and visceral fat in lactating women with a history of gestational
diabetes.
Metabolism.
2001;
50
715-719
48
Diniz J M, Da Costa T H.
Independent of body adiposity, breast-feeding has a protective effect on glucose metabolism
in young adult women.
Br J Nutr.
2004;
92
905-912
49
Stuebe A, Gillman M, Kleinman K, Rifas-Shiman S, Rich-Edwards J.
Duration of lactation and maternal metabolism at 3 years postpartum.
Am J Obstet Gynecol.
2007;
197
S128
50
Darmady J M, Postle A D.
Lipid metabolism in pregnancy.
Br J Obstet Gynaecol.
1982;
89
211-215
51
Knopp R H, Walden C E, Wahl P W et al..
Effect of postpartum lactation on lipoprotein lipids and apoproteins.
J Clin Endocrinol Metab.
1985;
60
542-547
52
Erkkola R, Viikari J, Irjala K, Solakivi-Jaakkola T.
One-year follow-up of lipoprotein metabolism after pregnancy.
Biol Res Pregnancy Perinatol.
1986;
7
47-51
53
Kallio M J, Siimes M A, Perheentupa J, Salmenpera L, Miettinen T A.
Serum cholesterol and lipoprotein concentrations in mothers during and after prolonged
exclusive lactation.
Metabolism.
1992;
41
1327-1330
54
Gunderson E P, Lewis C E, Wei G S et al..
Lactation and changes in maternal metabolic risk factors.
Obstet Gynecol.
2007;
109
729-738
55
Pesa J A, Shelton M M.
Health-enhancing behaviors correlated with breastfeeding among a national sample of
mothers.
Public Health Nurs.
1999;
16
120-124
56 National Center for Health Statistics .Table 18. Breastfeeding by mothers 15–44
years of age by year of baby's birth, according to selected characteristics of mother:
United States, average annual 1972–74 to 1999–2001. In: Health, United States, 2005,
With Chartbook on Trends in the Health of Americans. Hyattsville, MD 2005
57 Centers for Disease Control and Prevention .Breastfeeding Practices—Results from
the National Immunization Survey. Web site: http://www.cdc.gov/breastfeeding/data/NIS_data/data_2004.htm accessed July 21, 2008
58
Oddy W H, Li J, Landsborough L et al..
The association of maternal overweight and obesity with breastfeeding duration.
J Pediatr.
2006;
149
185-191
59
Donath S M, Amir L H.
Does maternal obesity adversely affect breastfeeding initiation and duration?.
Breastfeed Rev.
2000;
8
29-33
60
Hilson J A, Rasmussen K M, Kjolhede C L.
Maternal obesity and breast-feeding success in a rural population of white women.
Am J Clin Nutr.
1997;
66
1371-1378
61
Hilson J A, Rasmussen K M, Kjolhede C L.
High prepregnant body mass index is associated with poor lactation outcomes among
white, rural women independent of psychosocial and demographic correlates.
J Hum Lact.
2004;
20
18-29
62
Baker J L, Michaelsen K F, Sorensen T I, Rasmussen K M.
High prepregnant body mass index is associated with early termination of full and
any breastfeeding in Danish women.
Am J Clin Nutr.
2007;
86
404-411
63
Rasmussen K M, Kjolhede C L.
Prepregnant overweight and obesity diminish the prolactin response to suckling in
the first week postpartum.
Pediatrics.
2004;
113
e465-e471
64
Li R, Jewell S, Grummer-Strawn L.
Maternal obesity and breast-feeding practices.
Am J Clin Nutr.
2003;
77
931-936
65
Hilson J A, Rasmussen K M, Kjolhede C L.
Excessive weight gain during pregnancy is associated with earlier termination of breast-feeding
among white women.
J Nutr.
2006;
136
140-146
66
Kramer M S, Chalmers B, Hodnett E D et al..
Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the
Republic of Belarus.
JAMA.
2001;
285
413-420
67 National Center for Health Statistics .Fertility, Family Planning, and Reproductive
Health of U.S. Women: Data from the 2002 National Survey of Family Growth. In: Data
From the National Survey of Family Growth. Hyattsville, MD; Public Health Service
2006: 174
Alison M StuebeM.D.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School
of Medicine, University of North Carolina at Chapel Hill
3010 Old Clinic Building, CD# 7516, Chapel Hill, NC 27599-7516
eMail: astuebe@med.unc.edu