Am J Perinatol 2009; 26(1): 081-088
DOI: 10.1055/s-0028-1103034
© Thieme Medical Publishers

The Reset Hypothesis: Lactation and Maternal Metabolism

Alison M. Stuebe1 , Janet W. Rich-Edwards2 , 3
  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
  • 2Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital
  • 3Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
Further Information

Publication History

Publication Date:
21 November 2008 (online)

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.

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