Prolactin does not seem to mediate the improvement on insulin resistance markers and blood glucose levels related to breastfeeding

Frontiers in Endocrinology

Endocrinology

Rosiane Mattar¹  Alexandre Archanjo Ferraro²  Camila Rodrigues de Souza Carvalho³  Julia Martins de Oliveira³  Sérgio Atala Dib⁴  Patricia Medici Dualib⁴  Bianca de Almeida-Pititto⁵ 

[1] Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, Brazil;Department of Pediatrics, Universidade de São Paulo, São Paulo, Brazil;Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de Sao Paulo, São Paulo, Brazil;Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de Sao Paulo, São Paulo, Brazil;Department of Medicine, Universidade Federal de Sao Paulo, São Paulo, Brazil;Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de Sao Paulo, São Paulo, Brazil;Department of Preventive Medicine, Universidade Federal de Sao Paulo, São Paulo, Brazil;

关键词: breastfeeding;    gestational diabetes mellitus;    prolactin levels;    insulin resistance;    glucose tolerance;    postpartum;   

DOI  :  10.3389/fendo.2023.1219119

 received in 2023-05-08, accepted in 2023-07-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Strategies to decrease this risk should be strongly encouraged. Lactation has been associated, for the mother, with reduction in future T2DM risk in several studies. The mechanisms behind this phenomenon, however, are poorly understood. The aims of this study were, first, to compare blood glucose levels and markers of insulin resistance (MIR) in early postpartum women with overweight/obesity according to their breastfeeding status and, second, to evaluate whether prolactin (PRL) levels could mediate improvements in these parameters.MethodsThe prospective study followed 95 women older than 18 years from early pregnancy for up to 60 to 180 days postpartum. All participants had a BMI > 25 kg/m2 and a singleton pregnancy. At each visit, questionnaires and clinical and biochemical evaluations were performed. Participants were divided into two groups according to the breastfeeding status as “yes” for exclusive or predominant breastfeeding, and “no” for not breastfeeding.ResultsBreastfeeding women (n = 44) had significantly higher PRL levels [47.8 (29.6–88.2) vs. 20.0 (12.0–33.8), p< 0.001]. They also had significantly lower fasting blood glucose levels [89.0 (8.0) vs. 93.9 (12.6) mg/dl, p = 0.04], triglycerides (TG) [92.2 (37.9) vs. 122.4 (64.4) mg/dl, p = 0.01], TG/HDL ratio [1.8 (0.8) vs. 2.4 (1.6) mg/dl, p = 0.02], TyG index [8.24 (0.4) vs. 8.52 (0.53), p = 0.005], fasting serum insulin [8.9 (6.3–11.6) vs. 11.4 (7.7–17.0), p = 0.048], and HOMA-IR [2.0 (1.3–2.7) vs. 2.6 (1.6–3.9), p = 0.025] in the postpartum period compared to the non-breastfeeding group. Groups were homogeneous in relation to prevalence of GDM, pre-gestational BMI, as well as daily caloric intake, physical activity, and weight loss at postpartum. Linear regression analysis with adjustments for confounders showed a statistically significant association of breastfeeding with fasting blood glucose [−6.37 (−10.91 to −1.83), p = 0.006], HOMA-IR [−0.27 (−0.51 to −0.04), p = 0.024], TyG index [−0.04 (−0.06 to −0.02), p = 0.001], and TG/HDL ratio [−0.25 (−0.48 to −0.01), p = 0.038]. Mediation analysis showed that PRL did not mediate these effects. Sensitivity analyses considering different cutoffs for PRL levels also did not show modification effect in the mediation analyses.ConclusionBreastfeeding was associated with improvement in glucose metabolism and MIR 60 to 180 days after birth in overweight and obese women, even when adjusted for confounders. PRL levels were not found to mediate the association between breastfeeding and improvement in MIR.

【 授权许可】

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Copyright © 2023 Oliveira, Dualib, Ferraro, Carvalho, Mattar, Dib and Almeida-Pititto