Study of Women, Infant feeding, and Type 2 diabetes mellitus after GDM pregnancy (SWIFT), a prospective cohort study: methodology and design

<p>Abstract</p> <p>Background</p> <p>Women with history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes within 5 years after delivery. Evidence that lactation duration influences incident type 2 diabetes after GDM pregnancy is based on one retrospective study reporting a null association. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM pregnancy (SWIFT) is a prospective cohort study of postpartum women with recent GDM within the Kaiser Permanente Northern California (KPNC) integrated health care system. The primary goal of SWIFT is to assess whether prolonged, intensive lactation as compared to formula feeding reduces the 2-year incidence of type 2 diabetes mellitus among women with GDM. The study also examines whether lactation intensity and duration have persistent favorable effects on blood glucose, insulin resistance, and adiposity during the 2-year postpartum period. This report describes the design and methods implemented for this study to obtain the clinical, biochemical, anthropometric, and behavioral measurements during the recruitment and follow-up phases.</p> <p>Methods</p> <p>SWIFT is a prospective, observational cohort study enrolling and following over 1, 000 postpartum women diagnosed with GDM during pregnancy within KPNC. The study enrolled women at 6-9 weeks postpartum (baseline) who had been diagnosed by standard GDM criteria, aged 20-45 years, delivered a singleton, term (greater than or equal to 35 weeks gestation) live birth, were not using medications affecting glucose tolerance, and not planning another pregnancy or moving out of the area within the next 2 years. Participants who are free of type 2 diabetes and other serious medical conditions at baseline are screened for type 2 diabetes annually within the first 2 years after delivery. Recruitment began in September 2008 and ends in December 2011. Data are being collected through pregnancy and early postpartum telephone interviews, self-administered monthly mailed questionnaires (3-11 months postpartum), a telephone interview at 6 months, and annual in-person examinations at which a 75 g 2-hour OGTT is conducted, anthropometric measurements are obtained, and self- and interviewer-administered questionnaires are completed.</p> <p>Discussion</p> <p>This is the first, large prospective, community-based study involving a racially and ethnically diverse cohort of women with recent GDM that rigorously assesses lactation intensity and duration and examines their relationship to incident type 2 diabetes while accounting for numerous potential confounders not assessed previously.</p

Continuous transcutaneous carbon dioxide measurement from the fetal scalp during labor and during first minutes of extrauterine life

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Breastfeeding patterns: comparing the effects on infant behavior and maternal satisfaction of using one or two breasts

In the Western world advice given by breastfeeding consultants about the use of one or two breasts at each feed has resulted in apparently arbitrary changes over time. This study compared 1-month-old breastfed infants' reactions to single- and two-breast feeds in terms of restlessness, crying, sleeping, and frequency of feeds, wet diapers, and loose stools. Eighty mothers were randomly assigned at the maternity ward, 44 to the single-breast group and 36 to the two-breast group. At one-month follow-up no differences between the groups were seen regarding any infant behavior variables, or in terms of maternal satisfaction, confidence, and mood throughout the full 24-hour observation period or during a 6-hour period in the evening. Compliance with the assigned feeding method was better in the two-breast than in the one-breast group. This may partly be due to tradition, since the two-breast practice has been recommended by child health nurses in Sweden for over 50 years. It seems reasonable that a baby should be allowed to finish the first breast and, if still hungary, be offered the second breast. The baby's appetite is the deciding factor

Printed advice on initiating and maintaining breastfeeding in mid-20th-century Queensland

This article, which is part of a larger historical study of infant-feeding advice received by mothers in Queensland, Australia, identifies and examines print materials that were used by mothers, or that influenced other texts, during the postwar period from 1945 to 1965. The texts are described within the context of their environmental influences and the medical knowledge and research of the time to assess what effect, if any, these latter materials had on the established system of infant-feeding advice. Two innovations that were employed are the use of interviews to identify the most-used texts and the comparison of popular advice books with medical journal material