Abstract
Background
Breastfeeding offers significant health benefits for mothers and infants affected by gestational diabetes mellitus (GDM). The absence of breast fullness within 72 h after childbirth, known as delayed onset of lactogenesis II (DOL), frequently poses a challenge to successful early breastfeeding. The research focused on exploring the link between gestational weight gain (GWG) and DOL across different prepregnancy BMI categories, offering insights for better weight management and breastfeeding promotion in women with GDM.
Methods
A prospective cohort study was conducted with 711 women with singleton pregnancies diagnosed with GDM, who delivered at Fujian Provincial Maternity and Child Health Hospital in 2022 and planned to breastfeed. Data on demographic, clinical, and breastfeeding variables were collected through structured questionnaires and medical record reviews. DOL was assessed by maternal self‐report based on the absence of noticeable breast fullness by 72 h postpartum. The relationship between GWG and DOL risk, stratified by prepregnancy BMI, was evaluated using multivariable logistic regression and restricted cubic splines. An ROC curve analysis was conducted to determine the optimal GWG cutoffs for predicting DOL.
Results
The incidence of DOL was 37.6% (267/711). The median GWG was 11.00 kg (interquartile range: 8.00–14.00), decreasing significantly with higher prepregnancy BMI (
p
= 0.008). In both normal‐weight and overweight/obese women, higher GWG was associated with a higher risk of DOL, with significant trends across GWG quartiles (
p
for trend p
Conclusion
Women in the upper GWG quartiles had a higher risk of DOL, particularly those with normal prepregnancy BMI, demonstrating a dose–response relationship. Individualized GWG recommendations tailored to prepregnancy BMI may help reduce DOL incidence and support successful breastfeeding initiation in this population.