Women with Gestational Diabetes Mellitus Have Greater Formula Supplementation in the Hospital and at Home Despite Intention to Exclusively Breastfeed

Background: Women with gestational diabetes mellitus (GDM) have lower rates of exclusive breastfeeding compared with women without diabetes.Objectives: To assess associations between GDM and breastfeeding intentions and attitudes, formula supplementation, reasons for formula supplementation, and knowledge of type 2 diabetes mellitus (T2DM) risk reduction associated with breastfeeding among U.S. mothers.Design/Methods: Participants completed an online survey assessing infant feeding knowledge, attitudes, and practices; demographics; and pregnancy-related medical history. Multivariable logistic regression was used to estimate adjusted odds ratios for formula supplementation in the hospital and at home.Results: Of 871 respondents, a smaller proportion of women with GDM compared with women without diabetes intended to exclusively breastfeed. There were no differences between groups in attitudes toward public breastfeeding, attitudes toward breastfeeding beyond infancy, or actual duration of any breastfeeding. Approximately one in four participants believed that breastfeeding mothers may be less likely to develop T2DM, regardless of GDM status. Among those who intended to exclusively breastfeed, GDM was associated with higher odds of formula supplementation in the hospital (adjusted odds ratio [OR] 1.75, 95% confidence interval [CI] 0.97-3.18) and at home (adjusted OR 2.02, 95% CI 1.05-3.89). "Medical reasons," which was reported as an important reason for formula supplementation, was reported more frequently by women with GDM.Conclusions: Women with GDM who intended to exclusively breastfeed had higher odds of in-hospital and at-home formula supplementation, cited medical reasons as a main reason for formula supplementation more often, and were largely unaware of T2DM risk reduction associated with breastfeeding.