(1065) Factors Associated with Exclusive Formula Feeding in Individuals with History of Diabetes in Pregnancy

Infants of those with diabetes are less likely to be breastfed despite unique benefits in this population. Knowledge of factors associated with exclusive formula feeding (EFF) would enable identification of patients at high-risk of lactation difficulties. Our objective was to investigate factors associated with EFF in those with pregestational diabetes (PGDM) or gestational diabetes (GDM).

 

Study Design:

The United States Vital Statistics Birth Certificate data was utilized in this retrospective cohort study. Singleton pregnancies with PGDM or GDM from 2016-2022 were included. Pregnancies with missing infant feeding and diabetes data were excluded. We evaluated EFF risk at hospital discharge across multiple maternal and neonatal characteristics and morbidity within both groups. Composite maternal morbidity included admission to ICU, blood transfusion, clinical chorioamnionitis/fever, uterine rupture, unplanned hysterectomy, and perineal laceration. Composite neonatal morbidity included admission to NICU, APGAR score < 5 at 5 min, assisted ventilation > 6 hours and neonatal seizure.

 

Results:

Of the 1,796,752 births included, 227,948 (12.7%) had PGDM and 1,568,804 (87.3%) had GDM. Demographic factors associated with EFF included racial minorities especially non-Hispanic Black, education less than college level, single marital status, lack of prenatal care, smoking in pregnancy, underweight, overweight and obesity within both groups (Table 1).  EFF was more likely after caesarean delivery and operative vaginal delivery compared to vaginal delivery within both groups (Table 2). Composite maternal morbidity, ICU admission and transfusion were associated with increased EFF, while clinical chorioamnionitis/fever was not associated with increased EFF within both groups. EFF was more likely within the setting of composite neonatal morbidity or preterm delivery within both groups (Table 2).

 

Conclusion:

This study demonstrates that several maternal and neonatal risk factors are associated with EFF among those with PGDM or GDM. There is a need for enhanced breastfeeding support in this vulnerable population.