LOWER BREASTFEEDING rates among women with Type 2 diabetes may be more closely associated with higher body mass index (BMI) than diabetes itself, a prospective controlled study suggests.
The findings underline the importance of choosing an appropriate comparison group when examining whether a chronic condition independently influences outcomes after pregnancy.
Comparing Women with Similar BMI
Researchers compared women with Type 2 diabetes with normoglycaemic controls matched for age and parity, using both a BMI-matched group and a normal-BMI group. Four-month feeding data were available for 29, 29 and 28 women, respectively.
Full breastfeeding rates were 24% in women with diabetes, 38% in BMI-matched controls and 64% in normal-BMI controls. Rates of any breastfeeding were 55%, 54% and 82%, respectively.
Neither outcome differed significantly between women with diabetes and BMI-matched controls, whereas both were lower in women with diabetes than in normal-BMI controls.
Early Feeding Experiences Differed
Women with diabetes breastfed less frequently during the first 24 hours and their infants more often received formula in hospital. Neonatal hypoglycaemia was the most common reason for first formula use in that group.
The study’s small sample prevented comprehensive multivariable adjustment. Its observational design also means that higher BMI cannot be established as the cause of reduced breastfeeding.
Looking Beyond the Diabetes Diagnosis
The comparison has a useful clinical implication: a difference observed between women with diabetes and a normal-BMI population may reflect several overlapping influences. Matching for BMI helps examine one of those influences, but does not remove every social, biological or care-related difference between groups.
Similarly, a non-significant result is not proof that diabetes has no independent effect. With relatively few participants, uncertainty remains about the size of any difference that a larger study might detect.
Early formula use also requires context. When supplementation forms part of treatment for neonatal hypoglycaemia, it should not automatically be interpreted as an avoidable failure of breastfeeding support. The more useful question is how medically necessary care and a mother’s feeding goals can be supported together.
For maternity and diabetes teams, the findings encourage assessment of individual feeding barriers across pregnancy, hospital admission and the months after discharge. Such support can acknowledge clinical complexity without assuming that a diabetes diagnosis determines a woman’s feeding outcome.
Larger studies could help separate the effects of BMI, metabolic health, neonatal care and other circumstances, and test which support strategies improve breastfeeding continuation for women who wish to breastfeed.
Reference
Britten FL et al. A prospective controlled study assessing postpartum breastfeeding in women with type 2 diabetes: lower rates associated with elevated BMI rather than diabetes. Diabetologia. 2026. https://doi.org/10.1007/s00125-026-06879-z
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