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Associations Between Parity, Breastfeeding, and Risk of Maternal Type 2 Diabetes Among Postmenopausal Women

Luo, Juhua PhD; Hendryx, Michael PhD; LeBlanc, Erin S. MD; Shadyab, Aladdin H. PhD; Qi, Lihong PhD; Sealy-Jefferson, Shawnita MPH, PhD; Manson, JoAnn E. MD, DrPH

doi: 10.1097/AOG.0000000000003407
Contents: Menopause: Original Research

OBJECTIVE: To examine associations among parity, breastfeeding history, and risk of developing type 2 diabetes among postmenopausal women.

METHODS: A prospective cohort study was conducted. One hundred thirty-six thousand six hundred fifty-two postmenopausal women aged 50–79 years participating in the Women's Health Initiative recruited from 40 clinical centers throughout the United States between 1993 and 1998, without baseline cancer or diabetes were followed for 14.2 years. Parity and breastfeeding data were collected by questionnaires administrated to all participants at baseline. Incident diabetes was assessed via validated self-report of physician-diagnosed diabetes treated with insulin or other hypoglycemic medications. Multivariable Cox proportional hazards regression models were used to assess associations between parity, breastfeeding and diabetes incidence, and racial–ethnic differences in the associations.

RESULTS: During follow-up, 18,812 cases of incident diabetes were identified. Overall, a greater number of term pregnancies was associated with increased risk of diabetes (P for trend=.002), and longer duration of breastfeeding was associated with lower risk of diabetes (P for trend <.01). After further adjusting for adult weight gain among a subset of the cohort (n=75,558) with 9,110 cases, the association between parity and risk of diabetes were attenuated and became nonsignificant. Also, parous women with fewer than five term pregnancies did not have increased diabetes risk when breastfeeding for 3 months or more per child, which was associated with less weight gain.

CONCLUSION: The results of this large, prospective study showed that the association between parity and risk of type 2 diabetes was most likely confounded by adult weight gain among postmenopausal women.

The risk of diabetes among postmenopausal women can be reduced by preventing adult weight gain.

Departments of Epidemiology and Biostatistics and Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, Indiana; the Kaiser Permanente Center for Health Research NW, Portland, Oregon; the Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, California; the Department of Public Health Science, School of Medicine, University of California, Davis, Davis, California; the College of Public Health, The Ohio State University, Columbus, Ohio; and the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Corresponding author: Juhua Luo, PhD, Department of Epidemiology and Biostatistics, School of Public Health—Bloomington, Indiana University, Bloomington, IN; email:

Financial Disclosure Erin LeBlanc's institution received funding from Merck Inc. for unrelated work. It was for a study of atypical fractures and she was PI of the work. The other authors did not report any potential conflicts of interest.

For a list of investigators in the WHI Program, see Appendix 1 online at

This study was partially supported by a Pilot and Feasibility Award within the CDMD NIH/NIDDK Grant Number P30 DK097512. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.