The importance of breast milk in early childhood health and development is well known (1). While feeding decisions are known to be strongly influenced by socioeconomic, ethnical, and cultural characteristics (2,3), the impact of chronic illness on feeding attitudes has not been extensively studied. We proposed to compare feeding choices made by pregnant women with and without preexisting type 1 diabetes.
We surveyed pregnant women, with and without diabetes, regarding their feeding decisions in six diverse practices in Nashville, Tennessee, representing a broad range of socioeconomic, racial, and practice characteristics. The study underwent review by the institutional review board.
Women were interviewed utilizing the Iowa Infant Feeding Attitude Survey (IIFAS), a validated instrument containing 17 questions assessing positive and negative attitudes toward breast-feeding, which has been shown to correlate with ultimate feeding decisions (4). After excluding 20 women with gestational diabetes, the final sample included 144 women, including 55 women with insulin-requiring diabetes (51 type 1 and 4 type 2 diabetes) and 89 women without diabetes.
The mean age of mothers was 28.4 years (range 15–42); 27% of the sample was African American, and just over one-third was enrolled in Medicaid. Two-thirds of the mothers (65%) planned to return to work after delivery. The mean IIFAS score for the entire sample was 59.9. IIFAS scores did not differ by age, race, maternal education, or marital status. Women who did not plan to return to work had higher mean IIFAS scores than women who planned to return to work (62.3 ± 7.4 vs. 58.8 ± 9.1; P = 0.05). There was no difference in the mean IIFAS score for diabetic versus nondiabetic women (P = 0.54) and no difference in the proportion of women with diabetes who planned to breast-feed (56 vs. 62%; P = 0.56).
While women with diabetes felt that diabetes prevented them from doing things other mothers do during pregnancy (39% endorsed this statement vs. 3% of nondiabetic mothers), the two groups did not differ in their attitudes toward problems with breast-feeding for women taking medications or whether women with diabetes should feed their infants with formula.
Our results showed that having preexisting type 1 diabetes did not influence maternal decision making, as indicated by the IIFAS score and stated intention to feed. The findings of this study have implications for providers caring for women of child-bearing age with type 1 diabetes, as this group appears to be similar to women without diabetes with respect to infant feeding decisions.
