582-P: Gestational Diabetes and Breastfeeding: Evidence from PRAMS Free

Gestational diabetes (GD) disproportionately affects American Indian and Alaska Native (AI/AN) women, who are nearly twice as likely to experience GD as non-Hispanic White women. Despite the well-established benefits associated with breastfeeding, including reduction of risk of type 2 diabetes, women who develop GD are frequently less likely to breastfeed than women who do not develop GD. AI/AN women are less likely to initiate breastfeeding and breastfeed for a shorter duration compared to other women. No previous study has evaluated the potential link between GD and breastfeeding outcomes among AI/AN women. The purpose of this study was to examine the relationship between GD and breastfeeding among women of different ethnicities in four states using the Pregnancy Risk Assessment Monitoring Surveillance (PRAMS). We used data from Phase 8 (2016-2018) of PRAMS from Alaska, Oklahoma, South Dakota, and Washington. We used logistic regression to estimate factors associated with breastfeeding initiation for each group of women, conducted survival analysis using Kaplan Meier curves, and Cox proportional hazards regression to analyze duration of breastfeeding. Twelve percent of AI/AN and Hispanic women had GD in their most recent pregnancy, compared to less than 9 percent among non-Hispanic White and non-Hispanic Black women (p<0.0001). AI/AN women were the least likely to initiate breastfeeding compared to other women (85% vs. 88-93%, p<0.0001) and the least likely to be breastfeeding at the time of survey (51% vs. 57-69%, p<0.0001). While there was no association between GD and initiation of breastfeeding, women who had GD had a shorter duration of breastfeeding compared to women who did not have GD. GD significantly modifies the association between race/ethnicity and breastfeeding duration. Increasing support for AI/AN women with GD to initiate and continue breastfeeding may represent an effective and culturally appropriate intervention to improve maternal and child health outcomes and reduce disparities.