Breastfeeding Challenges and Determinants among Mothers withGestational Diabetes: A Systematic Review.

Abstract

Background: The prevalence of gestational diabetes has increased in parallel with risk factors such as obesity, a family history of diabetes, and advanced maternal age. Studies suggest that gestational diabetes may negatively affect breastfeeding outcomes. This systematic review aimed to investigate the relationship between gestational diabetes and breastfeeding, as well as the contributing factors influencing breastfeeding among affected women.

Materials and methods: Articles published up to January 2023, with an update through 2025, were included. A comprehensive search was conducted across databases including Medline, PubMed, Scopus, and others, using relevant keywords such as gestational diabetes, breastfeeding, blood sugar, misconception, cultural factors, and predisposing factors. Quantitative studies were assessed using the STROBE checklist, and qualitative studies were evaluated using the CASP tool. Key challenges identified include delayed onset of lactogenesis, misconceptions regarding diabetes transmission, and insufficient support.

Results: A total of 19 studies (16 quantitative and 3 qualitative) were included. Analysis revealed several trends: ten quantitative studies reported a reduction in exclusive breastfeeding duration; three indicated lower breastfeeding rates at hospital discharge; and three studies identified difficulties in breastfeeding initiation and continuation. Notably, three studies found similar breastfeeding continuation rates between mothers with gestational diabetes and healthy controls. Factors associated with reduced breastfeeding included maternal obesity, cesarean delivery, prematurity, advanced maternal age, racial disparities, insulin treatment, limited knowledge about complementary feeding, misconceptions about exclusive breastfeeding, and concerns over diabetes transmission through breast milk.

Conclusion: Addressing breastfeeding barriers among mothers with gestational diabetes requires targeted education, social support, and attention to professional challenges. Additional barriers included insufficient organizational resources, lack of hospital policies supporting breastfeeding, inadequate post-discharge support, and poor coordination with other healthcare facilities. Strengthening post-discharge support and inter-facility collaboration is essential. Future longitudinal and qualitative research should integrate cultural and psychosocial dimensions into evidence-based practices.