Energy Restriction, Weight Loss, Glycemia, and Breastfeeding Outcomes in Gestational Diabetes: A DiGest Trial Secondary Analysis

OBJECTIVE We aimed to assess whether energy restriction, weight loss, or maternal glycemia in late pregnancy were associated with breastfeeding outcomes. RESEARCH DESIGN AND METHODS This is a secondary analysis of the Dietary Intervention in Gestational Diabetes (DiGest) randomized controlled trial, which included 425 participants with gestational diabetes who were randomly assigned to receive a standard-energy (2,000 kcal/day) or reduced-energy (1,200 kcal/day) diet box from 29 weeks until delivery, with masked continuous glucose monitoring. Breastfeeding intentions and outcomes were documented (n = 304 of 425) and analyzed using regression models. RESULTS Energy restriction in late pregnancy did not affect breastfeeding outcomes. Achieving ≥90% time in range (3.5–6.7 mmol/L; 63–120 mg/dL) with a low glycemic variability (coefficient of variation and SD), but not weight loss, were associated with any breastfeeding at 3 months postnatally. CONCLUSIONS Improved late pregnancy glycemia and decreased glucose variability, but not weight loss or energy restriction, were associated with breastfeeding after gestational diabetes.