General. Heart disease, diabetes, hepatitis, nephrosis, and most other chronic medical conditions are not themselves a contraindication to breast-feeding. Usually if the condition can be managed well enough to allow successful completion of pregnancy, breast-feeding may be the feeding method of choice because it is less tiring for the mother. Since management of the diabetic-woman in pregnancy has become increasingly more successful, many diabetic mothers are now choosing to breast-feed. In fact some diabetics enjoy a postpartum remission of their diabetes, which may last through lactation and in some cases several years longer. The remission has been attributed to the hormone interactions. Since diabetics are known to be prone to infection, mastitis may pose a significant threat, and vaginitis may also be more common. Fungal infection of the nipples may also occur. Careful anticipatory care, avoidance of fatigue, and early antibiotic management of developing problems are wise. Management of lactation for the diabetic woman depends on the type of diabetes that exists. The mild diabetic whose condition can be controlled by diet alone should modify her diet to meet her increased caloric needs.
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