Department of Psychology, Faculty of Science, McGill University, Montreal, Quebec, Canada.
Department of Obstetrics and Gynecology, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Acta Obstet Gynecol Scand. 2022 Aug;101(8):871-879. doi: 10.1111/aogs.14378. Epub 2022 May 24.
Hypertensive disorders of pregnancy occur in approximately 7%-10% of pregnancies and are associated with adverse maternal cardiovascular health outcomes across the lifespan. In contrast, breastfeeding has been associated with a reduction in cardiovascular risk factors in a dose-dependent manner. Despite the potential protective effects of lactation on cardiovascular risk, how hypertensive disorders of pregnancy relate to breastfeeding practices and experiences is not well understood. The aim of this study was to investigate the association between hypertensive disorders of pregnancy and breastfeeding outcomes in the first year postpartum.
We conducted a secondary analysis of prospective data from the All Our Families Cohort, a population-based study conducted in Calgary, Alberta, Canada. Women with a singleton pregnancy (n = 1418) who completed self-report questionnaires at <25 weeks and 34-36 weeks of gestation, and 4 months and 12 months postpartum, and provided consent to link to electronic medical records that identified diagnoses of hypertensive disorders of pregnancy (n = 122). Logistic and multiple linear regression analyses were used to model associations between hypertensive disorders of pregnancy and breastfeeding outcomes. Outcomes included breastfeeding intention, intended duration, exclusive breastfeeding at 4 months, breastfeeding duration at 12 months and breastfeeding difficulties.
Hypertensive disorders of pregnancy were not associated with breastfeeding intention (odds ration [OR] 1.30, 95% confidence interval [CI] 0.47-3.03, P = 0.57), intended breastfeeding duration (b = -3.28, 95% CI -7.04 to 0.48, P = 0.09), or initiation (OR = 0.64, 95% CI 0.29- 1.65, P = 0.32), but were associated with an increase in the odds of non-exclusive breastfeeding at 4 months postpartum (OR = 2.11, 95% CI 1.39-3.22, P < 0.001). Women with hypertensive disorders breastfed for 6.26 (95% CI -10.00 to -2.51, P < 0.001) weeks less over 12 months postpartum, had significantly higher odds of reporting insufficient milk supply (OR = 1.75, 95% CI 1.19-2.46, P < 0.05) and had lower odds of breast and/or nipple pain (OR = 0.66, 95% CI 0.44-0.92, P < 0.05) compared with those without hypertensive disorders of pregnancy.
Hypertensive disorders of pregnancy are associated with altered breastfeeding practices and experiences during the first year postpartum. Further research is needed to examine biopsychosocial mechanisms through which hypertensive disorders associate with shorter breastfeeding duration, and to examine whether greater breastfeeding duration, intensity or exclusivity reduces short- or long-term maternal cardiovascular risk.
妊娠高血压疾病在大约 7%-10%的妊娠中发生，并与整个生命周期内的不良母婴心血管健康结局有关。相比之下，母乳喂养与心血管危险因素的减少呈剂量依赖性相关。尽管哺乳对心血管风险有潜在的保护作用，但妊娠高血压疾病与母乳喂养实践和经验的关系尚不清楚。本研究旨在探讨妊娠高血压疾病与产后第一年母乳喂养结局之间的关系。
我们对来自加拿大阿尔伯塔省卡尔加里市的全国家庭队列的前瞻性数据进行了二次分析。该队列纳入了 1418 名单胎妊娠的女性，她们在妊娠<25 周和 34-36 周、产后 4 个月和 12 个月时完成了自我报告问卷，并同意将其链接至电子病历，以确定妊娠高血压疾病的诊断（n=122）。使用逻辑回归和多元线性回归分析来评估妊娠高血压疾病与母乳喂养结局之间的关联。结局包括母乳喂养意愿、预期持续时间、4 个月时的纯母乳喂养、12 个月时的母乳喂养持续时间和母乳喂养困难。
妊娠高血压疾病与母乳喂养意愿（优势比 [OR] 1.30，95%置信区间 [CI] 0.47-3.03，P=0.57）、预期母乳喂养持续时间（b=-3.28，95% CI -7.04 至 0.48，P=0.09）或开始母乳喂养（OR=0.64，95% CI 0.29-1.65，P=0.32）无关，但与 4 个月时非纯母乳喂养的几率增加相关（OR=2.11，95% CI 1.39-3.22，P<0.001）。患有妊娠高血压疾病的女性在产后 12 个月内母乳喂养的时间减少了 6.26 周（95% CI -10.00 至 -2.51，P<0.001），报告乳汁供应不足的几率显著更高（OR=1.75，95% CI 1.19-2.46，P<0.05），乳房和/或乳头疼痛的几率更低（OR=0.66，95% CI 0.44-0.92，P<0.05）与无妊娠高血压疾病的女性相比。
妊娠高血压疾病与产后第一年的母乳喂养方式和体验有关。需要进一步研究以探讨通过哪些生物心理社会机制，妊娠高血压疾病与母乳喂养时间缩短有关，以及研究母乳喂养时间、强度或排他性是否会降低短期或长期的母亲心血管风险。
