Hypertensive Disorders of Pregnancy and Breastfeeding Among US Women.

IMPORTANCE

Hypertension contributes to US maternal-infant morbidity and mortality, with potential attenuation from breastfeeding. Little is known regarding breastfeeding outcomes among mother-infant dyads exposed to hypertensive disorders of pregnancy (HDP).

OBJECTIVE

To quantify the extent to which HDP is associated with never breastfeeding and the time to breastfeeding cessation among postpartum women in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nationally representative data from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System (PRAMS). Participants included women from 43 US states, Washington, DC, and Puerto Rico who had a live birth between January 2016 and November 2022. Complete data for HDP exposure, outcomes of breastfeeding noninitiation or cessation, and all covariates were included in the analysis, performed from October to December 2024.

EXPOSURE

Self-reported high blood pressure or hypertension, preeclampsia, or eclampsia before or during pregnancy.

MAIN OUTCOMES AND MEASURES

Odds of never breastfeeding, hazard of breastfeeding cessation, and median time to breastfeeding cessation, adjusted for sociodemographic and maternal-infant health covariates.

RESULTS

Of 205 247 women (weighted number, 10 915 302), mean (SD) age was 30.0 (5.8) years; 99.0% were first-time mothers; 54.0% had private and 40.0% had Medicaid insurance; and 91.0% delivered a term infant. HDP and breastfeeding initiation were reported by approximately 17.0% and 88.0% of women, respectively. Adjusting for covariates, HDP was associated with higher odds of never breastfeeding (adjusted odds ratio, 1.11; 95% CI, 1.05-1.18), and among those who breastfed, a higher adjusted hazard of breastfeeding cessation (adjusted hazard ratio, 1.17; 95% CI, 1.14-1.21). The median time to breastfeeding cessation among those with HDP was 17 weeks shorter than among those without HDP (unadjusted median duration, 17 [IQR, 5.0 to >46.7] vs 34 [IQR, 9.0 to >46.7] weeks).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study representing more than 10 million US postpartum women, HDP was associated with higher odds of never breastfeeding and a higher hazard of breastfeeding cessation. Studies to understand the potential mechanisms of this association are required to develop targeted breastfeeding support strategies for individuals with HDP.