Hypertensive disorders in pregnancy linked to lower breastfeeding rates

Hypertensive disorders in pregnancy linked to lower breastfeeding rates | Image Credit: © Seventyfour – © Seventyfour – stock.adobe.com.

The odds of never breastfeeding and of breastfeeding cessation are increased among women with hypertensive disorders of pregnancy (HDPs), according to a recent study published in JAMA Network Open.

HDPs have been reported as the leading cause of maternal and infant morbidity and mortality in the United States. However, these risks may be reduced through breastfeeding, based on data from previous studies. Breastfeeding is performed by 83% of US women at delivery, but only 25% exclusively through 6 months.

“Though other maternal comorbidities, including gestational diabetes, have been seen to negatively influence breastfeeding outcomes, little is known about breastfeeding outcomes for the 16% of US pregnant women with HDP compared with women without HDP,” wrote investigators.

Assessing breastfeeding duration and HDP diagnosis

The cross-sectional study was conducted to determine the impact of HDP exposure on never breastfeeding and breastfeeding cessation among US women. Data was obtained from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System.

Women with complete HDP data and a live infant at survey completion, alongside noninitiation or cessation of breastfeeding, were included in the analysis. Deliveries between 2016 and 2021 were eligible, with never breastfeeding and time to breastfeeding cessation in weeks reported as dependent variables.

Breastfeeding less than 1 week was categorized as cessation at 0.5 weeks. Other responses for breastfeeding included the exact breastfeeding duration in weeks and a response of “still breastfeeding.” HDP was defined as self-reported high blood pressure or hypertension, preeclampsia, or eclampsia before or during pregnancy.

Maternal age, insurance, race and ethnicity, household income, enrollment in the Women, Infants and Children program, educational level, and marital status were reported as covariates. Health-related covariates included preterm birth, singleton live birth, cesarean delivery, smoking in pregnancy, body mass index over 30, and gestational diabetes.

Prevalence and risk factors for HDP

There were 205,247 women across 43 US states included in the final analysis, 0.8% of whom were American Indian, 5.3% Asian, 15% Black, 18% Hispanic, 50.8% White, 2.3% multiracial, and 0.7% other. Ninety-nine percent of samples were from first time mothers, with 54% having private insurance and 91% delivering at term.

An HDP diagnosis was reported in 17% of participants, with women aged under 18 years or at least 35 years more likely to be diagnosed. Additional groups with an increased HDP prevalence included American Indian or Black women, not married, insured by Medicaid, and with a household income of $40,000 or less.

Women with HDP were also more likely to have a body mass index of 30 or higher, gestational diabetes, and to smoke. Infants of these women were more often born preterm, had a low birth weight, and were admitted to a hospital for over 5 days after delivery.

Lower breastfeeding among women with HDP

Breastfeeding initiation was reported in 85% of women with HDP vs 88% without. When adjusted for covariates, an odds ratio of 1.11 was reported for never breastfeeding among women with HDP. Race and ethnicity did not significantly influence this link.

The odds of breastfeeding cessation were also increased among women with HDP, with an adjusted hazard ratio (HR) of 1.17. The median time to breastfeeding cessation was 17 weeks among this population, vs 34 weeks among women without HDP. Since over 25% of the population was still breastfeeding at the last observation, an upper quartile was not obtained.

Race and ethnicity influenced the association between HDP and breastfeeding cessation. Asian, non-Hispanic Black, and American Indian patients had increased risks, with HRs of 1.34, 1.19, and 1.18, respectively. Overall, the data highlighted increased risks of never breastfeeding and breastfeeding cessation among women with HDP.

“Further analyses could inform tailored approaches to promote breastfeeding for dyads experiencing higher cardiometabolic risk and promote health equity for US women and infants,” wrote investigators.

References

1. Nardella D, Canavan ME, Taylor SN, Sharifi M. Hypertensive disorders of pregnancy and breastfeeding among US women. JAMA Netw Open. 2025;8(7):e2521902. doi:10.1001/jamanetworkopen.2025.21902
2. Ford ND, Cox S, Ko JY, et al. Hypertensive disorders in pregnancy and mortality at delivery hospitalization – United States, 2017-2019. MMWR Morb Mortal Wkly Rep. 2022;71(17):585-591. doi:10.15585/mmwr.mm7117a1