Hi everyone, welcome to the LactFact weekly podcast, which highlights recent, clinically relevant research, policy statements, and protocols that you, as a practicing lactation professional, should know about. I am your host, Dr Anne Eglash. I am a board-certified family physician and breastfeeding and lactation medicine specialist at the University of Wisconsin School of Medicine and Public Health.

This podcast is written and produced by the nonprofit organization IABLE, which is the Institute for the Advancement of Breastfeeding and Lactation Education. There are no commercial funders for this podcast series.

Today’s LactFact comes from the following article:
Article- Hypertensive Disorders of Pregnancy and Breastfeeding Among US Women
First author- Deanna Nardella, MD, MHS
Published – in JAMA Network Open for July 2025

For background
According to the authors, Hypertensive disorders of pregnancy including chronic or gestational hypertension, preeclampsia, and eclampsia, are major drivers of morbidity and mortality for both mothers and infants. This is because hypertensive disorders of pregnancy increase women’s long term risks for heart disease, chronic kidney disease and stroke, and in the short term, as a maternal complication, increases the mortality rate for infants. In fact, in the last 2 decades there has been a 9% increase in infant death in the US due to maternal complications.

While socially and economically disadvantaged populations are at higher risk for maternal and infant morbidity and mortality related to hypertensive disorders of pregnancy, breastfeeding might mitigate the long term impact because breastfeeding reduces long term maternal and infant risks for cardiovascular diseases. Therefore, supporting breastfeeding can be a strategy to decrease the inequity of long term cardiovascular risk factors for mothers and infants.

The authors in this study sought to identify the association between Hypertensive disorders of pregnancy and breastfeeding outcomes.

This was a cross-sectional analysis of approximately 205,000 women, using data from the CDC and PRAMs survey between 2016-2022. PRAMs is the acronym for the Prevention Pregnancy Risk Assessment Monitoring System that surveys women in the US between 2-6 months pp on their attitudes, beliefs and experiences during pregnancy, prenatal and postpartum periods.

In this survey, the subjects self-reported high blood pressure, hypertension, preeclampsia, or eclampsia before or during pregnancy.

50% of the subjects were white, 18% Hispanic, and 13% Black, and the rest were either American Indian, Alaskan native, multiracial or other.

17% reported a hypertensive disorder of pregnancy, which was more common among women under age18, over age 35, American Indian or Alaskan Native, nonHispanic Black, lower income, and BMI over 30. Infants of mothers with hypertensive disorders of pregnancy were more likely to be premature, have low or very low birth weight, or be admitted to the hospital more than 5 days after birth.

Breastfeeding initiation occurred among 85% of women with hypertensive disorders of pregnancy vs 88% of those without.

Among those who initiated breastfeeding, women with hypertensive disorders stopped breastfeeding at the median time of 17 weeks, vs 34 weeks among women without hypertensive disorders. The time to breastfeeding cessation was even shorter among women with hypertensive disorders who were among minoritized races and ethnicities.

The authors shared a few hypotheses for this observation. They mention issues such as women being told that their medication for HBP would not be compatible with breastfeeding, and/or being separated for medical interventions and medical comorbidities. Also, hypertensive disorders of pregnancy have comorbidities that delay secretory activation including elevated BMI and insulin resistance.

The bottom line is that we don’t know exactly why women with hypertensive disorders wean earlier, and I suspect it is related to low milk production.

The dilemma is that breastfeeding, as mentioned earlier, mitigates the long-term risks of cardiovascular diseases for both mother and infant. Some observational studies have found maternal cardiometabolic benefits after just 4 or 6 months of breastfeeding.

We can learn more about this population and hopefully support their intentions by proactively referring these mothers to a breastfeeding medicine specialist or a lactation consultant early postpartum for close monitoring and support.

Thanks for listening. I encourage you to check out IABLE at lacted.org to learn more about our educational projects, courses, educational handouts, videos, events. By becoming a member, you are not only supporting our projects, but also receiving a discount on educational courses, participation in our google group listserv, and a free pin on our LactMap.

I will talk to you again in 2 weeks!