Immediate Postpartum Breastfeeding Following Pregnancy with Cardiac Disease

Yolanda Tinajero; Nisha I Parikh; Ian S Harris; Juan M Gonzalez; Anushree Agarwal; Nasim C Sobhani

doi:10.1055/s-0044-1780530

Immediate Postpartum Breastfeeding Following Pregnancy with Cardiac Disease

Am J Perinatol. 2024 Feb 19. doi: 10.1055/s-0044-1780530. Online ahead of print.

Authors

Yolanda Tinajero¹, Nisha I Parikh², Ian S Harris^{2

3}, Juan M Gonzalez^{3

4}, Anushree Agarwal^{2

3}, Nasim C Sobhani^{3

4}

Affiliations

¹ Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
² Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, California.
³ Pregnancy and Cardiac Treatment Clinic, University of California, San Francisco, California.
⁴ Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.

PMID: 38373708
DOI: 10.1055/s-0044-1780530

Abstract

Objective: This study aimed to identify predictors of immediate postpartum breastfeeding among women with maternal cardiac disease (MCD).

Study design: This study included all gravidas with MCD who delivered at a single institution from 2012 to 2018. Charts were abstracted for maternal demographics, obstetrical outcome, cardiac diagnoses, cardiac risk stratification scores, and prepregnancy echocardiogram findings. Kruskal-Wallis and Fisher's exact tests were used to compare the breastfeeding (BF) group versus the nonbreastfeeding (NBF) group. Logistic regression was used to obtain odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Among 211 gravidas with MCD, 12% were not breastfeeding at the time of postpartum hospital discharge. Compared with the BF group, the NBF group had a significantly higher proportion of women with cardiomyopathy (21% NBF vs. 7% BF, OR 3.44, 95% CI 1.12-10.71), with modified World Health Organization (WHO) classification ≥III (33 vs. 14%, OR 3.16, 95% CI 1.22-8.15), and with prepregnancy ejection fraction (EF) < 50% (55 vs. 14%, OR 7.20, 95% CI 1.92-27.06). There were otherwise no differences between the two groups with regards to other cardiac diagnoses or cardiac risk scores.

Conclusion: In women with MCD, cardiomyopathy, modified WHO class ≥III, and a prepregnancy EF < 50% were associated with NBF in the immediate postpartum period. These findings may guide providers in identifying a subset of women with MCD who can benefit from increased breastfeeding counseling and support.

Key points: · Eighty-two percent of patients with cardiac disease are breastfeeding at the time of postpartum discharge.. · Cardiomyopathy is associated with an increased odds of not breastfeeding at postpartum discharge.. · Rationale for not breastfeeding is infrequently documented in the medical record..