Postpartum Nipple Symptoms: Risk Factors and Dermatologic Characterization

Nipple discomfort inhibits breastfeeding goals, particularly between 0 and 8 weeks postpartum (PP), and yet the specific dermatologic entities that contribute to nipple soreness have not been clearly delineated. Moreover, there remains a lack of evidence-based guidelines for nipple symptoms and skin diseases. A survey was distributed to 6-8-week PP women, 18-50 years of age, with an intent to exclusively or partially breastfeed ("at the breast" or "pump"). The study aimed to characterize nipple skin symptoms (pain and itching) and lesions (eczema, redness, cuts, or wounds) and any association between these nipple problems and past dermatologic history, breastfeeding outcomes, and the ability to meet her breastfeeding goals. Findings paralleled Centers for Disease Control and Prevention (CDC) statistics with a 25% decline in breastfeeding rates between birth, 86.3% (189), and 6-8 weeks PP, 64.5% (145). By 6-8 weeks PP, exclusive "formula" and "exclusive feeding at the breast" showed the largest increase (+16.4%) and decrease (-22.9%), respectively. Although no significant difference was found in comparison of nipple problems to feeding methods or skin history, women who reported pumping or PP redness/eczema had higher odds ratios of a change in feeding practice, history of eczema, and sensitive skin. Strong pumping intentions were also associated with the highest risk of unmet breastfeeding goals. Regardless of feeding method, product, or provider use, PP nipple problems predominantly arose between 1 and 3 weeks PP. Clinical Trial Registration number 201901737.