Association Between Prepregnancy Hypertension and Breastfeeding Duration

Background: Studies have identified the link between hypertension (HTN) during pregnancy and breastfeeding, but the role of prepregnancy HTN and breastfeeding practices remains unexplored. This study aims to investigate the association between prepregnancy HTN and breastfeeding duration. Methods: We used data from the Pregnancy Risk Assessment Monitoring System, 2016-2022 (n  = 127,510). The outcome of interest was breastfeeding for at least 3 months. The main independent variable was prepregnancy HTN. Multivariable logistic regression was used to examine the independent association between prepregnancy HTN and breastfeeding for at least 3 months. Cox proportional hazards models were used to determine whether the hazards of breastfeeding cessation before 3 months differed by prepregnancy HTN. Results: Overall, 71.5% (n  = 71,211) of women breastfed for at least 3 months, and 3.3% (n  = 4,543) had prepregnancy HTN. The proportion of breastfeeding for at least 3 months was significantly lower in women with prepregnancy HTN compared with those without prepregnancy HTN (66.1% versus 71.6% p < 0.001). In the multivariable logistic regression model, the odds of breastfeeding for at least 3 months were significantly lower among women with prepregnancy HTN compared with those without prepregnancy HTN (adjusted odds ratio, 0.86; 95% confidence interval [CI], 0.78-0.95; p = 0.003). The adjusted hazard ratio (aHR) for breastfeeding cessation before 3 months among women with prepregnancy HTN was significantly higher compared with those without prepregnancy HTN (aHR, 1.25; 95% CI: 1.16-1.35; p < 0.001). Conclusion: In addition to preventing other adverse pregnancy outcomes, identifying and treating women with prepregnancy HTN during the preconception care encounter may improve breastfeeding outcomes.