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Updated: Jun 6, 2026

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Severe Maternal Morbidity and Breastfeeding Among Nulliparous Individuals in the United States

T Caroline Bank1, Jiqiang Wu, Janet Catov

  • 1Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, and the MetroHealth System, Case Western Reserve University, Cleveland, Ohio, the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania, Northwestern University, Chicago, Illinois, Indiana University, Indianapolis, Indiana, Yale University, New Haven, Connecticut, Columbia University, New York, New York, the University of Utah, Salt Lake City, Utah, EVMS, Norfolk, Virginia, the University of California, Irvine, Orange, California, and Brown University, Providence, Rhode Island; and RTI International, Durham, North Carolina.

Obstetrics and Gynecology
|June 4, 2026
PubMed

We examined whether severe maternal morbidity (SMM) at delivery was associated with the initiation and duration of breastfeeding among nulliparous individuals in the United States in a secondary analysis from the prospective nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be Heart Health Study). Among 6,762 nulliparous individuals, the frequency of any breastfeeding by duration was as follows: 759 (11.2%) breastfed for less than 6 weeks; 1,847 (27.3%) breastfed for 6 weeks to 6 months; and 3,359 (49.7%) breastfed for more than 6 months, and the frequency of exclusive breastfeeding among those with any breastfeeding was 4,653 (85.4%). The frequency of any SMM was 160 (2.4%) and nontransfusion SMM was 124 (1.8%). Breastfeeding initiation did not vary by SMM status. Among those who breastfed, SMM was associated with a lower likelihood of breastfeeding for more than 6 months (adjusted odds ratio [aOR] 0.50; 95% CI, 0.36-0.68) and a lower likelihood of exclusive breastfeeding (aOR 0.60; 95% CI, 0.37-0.98). In a prospective cohort of nulliparous pregnant individuals from across the United States, SMM at delivery was not associated with breastfeeding initiation, but was associated with a significantly lower likelihood of breastfeeding duration and exclusive breastfeeding.

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