Influence of breastfeeding on maternal blood pressure at one month postpartum

The association of breast feeding for at least six months with hemodynamic and metabolic health of women and their children aged three years: an observational cohort study

BACKGROUND

Breastfeeding is important for both mother and child in reducing risk of future cardiovascular disease. Therefore, it may be an effective method to improve cardio-metabolic health, particularly those who are exposed to pregnancy complications which increase later CVD risk for both mother and child. The aim of this study is to assess differences in cardiometabolic health at three years postpartum in mothers who breastfed for at least six months and their children compared to those who did not.

METHODS

Women and children from the Screening Tests to Predict Poor Outcomes of Pregnancy (STOP) study (2015-2017) were invited to attend a health check-up at three years postpartum. Women's breastfeeding status at least six months postpartum was ascertained through their child health record. Anthropometric and hemodynamic measurements were taken from women and their children. A fasting blood sample was taken from women to measure blood glucose and lipids.

RESULTS

A total of 160 woman-child dyads were assessed in this study. Women who breastfed for at least six months had significantly lower maternal BMI, systolic blood pressure, diastolic blood pressure, mean arterial pressure, central systolic blood pressure, and central diastolic blood pressure than those who did not and this did not change after adjusting for BMI and socioeconomic index in early pregnancy, prenatal smoking and maternal age in early pregnancy. Subgroup analysis on women who had one or more pregnancy complications during the index pregnancy (i.e. preeclampsia, gestational hypertension, delivery of a small for gestational age infant, delivery of a preterm infant, and/or gestational diabetes mellitus) demonstrated that women who breastfed for at least six months had significantly lower maternal systolic and diastolic blood pressures, serum insulin and triglycerides, and higher HDL cholesterol. There were no differences in child anthropometric or hemodynamic variables at three years of age between those children who had been breastfed for at least six months and those who had not.

CONCLUSION

Breastfeeding for at least six months may reduce some maternal; cardiovascular risk factors in women at three years postpartum, in particular, in those who have experienced a complication of pregnancy.

TRIAL REGISTRATION

ACTRN12614000985684 (12/09/2014).

Use of Herbal Medicines Among Breastfeeding Mothers in Tanzania: A Cross-Sectional Study

Background: There are limited data on the use of herbal medicines (HM) among breastfeeding mothers, despite the fact that knowledge of the possible benefits or harms of HM use has a direct relationship with the health of infants, especially in resource-limited countries. The study aims to determine the prevalence and factors associated with HM use among breastfeeding mothers in Tanzania. Methods: The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from the reproductive and child health clinic at Uhuru health center in Morogoro, Tanzania. The survey instrument comprised of 34 questions, including demographic information, the pattern of HM use during breastfeeding, and women's perceptions of HM. Chi-square test and logistic regression were used for data analysis using SPSS ver. 24.0. Results: The majority of the respondents (53.8%) used HM during breastfeeding. The most commonly used HM was black pepper (Piper nigrum L.; 80.0%), followed by pumpkin seeds (Cucurbita pepo L.; 18.0%). About one-third (27.5%) of HM users discussed their use with their healthcare providers. In addition, higher education levels and low breastmilk supply were identified as potential predictors of HM use. Conclusion: The practice of HM use among breastfeeding mothers in Tanzania is popular to ease breastfeeding difficulties. However, the issue of the safety or effectiveness of HM is still an unknown agenda. This awakens the need to evaluate HM's safety, efficacy, and quality through pharmacological studies for scientific evidence. Lastly, a clinical guideline should be developed in healthcare settings to promote open dialogues between the healthcare providers and mothers to ensure the safe use of HM.

Association between breastfeeding and preeclampsia in parous women: a case -control study

Background

Preeclampsia is a global health problem and it is the main cause of maternal and perinatal morbidity and mortality. Breastfeeding has been reported to be associated with lower postpartum blood pressure in women with gestational hypertension. However, there is no published data on the role that breastfeeding might play in preventing preeclampsia. The aim of the current study was to investigate if breastfeeding was associated with preeclampsia in parous women.

Method

A case-control study was conducted in Saad Abualila Maternity Hospital in Khartoum, Sudan, from May to December 2019. The cases (n = 116) were parous women with preeclampsia. Two consecutive healthy pregnant women served as controls for each case (n = 232). The sociodemographic, medical, and obstetric histories were gathered using a questionnaire. Breastfeeding practices and duration were assessed.

Results

A total of 98 (84.5%) women with preeclampsia and 216 (93.1%) women in the control group had breastfed their previous children. The unadjusted odds ratio (OR) of preeclampsia (no breastfeeding vs breastfeeding) was 3.55, 95% confidence interval (CI) 1.64,7.70 and p value = 0.001 based on these numbers. After adjusting for age, parity, education level, occupation, history of preeclampsia, history of miscarriage, body mass index groups the adjusted OR was 3.19, 95% CI 1.49, 6.82 (p value = 0.006).

Conclusion

Breastfeeding might reduce the risk for preeclampsia. Further larger studies are required.

Lactation and Maternal Subclinical Atherosclerosis Among Women With and Without a History of Hypertensive Disorders of Pregnancy

Background: We evaluated subclinical cardiovascular disease in relation to lactation history among women with normotensive pregnancies and women with hypertensive pregnancies, a distinction not previously examined. Materials and Methods: The POUCHmoms study included 678 women from a pregnancy cohort who were followed 7-15 years after delivery. We measured blood pressure, lipid levels, carotid intima-media thickness (CIMT), and lactation duration for each live birth (LB) at follow-up. We categorized lactation as never, <6 months/LB, or ≥6 months/LB. We analyzed associations between lactation and cardiometabolic risk factors and CIMT by using analysis of variance and multivariable linear regression (adjusted for age, race, socioeconomic status, smoking, time from last pregnancy, and total parity), which produced adjusted least square mean differences (LSMdiff) between groups. Results: In the normotensive pregnancies group with women who never lactated as the referent (n = 157): Women with some lactation but <6 months/LB (n = 284) had higher high density lipoprotein (HDL) (LSMdiff = +4.47 mg/dL, p = 0.013), lower triglycerides (LSMdiff = -38.1 mg/dL, p = 0.02), and thinner mean CIMT (LSMdiff = -0.03 mm, p = 0.005); women who lactated for ≥6 months/LB (n = 133) also had higher HDL (LSMdiff = +7.59 mg/dL, p < 0.001), lower triglycerides (LSMdiff = -41.6 mg/dL, p = 0.01), and thinner mean CIMT (LSMdiff = -0.03 mm, p = 0.003). After further adjustment for body mass index, associations between lactation and HDL, triglycerides, and mean CIMT persisted. These associations were not detected in women with prior hypertensive pregnancies. Conclusions: Women with a history of normotensive pregnancies and lactation for any duration had a more favorable cardiometabolic profile and were at decreased risk of subclinical atherosclerosis compared with those who never lactated.

Breastfeeding and maternal cardiovascular risk factors: 1982 Pelotas Birth Cohort

This study evaluated the association of breastfeeding duration with maternal metabolic cardiovascular risk factors among women who have been prospectively followed since birth in a southern Brazilian city. In the unadjusted analysis, total cholesterol was higher among women who never breastfed in relation to those who breastfed ≥12 months. Among women with one livebirth, a shorter duration of breastfeeding was associated with lower HDL, while those with two or more livebirths and that breastfed for shorter time presented lower pulse wave velocity, glycaemia and non-HDL measures. After controlling for confounding variables, the magnitude of these associations decreased, and the confidence intervals included the reference. Concerning the duration of breastfeeding of the last child, the analysis was stratified by time since last birth. After controlling for confounders, systolic blood pressure was lower among women who breastfed 3 to <6 months and had a child within the last five years in relation to those who breastfed ≥6, but no clear trend was observed (p = 0.17). In conclusion, our findings suggest that there is no association between lactation and maternal cardiometabolic risk factors.

Quantile regression analysis of modifiable and non-modifiable drivers' of blood pressure among urban and rural women in Ghana

High blood pressure is an increasingly problematic public health concern in many developing countries due to the associated cardiovascular and renal complications. This study set out to investigate the drivers of blood pressure among urban and rural women using the 2014 Ghana Demographic and Health Survey data. Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were the outcomes of interest. Our findings showed that body mass index (BMI) had a significant positive effect on DBP and SBP in both urban and rural settings, with the largest effect occurring among women in the 75^th quantile. Arm circumference also had a positive effect on DBP and SBP across all quantiles in both settings. Age had an increasing positive effect along the entire conditional DBP and SBP distribution in both settings. Women who were pregnant had lower DBP and SBP relative to those who were not pregnant in both settings. These results highlight the important drivers of DBP and SBP, and the differential effects of these drivers on blood pressure (BP) among women in urban and rural settings. To increase their effectiveness, interventions to address high BP should take into account these differential effects.

Breastfeeding and the Benefits of Lactation for Women's Health

The offer of the maternal breast to the baby is an unquestionable right of mothers and their children, and all efforts should be made to promote, follow and maintain exclusive breastfeeding for up to 6 months and supplement it until the child completes 2 years of age. Many publications are available in the literature about the qualities of breast milk, its benefits and health repercussions, stimulating the practice of breastfeeding and supporting campaigns for its implementation. However, although it is widely known that breastfeeding is an important step in the reproductive process of women and its practice offers benefits to both mother and child, most of the available information highlights the benefits of breast milk for children, while mention of the effects of breastfeeding on the health of the mother is usually neglected. Thus, the objective of the present study is to highlight the multiple benefits of breastfeeding for the physical and emotional health of the nursing mother. The authors consulted articles published in the databases PubMed, Virtual Health Library and Web of Science using the keywords breastfeeding, breast milk, lactation and maternal health.

Association Between Intimate Partner Violence and Breastfeeding Duration: Results From the 2004-2014 Pregnancy Risk Assessment Monitoring System

BACKGROUND

Intimate partner violence is a major public health problem that disproportionately affects women. Current literature investigating the relationship between intimate partner violence and breastfeeding is inconsistent. Research aim: This study aims to investigate the relationship between physical intimate partner violence that occurs in the preconception or prenatal period and any breastfeeding duration.

METHODS

Data from the retrospective, cross-sectional 2004-2014 Pregnancy Risk Assessment Monitoring System were analyzed ( N = 195,264). The outcome, breastfeeding duration, was categorized as never breastfed, breastfed 8 weeks or less, and breastfeed more than 8 weeks. Multinomial logistic regression was used to obtain crude and adjusted odds ratios and 95% confidence intervals.

RESULTS

Approximately 6% ( n = 11,766) of survey respondents reported preconception and/or prenatal intimate partner violence, and 36.3% ( n = 67,667) of women reported never breastfeeding. The odds of discontinuing breastfeeding before 8 weeks were 18% higher among women who reported experiencing abuse 12 months before pregnancy compared with women who did not report intimate partner violence (adjusted odds ratio = 1.18; 95% confidence interval [1.01, 1.37]). All other estimates showed an overlapping 95% confidence interval.

CONCLUSION

Breastfeeding is essential in improving maternal and child health; however, women in abusive relationships may face additional barriers to breastfeeding. Further research is needed to better understand the impact of violence on breastfeeding behaviors to inform healthcare practices and interventions.

Cumulative Lactation and Onset of Hypertension in African-American Women

Hypertension affects nearly 1 of 3 women and contributes to cardiovascular disease, the leading cause of death in the United States. Breastfeeding leads to metabolic changes that could reduce risks of hypertension. Hypertension disproportionately affects black women, but rates of breastfeeding among black women lag behind those in the general population. In the Black Women's Health Study (n = 59,001), we conducted a nested case-control analysis using unconditional logistic regression to estimate the association between breastfeeding and incident hypertension at ages 40-65 years using data collected from 1995 to 2011. Controls were frequency-matched 2:1 to 12,513 hypertensive women by age and questionnaire cycle. Overall, there was little evidence of association between ever breastfeeding and incident hypertension (odds ratio = 0.97, 95% confidence interval: 0.92, 1.02). However, age modified the relationship (P = 0.02): Breastfeeding was associated with reduced risk of hypertension at ages 40-49 years (odds ratio = 0.92, 95% confidence interval: 0.85, 0.99) but not at older ages. In addition, risk of hypertension at ages 40-49 years decreased with increasing duration of breastfeeding (P for trend = 0.08). Our results suggest that long-duration breastfeeding may reduce the risk of incident hypertension in middle age. Addressing breastfeeding as a potential preventative health behavior is particularly compelling because it is required for only a discrete period of time.

Effect of Lactation on myocardial vulnerability to ischemic insult in rats

Background

Cardiovascular diseases are the leading cause of mortality and long-term disability worldwide. Various studies have suggested a protective effect of lactation in reducing the risk of cardiovascular diseases.

Objective

This study was designed to assess the effects of pregnancy and lactation on the vulnerability of the myocardium to an ischemic insult.

Methods

Eighteen female rats were randomly divided into three groups: ischemia-reperfusion (IR), in which the hearts of virgin rats underwent IR (n = 6); lactating, in which the rats nursed their pups for 3 weeks and the maternal hearts were then submitted to IR (n = 6); and non-lactating, in which the pups were separated after birth and the maternal hearts were submitted to IR (n = 6). Outcome measures included heart rate (HR), left ventricular developed pressure (LVDP), rate pressure product (RPP), ratio of the infarct size to the area at risk (IS/AAR %), and ventricular arrhythmias - premature ventricular contraction (PVC) and ventricular tachycardia (VT).

Results

The IS/AAR was markedly decreased in the lactating group when compared with the non-lactating group (13.2 ± 2.5 versus 39.7 ± 3.5, p < 0.001) and the IR group (13.2 ± 2.5 versus 34.0 ± 4.7, p < 0.05). The evaluation of IR-induced ventricular arrhythmias indicated that the number of compound PVCs during ischemia, and the number and duration of VTs during ischemia and in the first 5 minutes of reperfusion in the non-lactating group were significantly (p < 0.05) higher than those in the lactating and IR groups.

Conclusion

Lactation induced early-onset cardioprotective effects, while rats that were not allowed to nurse their pups were more susceptible to myocardial IR injury.

Effects of lactation on postpartum blood pressure among women with gestational hypertension and preeclampsia

BACKGROUND

Women with a history of hypertensive disorders of pregnancy are at an increased risk of hypertension and cardiovascular disease in later life. Lactation has been associated with a reduced risk of maternal hypertension, both in the postpartum period and later life. However, little is known about whether lactation is also cardioprotective in women with hypertensive disorders of pregnancy such as preeclampsia or gestational hypertension.

OBJECTIVE

This study aimed to characterize the relationship between lactation and postpartum blood pressure among women with preeclampsia and gestational hypertension.

STUDY DESIGN

Data were obtained from women who participated in the Prenatal Exposures and Preeclampsia Prevention study (n = 379; 66% African American; 85% overweight or obese). Women enrolled during pregnancy and attended a postpartum visit (on average, 9.1 months after delivery) during which data on lactation duration and blood pressure were collected. The significance of the associations between postpartum blood pressure and lactation among women who remained normotensive during pregnancy, developed gestational hypertension, or developed preeclampsia were assessed with an analysis of variance. Linear regression models were used to adjust for maternal age, race, education, prepregnancy weight, and time since delivery.

RESULTS

Gestational hypertension affected 42 subjects (11%) and preeclampsia affected 33 (9%). Lactation was reported by 217 (57%) with 78 (21%) reporting ≥ 6 months of lactation. Women who lactated were somewhat older, more educated, and had higher socioeconomic status. Among women who had gestational hypertension, lactation was associated with lower systolic blood pressure (P = .02) and diastolic blood pressure (P = .02). This association persisted after adjustment for age, race, education, prepregnancy weight, and time since delivery. However, for women who had preeclampsia and women who remained normotensive during pregnancy, lactation was not associated with postpartum blood pressure in either bivariate or multivariate analyses.

CONCLUSION

This study found that lactation is associated with lower postpartum blood pressure among overweight women who develop gestational hypertension but not among women who develop preeclampsia. Future studies are needed to explore the association of lactation and blood pressure in later life for women with hypertensive disorders of pregnancy.

Breastfeeding and maternal health outcomes: a systematic review and meta-analysis

AIM

To evaluate the effect of breastfeeding on long-term (breast carcinoma, ovarian carcinoma, osteoporosis and type 2 diabetes mellitus) and short-term (lactational amenorrhoea, postpartum depression, postpartum weight change) maternal health outcomes.

METHODS

A systematic literature search was conducted in PubMed, Cochrane Library and CABI databases. Outcome estimates of odds ratios or relative risks or standardised mean differences were pooled. In cases of heterogeneity, subgroup analysis and meta-regression were explored.

RESULTS

Breastfeeding >12 months was associated with reduced risk of breast and ovarian carcinoma by 26% and 37%, respectively. No conclusive evidence of an association between breastfeeding and bone mineral density was found. Breastfeeding was associated with 32% lower risk of type 2 diabetes. Exclusive breastfeeding and predominant breastfeeding were associated with longer duration of amenorrhoea. Shorter duration of breastfeeding was associated with higher risk of postpartum depression. Evidence suggesting an association of breastfeeding with postpartum weight change was lacking.

CONCLUSION

This review supports the hypothesis that breastfeeding is protective against breast and ovarian carcinoma, and exclusive breastfeeding and predominant breastfeeding increase the duration of lactational amenorrhoea. There is evidence that breastfeeding reduces the risk of type 2 diabetes. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not evident.

Hypertension Risk Subsequent to Gestational Dysglycemia Is Modified by Race/Ethnicity

Gestational diabetes mellitus is associated with an increased risk of type 2 diabetes mellitus and hypertension. Additionally, gestational dysglycemia has been associated with an increased risk of type 2 diabetes mellitus but not yet associated with hypertension subsequent to pregnancy in long-term follow-up. Therefore, we set out to examine this relationship as well as the role of race/ethnicity in modifying this relationship. We analyzed a prospective observational cohort followed between 1998 and 2007. There were 17 655 women with self-reported race/ethnicity and full-term, live births. A 1-hour 50 g oral glucose-load test and a 3-hour 100 g oral glucose-tolerance test enabled third trimester stratification of women into 1 of 4 glucose-tolerance groups: (1) normal (n=15 056); (2) abnormal glucose-load test (n=1558); (3) abnormal glucose-load and -tolerance tests (n=520); and (4) gestational diabetes mellitus (n=521). Women were then followed for a mean±standard deviation of 4.1±2.9 years after delivery for the development of hypertension. Although gestational diabetes mellitus was associated with an increased risk of hypertension after pregnancy (odds ratio [95% confidence interval]: 1.58 [1.02, 2.45]; P=0.04), dysglycemia defined by an abnormal glucose-load test predicted hypertension only among black women (4.52 [1.24, 16.52]; P=0.02). The risk of hypertension after pregnancy among dysglycemia groups not meeting criteria for gestational diabetes mellitus varied based on the race/ethnicity of the population. Further research on the implications of the intersection of race/ethnicity and gestational dysglycemia on subsequent hypertension is warranted.

Lactation Duration and Midlife Atherosclerosis

OBJECTIVE

To evaluate lactation duration in relation to subsequent atherosclerosis in women during midlife.

METHODS

The Coronary Artery Risk Development in Young Adults study is a multicenter prospective cohort that enrolled 2,787 women in 1985-1986 (ages 18-30 years, 52% black, 48% white), of whom 2,014 (72%) attended the 20-year follow-up examination in 2005-2006. We selected 846 women (46% black) without heart disease or diabetes at baseline who delivered one or more times after the baseline evaluation, had cardiometabolic risk factors measured at baseline, and had maximum common carotid intima-media thickness (mm) measured at the 20-year follow-up examination in 2005-2006. Lactation duration was summed across all postbaseline births for each woman and (n, women) categorized as: 0 to less than 1 month (n=262), 1 to less than 6 months (n=210), 6 to less than 10 months (n=169), and 10 months or greater (n=205). Multiple linear regression models estimated mean common carotid intima-media thickness (95% confidence interval) and mean differences among lactation duration groups compared with the 0 to less than 1-month group adjusted for prepregnancy obesity, cardiometabolic status, parity, and other risk factors.

RESULTS

Lactation duration had a graded inverse association with common carotid intima-media thickness; mean differences between 10 months or greater compared with 0 to less than 1 month ranged from -0.062 mm for unadjusted models (P trend <.001) to -0.029 mm for models fully adjusted for prepregnancy body mass index (BMI) and cardiometabolic risk factors, parity, smoking, and sociodemographics (P trend=.010). Stepwise addition of potential mediators (BMI, systolic blood pressure at the 20-year follow-up examination) modestly attenuated the lactation and common carotid intima-media thickness association to -0.027 and -0.023 mm (P trend=.019 and .054).

CONCLUSION

Shorter lactation duration is associated with subclinical atherosclerosis independent of prepregnancy cardiometabolic risk factors and traditional risk factors. The magnitude of differences in carotid artery intima-media thickness may represent greater vascular aging. Lactation may have long-term benefits that lower cardiovascular disease risk in women.

LEVEL OF EVIDENCE

II.

Breastfeeding status and maternal cardiovascular variables across the postpartum

BACKGROUND

There have been recent reports that lactational history is associated with long-term women's health benefits. Most of these studies are epidemiological. If particular cardiometabolic changes that occur during lactation ultimately influence women's health later is unknown.

METHODS

Seventy-one healthy women participated in a prospective postpartum study that provided an opportunity to study anthropometric, endocrine, immune, and behavioral variables across time. Variables studied were heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), C-reactive protein, body mass index (BMI), perceived stress, and hormones. A cohort of women without a change in breastfeeding (N=22) or formula feeding (N=23) group membership for 5 months was used for analysis of effects of feeding status. The data were analyzed using factorial repeated measures analysis of variance and analysis of covariance.

RESULTS

SBP and HR declined across the postpartum and were significantly lower in breastfeeding compared to formula feeding mothers (p<0.05). These differences remained statistically significant when BMI was added to the model. Other covariates of income, stress, marital status, and ethnicity were not significantly associated with these variables over time. DBP was also lower, but the significance was reduced by the addition of BMI as a covariate. Stress also was lower in breastfeeders, but this effect was reduced by the addition of income as a covariate.

CONCLUSIONS

These data suggest that there are important physiological differences in women during months of breastfeeding. These may have roles in influencing or programming later risks for a number of midlife diseases.

A prospective population-based cohort study of lactation and cardiovascular disease mortality: the HUNT study

Background

Recent studies suggest that lactation has long-term effects on risk for cardiovascular disease in women, but the effects on cardiovascular mortality are less well known.

Method

In a Norwegian population-based prospective cohort study, we studied the association of lifetime duration of lactation with cardiovascular mortality in 21,889 women aged 30 to 85 years who attended the second Nord-Trøndelag Health Survey (HUNT2) in 1995–1997. The cohort was followed for mortality through 2010 by a linkage with the Cause of Death Registry. Adjusted hazard ratios (HR) for death from all causes and cardiovascular disease were calculated using Cox regression.

Results

During follow-up, 1,246 women died from cardiovascular disease. Parous women younger than 65 years who had never lactated had a higher cardiovascular mortality than the reference group of women who had lactated 24 months or more (HR 2.77, 95% confidence interval [CI]: 1.28, 5.99). There was some evidence of a U-shaped association, where women who reported lactating 7–12 months had a HR of 0.55 (95% CI: 0.27, 1.09). No clear associations were observed among women 65 years or older.

Conclusions

Excess cardiovascular mortality rates were observed among parous women younger than 65 years who had never lactated. These findings support the hypothesis that lactation may have long-term influences on maternal cardiovascular health.