Immediate Postpartum Breastfeeding Following Pregnancy with Cardiac Disease.

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.