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. 2025 Jan-Dec:21:17455057251366819.
doi: 10.1177/17455057251366819. Epub 2025 Aug 30.

Knowledge on breastfeeding and improving cardiometabolic disease following a major complication of pregnancy: A qualitative analysis

Maleesa M Pathirana  1   2   3 , Emily Aldridge  1   2   3 , Prabha H Andraweera  1   2   3 , Katie Lowe  1   2   3 , Melanie Wittwer  1   3 , Susan Sierp  3 , Gustaaf Dekker  1   2   4 , Margaret A Arstall  2   3
Affiliations

Knowledge on breastfeeding and improving cardiometabolic disease following a major complication of pregnancy: A qualitative analysis

Maleesa M Pathirana et al. Womens Health (Lond). 2025 Jan-Dec.

Abstract

Background: Maternal complications of pregnancy such as preeclampsia and gestational diabetes are independent risk factors for developing premature cardiovascular disease. Breastfeeding may improve immediate cardiometabolic health in these patients; however, women with pregnancy complications are less likely to initiate breastfeeding and more likely to cease breastfeeding early. It is still not known if women understand that breastfeeding can improve cardiovascular disease risk following a pregnancy complication, and if this knowledge would influence breastfeeding outcomes.

Objectives: To assess women's awareness of breastfeeding and cardiovascular disease risk reduction following a pregnancy complication.

Design: Qualitative, descriptive study.

Methods: Women with previous complications of pregnancy completed self-administered questionnaires and attended focus group style or one-to-one interviews at a tertiary hospital in Adelaide, South Australia. The following themes were discussed: experience with breastfeeding following a complication of pregnancy, knowledge on the benefit of breastfeeding for reducing heart disease, support for women to breastfeed for 6 months postpartum and integrated support during postpartum cardiovascular risk counselling. Interviews were transcribed, and deductive thematic analysis was undertaken with NVIVO V12.

Results: Eight women attended interview sessions, with all women being aware that breastfeeding improves heart disease risk factors. However, only 75% of women knew that breastfeeding was particularly beneficial for women with a previous complication of pregnancy. Women reported attachment and guilt as major barriers to breastfeeding, and that breastfeeding support could be improved with individualised counselling prior to discharge, more frequent postpartum visits and explaining that breastfeeding can reduce cardiometabolic disease.

Conclusion: These patient-reported barriers and areas of improvement are important to consider when tailoring lactation counselling support for women with previous complications of pregnancy.

Keywords: breastfeeding; pregnancy complications.

Plain language summary

Women’s understanding of breastfeeding and improving heart health after a pregnancy complicationWomen who experience a complication of pregnancy like preeclampsia or gestational diabetes have a greater risk of developing heart disease later in life. Breastfeeding for at least six months can reduce this risk, but women who have complications of pregnancy often also experience difficulties breastfeeding. We asked eight women who delivered their babies from 2021–2022, experienced a major complication of pregnancy and attended the postpartum lifestyle clinic for women with pregnancy complications at the Lyell McEwin Hospital what they knew about their risk of developing heart disease and how breastfeeding can help. We also asked what challenges they faced while breastfeeding, how they overcame these challenges and how women might be supported in future. Before the interviews, women were also given a questionnaire asking about their breastfeeding experience and understanding of breastfeeding and heart health. All interviewees agreed that ‘breastfeeding for at least 6 months can improve a mother’s blood pressure, weight and blood sugar’, however, only six agreed that this was also true for women who experienced a hypertensive disorder of pregnancy of gestational diabetes. Further, only six women had a health practitioner recommend breastfeeding for their health and not only to benefit their babies. Women reported a mix of positive and negative experiences about breastfeeding. The most common positive experience was women bonding with their baby. Women experienced the most common difficulty with getting an effective latch, especially when their babies were in the special care nursery. Women reported that the support they received that was beneficial and received by a variety of resources, including midwives, lactation consultants, family health nurses and online resources. Overall women reported that more support was needed greater support from health care professionals before leaving the hospital to improve breastfeeding confidence.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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