How Pregnancy-Related Hypertension Impacts Breastfeeding: New Yale Insights


 A recent study from Yale University, featured in JAMA Network Open, explores how hypertensive disorders during pregnancy are linked to lower breastfeeding initiation and shorter duration.

The Scope of Hypertensive Disorders in Pregnancy (HDP)

Hypertensive disorders of pregnancy (HDP)—which include chronic or gestational hypertension, preeclampsia, and eclampsia—pose serious risks for mothers and babies in the U.S. From 2017 to 2019, HDP affected approximately 16% of pregnancies, disproportionately impacting non‑Hispanic Black and American Indian/Alaska Native women .

Beyond immediate complications like preterm birth, HDP also raises long-term risks of cardiovascular disease, kidney failure, and stroke .

Key Findings: Hypertension Undermines Breastfeeding Success

Yale researchers analyzed national data from the CDC Pregnancy Risk Assessment Monitoring System (PRAMS), covering live births between January 2016 and November 2021 . Their weighted sample included 205,247 women (representing nearly 11 million) across 43 states, Washington, D.C., and Puerto Rico .

The study revealed two critical outcomes:

  1. Lower initiation rates: Women with HDP had 11% higher odds of never starting breastfeeding (adjusted OR = 1.11; 95% CI, 1.05–1.18) 5.
  2. Earlier cessation: Among those who did initiate breastfeeding, HDP increased the likelihood of stopping early by 17% (adjusted hazard ratio = 1.17; 95% CI, 1.14–1.21); the median duration was 17 weeks shorter (17 weeks vs. 34 weeks) .

Why Breastfeeding Matters—Especially After HDP

  • Cardioprotective benefits: Breastfeeding reduces maternal risk of hypertension, diabetes, and metabolic disease later in life .
  • Health equity implications: HDP disproportionately affects Black and Native American women, populations that already experience lower breastfeeding rates—potentially increasing health disparities .

By identifying HDP as a risk factor for breastfeeding discontinuation, the study urges healthcare systems to implement targeted support strategies throughout pregnancy and postpartum periods.

Obstacles to Breastfeeding for Women with HDP

Despite 83% of U.S. mothers attempting breastfeeding, only about 25% maintain exclusive breastfeeding for six months—the benchmark recommended by AAP and WHO . Women with HDP face added impediments:

  • Lactation issues: Pain, poor latch, and delayed milk supply often go unaddressed.
  • Policy gaps: Short parental leave and limited access to lactation consulting.
  • Knowledge gaps: Misinformation or lack of awareness among patients and providers regarding breastfeeding after HDP.

Expert Voices

“We looked at whether women ever initiated breastfeeding—and how long they continued,” explained Deanna Nardella, MD, first author and pediatric instructor at Yale School of Medicine. “Having hypertensive disorders around pregnancy was tied to poorer metrics in both initiation and duration.” 
“Most families want to breastfeed, but often encounter hurdles early on—pain, latch problems, supply concerns—and don’t receive timely help,” she added. “These systemic gaps contribute significantly to the drop‑off in U.S. breastfeeding rates.” 
“Black and Native women face higher rates of HDP and lower breastfeeding,” noted co-author Dr. Sarah Taylor. “Understanding this link can guide more equitable, cardiometabolic interventions.” 

Exploring Causes & Planning Solutions

The PRAMS survey—reaching women about four months postpartum—collects self‑reported HDP status (hypertension, preeclampsia, or eclampsia) and breastfeeding habits . Analysis adjusted for age, socioeconomic status, insurance, infant health, and geography.

To bridge gaps, Yale experts propose:

  • Prenatal lactation planning: Early education and specialist consults for pregnant women with HDP.
  • Enhanced postpartum support: Readily available lactation professionals and peer networks in early weeks.
  • Policy advocacy: Extended paid leave and workplace accommodations to support sustained breastfeeding.
  • Clinician training: Equip providers to proactively identify and manage breastfeeding challenges.

These initiatives aim to help women with HDP meet recommended breastfeeding milestones and safeguard their postpartum health.

Broader Implications & Future Directions

HDP can have lasting effects, including higher maternal risk of cardiovascular disease, kidney problems, and even neonatal developmental issues in preterm infants .

Mothers who breastfeed may offset some of these risks. Future research should delve into:
• Biological links between HDP and lactation physiology
• Sociodemographic stressors and access barriers
• Targeted interventions spanning pre- and postnatal care


This study underscores a compelling need: hypertensive disorders during pregnancy are not just immediate risks—they’re predictors of reduced breastfeeding, which may further escalate long-term maternal health burdens.

By integrating targeted lactation support into prenatal and postpartum care for women experiencing HDP, healthcare providers can promote breastfeeding success, improve maternal cardiovascular outcomes, and combat health inequities.

Funding support: Yale Pediatric Scholars Program, Yale National Clinician Scholars Program, and NIH’s NCATS Clinical and Translational Science Awards.

References

  1. Nardella D., Canavan M.E., Taylor S.N. et al. “Hypertensive Disorders of Pregnancy and Breastfeeding Among US Women,” JAMA Network Open, July 1 2025. 
  2. Yale News, “Study finds link between hypertension and breastfeeding outcomes,” July 18 2025. 
  3. PubMed abstract, PMID 40679825. 
  4. CDC PRAMS methodology overview. 
  5. Jain S. et al. “Maternal Hypertensive Disorders and Preterm Infant Neurodevelopment,” JAMA Network Open (2025).

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