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

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.