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

目的 本研究旨在确定患有心脏病 (MCD) 的女性产后立即母乳喂养的预测因素。

研究设计 本研究纳入了 2012 年至 2018 年在同一机构分娩的所有 MCD 孕妇。针对孕产妇人口统计、产科结果、心脏诊断、心脏风险分层评分和孕前超声心动图结果提取了图表。 Kruskal-Wallis 和 Fisher 精确检验用于比较母乳喂养 (BF) 组与非母乳喂养 (NBF) 组。使用逻辑回归来获得优势比 (OR) 和 95% 置信区间 (CI)。

结果 在 211 名患有 MCD 的孕妇中，12% 的人在产后出院时未进行母乳喂养。与 BF 组相比，NBF 组女性患心肌病的比例明显较高（21% NBF vs. 7% BF，OR 3.44，95% CI 1.12–10.71），修改后世界卫生组织（WHO）分类≥III （33 vs. 14%，OR 3.16，95% CI 1.22–8.15），并且孕前射血分数（EF）< 50%（55 vs. 14%，OR 7.20，95% CI 1.92–27.06）。两组之间在其他心脏诊断或心脏风险评分方面没有差异。

结论 在患有 MCD 的女性中，心肌病、改良 WHO 分级≥III 级和孕前 EF < 50% 与产后即刻的 NBF 相关。这些发现可以指导医疗服务提供者识别出可以从增加母乳喂养咨询和支持中受益的 MCD 女性子集。

关键点