Breastfeeding Initiation among Women with Preeclampsia with Severe Features Superimposed On Diabetes Mellitus

Abstract

Background: Timely delivery and magnesium sulfate (MgSO4) remain mainstays in the treatment of preeclampsia with severe features (PSF) which may be superimposed on preexisting conditions such as diabetes mellitus (PDM). Preeclampsia associated with premature delivery, severity of condition and mother-infant separation increase the risk of breastfeeding (BF) initiation failure. Objective: To compare BF initiation among 158 women with late-onset PSF with 111 women with PDM all of whom received postpartum MgSO4. Methods: Retrospective cohort study of women with PSF and PDM without major fetal malformations who delivered at ≥ 34 weeks GA. PDM group was composed of 33 gestational, 55 Type 1 and 22 Type 2 diabetics. Infant feeding preference declared prenatally was either BF, formula feeding (FF) or both. At discharge, exclusive BF was by direct BF alone or BF complemented with expressed breast milk (EBM), whereas formula supplementation defined partial BF, differences were statistically significant at p < 0.05*. Results: PSF and PDM groups were similar in age, race, and late preterm delivery (73 vs. 66%), however, differed in primiparity (65 vs. 45%)*, vaginal deliveries (58 vs. 31%)*, repeat cesarean (12 vs. 30%)*, admission to the NICU (44 vs. 58%)* and neonatal hypoglycemia (20 vs. 41%)*. Both groups were similar in prior BF experience (17 vs. 22%) and in intention to BF (80 vs. 71%), intention to FF (16 vs. 18%) or intention to partially BF (4 & 11%). At the time of discharge, the rate of exclusive BF among PSF was higher (37 vs. 18%)*, the rate of FF was lower (30 vs. 46%)* while the rate of partial BF was similar (33 vs. 36%) to those in the PDM group. Thus, BF initiation (exclusive plus partial BF) occurred in 70% of PSF and in 54% of PDM*. Conclusion: BF initiation rates for women with PDM were significantly lower than those for women with PSF alone. Although intention to BF was similar to that of the general maternal population, BF initiation rates were suboptimal for the PSF group and even lower and more concerning for the PDM group. Direct BF alone or combined with EBM, led to the exclusive provision of human milk during hospitalization to infants in both groups. Women with PSF and PDM represent groups that will require novel and targeted interventions to improve BF initiation rates.