The effects of social determinants of health on breastfeeding practices in patients with heart disease

Abstract

Data on the association between social determinants of health (SDOH), breastfeeding (BF) and maternal cardiac disease (MCD) are lacking. We sought to evaluate BF intent, BF rates at discharge, and continued BF at follow-up in patients managed in a comprehensive cardio-obstetrics program stratified by area deprivation index (ADI). Observational cohort of patients managed by the UAB Cardio-Obstetrics Program. Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team, delivered at UAB, and had a street address on file. The primary outcome was BF rate at hospital discharge. Secondary outcomes included BF intent on admission and BF at the postpartum (PP) visit. ADI reports socioeconomic disadvantage at the census tract level; 1 = least deprived, 100 = most deprived. Baseline characteristics and BF rates were compared by ADI tertiles: Low (ADI 1 – 33), Medium (ADI 34 – 66), and High (ADI 67 – 100). 148 patients were included: 14 (10%) Low ADI, 42 (28%) Medium ADI of 34 – 66, and 92 (62%) with an ADI of 67 – 100. Patients with the highest tertile ADI were younger relative to the medium or lower tertile (26 vs 28 vs. 32 years; p< 0.01) and less likely to be married or living with a partner (30.4% vs. 58.5% vs. 71.4%; p< 0.01). Importantly, BMI, race, GA at delivery, medical comorbidities and MCD classification were not different between groups. There was no difference in BF intent between the highest, medium, and lowest ADI tertiles (81.6% vs. 85.4% vs. 85.7%; p=0.38) or BF rates at hospital discharge (85.6% vs. 92.7% vs. 100%, p=0.23). However, there was a significant difference in BF rates at the PP visit (38.6% vs.63.0% vs. 90%; p< 0.01). Specifically, BF rates among patients from the high ADI group dropped from 86% at hospital discharge to 39% at the PP visit. There is a clear association between disadvantaged status, as defined by ADI, and early cessation of breastfeeding in our population of patients with maternal cardiac disease. Interventions to offset the effects of SDOH on BF in patients with MCD may improve maternal and infant health.View Large Image Figure ViewerDownload Hi-res image Download (PPT)