Poster Session 2
Emma Trawick Roberts, MD (she/her/hers)
Fellow
University of North Carolina
Chapel Hill, NC, United States
Sarah Heerboth, MD (she/her/hers)
Fellow
University of North Carolina
Chapel Hill, North Carolina, United States
Tracy A. Manuck, MD, MSCI (she/her/hers)
Professor
University of North Carolina
Chapel Hill, North Carolina, United States
Alison M. Stuebe, MD, MSc
Professor
UNC School of Medicine
Chapel Hill, NC, United States
To examine the association of postpartum hemorrhage (PPH) with reduced rates of breastfeeding at 4-8 weeks postpartum.
Study Design:
Secondary analysis of a multicenter randomized controlled trial of elective induction of labor at 39 weeks’ gestation vs. expectant management in low-risk nulliparous women from 2014-2017 (MFMU ARRIVE trial). Participants with singleton, non-anomalous pregnancies with no medical or obstetric indication for induction (as assessed at 38 weeks’ gestation/enrollment) were included. Those requiring ≥2 uterotonics in addition to oxytocin, transfusion, or surgical interventions to control bleeding (including peripartum hysterectomy) were considered to have PPH. At 4-8 weeks postpartum, participants self-reported infant feeding, categorized as exclusive breast (EBF), breast feeding in combination with formula (CF), or exclusive formula feeding (EFF). The primary outcome was any breastfeeding (EBF of CF) at 4-8 weeks postpartum. Multivariable logistic regression was used to model the relationship between PPH and breastfeeding.
Results:
Of 5454 participants that met inclusion criteria, 251 (5%) had a PPH, and 90/251 (36%) required blood transfusion. Clinical cohort characteristics are shown in table 1. At 4-8 weeks postpartum, 33% were EBF, 31% were CF, and 35% were EFF. Of those with a PPH, 72 (28.7%) were EBF, 84 (33.5%) were CF, and 95 (37.9%) were EFF (p >0.05). In regression models, PPH was associated with a non-statistically significant reduced odds of EBF or breastfeeding at all (Table 2). In regression models limited to those with PPH requiring blood transfusion, however, there was a significantly reduced odds of EBF or breastfeeding at all compared to those EFF (Table 2).
Conclusion:
In a low-risk nulliparous population, PPH requiring blood transfusion was associated with reduced odds of breastfeeding at 4-8 weeks postpartum. Women who have a PPH, especially if they require transfusion, may benefit from targeted breastfeeding support.
