(1079) Inequities in breastfeeding patterns among patients with HDP at a southwestern safety net hospital

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Kristin Hinsen

Medical Student
School of Medicine Health Sciences Center, University of New Mexico
Albuquerque, New Mexico, United States

Coauthor(s)

FL

Fiona LaRoc, N/A

Medical Student
School of Medicine Health Sciences Center, University of New Mexico
Albuquerque, New Mexico, United States
CY

Christina Yarrington, MD

University of New Mexico
Albuquerque, New Mexico, United States

Objective: Breastfeeding reduces lifelong cardiovascular (CV) risk, particularly in those with a hypertensive disorder of pregnancy (HDP). American Indian (AI) patients experience inequities in both preeclampsia and chronic CV disease. This study investigated newborn feeding differences among women with HDP in a cohort with a representative AI population.

Study Design: This retrospective cohort study analyzed patients with chronic hypertension or HDP using a quality improvement data set. Cases with uncertain diagnoses underwent direct chart review. The primary outcome was exclusive formula feeding (FF). Demographics included race, ethnicity, insurance type, cesarean delivery (CD), and selected comorbidities. Univariate and multivariable analysis used t-tests, chi-square, and logistic regression as appropriate, with a significance level of p< 0.05.

Results: Data were analyzed from 975 patients: 198 non-Hispanic white (NHW), 494 Hispanic (H), 178 AI, and 37 non-Hispanic Black (NHB). FF was higher (44%) and exclusive breastfeeding (EB) lower (16%) among AI patients compared to other groups (p< 0.001). Univariate analysis revealed increased odds of FF among patients with CD (OR 2.1 [1.6-2.9]), antihypertensive use (3.5 [2.5-4.8]), transfusion (2.2 [1.4-3.5]), and preterm birth (PTB) (13.7 [9.2-20.4]). AI patients were more likely to have diabetes (2.9 [1.8-4.7]), PTB (3.3 [2.0-5.5]), and require antihypertensives (1.8 [1.1-2.9]). FF rates were high ( >60%) in PTB cases across all groups. Multivariable analysis showed 80% increased odds of FF among AI patients compared to NHW, controlling for DM, CD, and HTN medications. Among term deliveries and controlling for the above, AI patients had higher odds of FF (aOR 1.9 [1.2-3.0]) as well as lower odds of EB (aOR 0.35 [0.21-0.59]) compared to NHW.

Conclusion: These findings demonstrate a higher rate of FF among AI patients compared to NHW, indicating a potential contributor of inequities in subsequent CV disease. Future educational and quality improvement measures should seek to optimize rates of breastfeeding in this high-risk population.