Abstract
OBJECTIVE: To estimate whether breastfeeding is associated with the estimated risk of long-term atherosclerotic cardiovascular disease (ASCVD) and whether this association varies with prior gestational diabetes mellitus (GDM). METHODS: We conducted a secondary analysis from the prospective HAPO (Hyperglycemia and Adverse Pregnancy Outcome) Follow-Up Study. The exposure was any breastfeeding (yes or no). The primary outcomes, measured 10–14 years after delivery with the Framingham Risk Score, were estimated ASCVD risk (composite of fatal and nonfatal coronary heart disease and stroke) over the subsequent 10- and 30-year time periods. Multivariable linear regression models were used and adjusted for baseline pregnancy covariates: field center, age, body mass index (BMI), height, smoking and alcohol use, parity, and time from delivery to ASCVD risk assessment. Secondarily, we examined whether the association between breastfeeding and ASCVD varied by GDM status (effect modification). RESULTS: Of 4,540 individuals, the median age was 30.6 years at baseline. More than three-fourths (79.7%) reported breastfeeding, which did not vary by GDM status (79.5% vs 81.0%). At 10–14 years after delivery (median 11.6 years), individuals who breastfed had a lower estimated risk of ASCVD over the subsequent 10 years (2.3% vs 2.5%, adjusted b 20.13, 95% CI, 20.25 to 20.02) and 30 years (6.2% vs 6.9%, adjusted b 20.36, 95% CI, 20.66 and 20.05). The association between breastfeeding and estimated ASCVD risk varied significantly by GDM status: The protective effect of breastfeeding was greater for individuals with GDM for estimated 10-year ASCVD risk (GDM: adjusted b 20.52, 95% CI, 20.98 and 20.05; no GDM: adjusted b 20.09, 95% CI, 20.20 and 20.02; interaction P5.004) and 30-year ASCVD risk (GDM: adjusted b 21.33, 95% CI, 22.53 and 20.14; no GDM: adjusted b 20.25, 95% CI, 20.54 and 0.03; interaction P5.003). CONCLUSION: Breastfeeding, particularly after an individual had GDM, was associated with a lower estimated risk of long-term ASCVD. These findings indicate the potential benefit of breastfeeding for long-term cardiovascular health, especially among those with GDM.
| Original language | English (US) |
|---|---|
| Article number | 10.1097/AOG.0000000000005943 |
| Journal | Obstetrics and gynecology |
| DOIs | |
| State | Accepted/In press - 2025 |
Funding
HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study) was conducted by the HAPO FUS Investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The HAPO Study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and American Diabetes Association. The data from the HAPO FUS reported here were supplied by the NIDDK Central Repository. This manuscript was prepared in collaboration with some of the investigators of the HAPO FUS and does not necessarily reflect the opinions or views of the HAPO FUS, the NIDDK Central Repository, or the NIDDK. Dr. Venkatesh was supported by the Care Innovation and Community Improvement Program at The Ohio State University. Dr. Khan was supported by National Heart, Lung, and Blood Institute grant HL161514.
ASJC Scopus subject areas
- Obstetrics and Gynecology
