OBSTETRICS

Association between parity and breastfeeding
with maternal high blood pressure
Samantha J. Lupton, BMedRes; Christine L. Chiu, PhD; Sanja Lujic, MBiostat;
Annemarie Hennessy, MBBS, PhD; Joanne M. Lind, PhD
OBJECTIVE: The objective of this study was to determine how parity
and breastfeeding were associated with maternal high blood pressure,
and how age modifies this association.
STUDY DESIGN: Baseline data for 74,785 women were sourced
from the 45 and Up Study, Australia. These women were 45 years of
age or older, had an intact uterus, and had not been diagnosed with
high blood pressure before pregnancy. Odds ratios (ORs) and 99%
confidence intervals (CIs) for the association between giving birth,
breastfeeding, lifetime breastfeeding duration, and average breast-
feeding per child with high blood pressure were estimated using lo-
gistic regression.
RESULTS: The combination of parity and breastfeeding was associated
with lower odds of having high blood pressure (adjusted OR, 0.89; 99%
CI, 0.82–0.97; P Ͻ .001), compared with nulliparous women,
whereas there was no significant difference between mothers who did
not breastfeed and nulliparous women (adjusted OR, 1.06; 99% CI,
0.95–1.18; P ϭ.20). Women who breastfed for longer than 6 months
in their lifetime, or greater than 3 months per child, on average, had
significantly lower odds of having high blood pressure when compared
with parous women who never breastfed. The odds were lower with lon-
ger breastfeeding durations and were no longer significant in the major-
ity of women over the age of 64 years.
CONCLUSION: Women should be encouraged to breastfeed for as long
as possible and a woman’s breastfeeding history should be taken into
account when assessing her likelihood of high blood pressure in later
life.
Key words: breastfeeding, cardiovascular disease, high blood
pressure, parity, women
Cite this article as: Lupton SJ, Chiu CL, Lujic S, et al. Association between parity and breastfeeding with maternal high blood pressure. Am J Obstet Gynecol
2013;208:454.e1-7.
P
regnancy and breastfeeding are asso-
ciatedwithlarge changes tothe female
hormonal profile. A correlation between
these events and a woman’s risk of cardio-
vascular disease has been reported since
the 1950s
1
with more recent large cohort
studies showing breastfeeding is beneficial
to maternal cardiovascular health.
2-5
Cardiovascular diseases are the lead-
ing cause of death among women in de-
veloped countries. Hypertension is one
of the most prevalent cardiovascular dis-
eases and is a strong predictor of other
cardiovascular diseases including ath-
erosclerosis, myocardial infarction, and
stroke. Age is a powerful predictor of hy-
pertension, with increasing age associ-
ated with increasing rates of hyperten-
sion in industrialized countries.
6
The association between pregnancy and
hypertension in later life remains unclear.
Earlyworkwithinthe fieldfoundanassocia-
tionbetweenincreasingnumberof pregnan-
cies and lower odds of hypertension,
7
whereas other studies have shownnoassoci-
ation between parity and blood pressure.
8,9
These studies had relatively small sample
sizes in comparison to the large cohorts that
have since beenestablished.
Breastfeeding has been reported to confer
many benefits uponthe newborn, including
reducedlevels of childhoodobesity,
10
hyper-
tension,
11-13
and hyperlipidemia.
14,15
More
recent studies have found an association be-
tween breastfeeding and a lower risk of ma-
ternal hypertension. This was first reported
in 2005 by the Korean Women’s Cohort
(KWC) Study
2
and has since been reported
by the Study of Women’s Health Across the
Nation(SWAN),
3
the Women’s Health Ini-
tiative (WHI) Study,
4
and the US Nurses’
Health Study II.
5
No studies have examined
whether the combined effect of parity and
breastfeeding is associated with high blood
pressure, and how age modifies the associa-
tion between breastfeeding and high blood
pressure.
The present study aimed to determine:
(a) the association between the event of
giving birth with high blood pressure in
later life, using observational data fromthe
45andUpStudy, Australia, (b) whether the
combination of giving birth and breast-
feeding is associated with high blood pres-
sure in later life, and (c) if the duration of
breastfeeding was associated with high
blood pressure in later life, and how this
association is modified as women age.
MATERIALS AND METHODS
This study obtained data from women
participating in the 45 and Up Study, a
Fromthe University of Western Sydney, School
of Medicine, Campbelltown, NSW, Australia.
Received Sept. 12, 2012; revised Dec. 19,
2012; accepted Feb. 5, 2013.
The authors report no conflict of interest.
Presented orally at the 24th Annual Scientific
Meeting of the International Society of
Hypertension, Sept. 30-Oct. 4, 2012, Sydney,
NSW, Australia.
Reprints not available fromthe authors.
0002-9378/free
© 2013 Mosby, Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ajog.2013.02.014
For Editors’ Commentary, see
Contents
Research www.AJOG.org
454.e1 American Journal of Obstetrics &Gynecology JUNE 2013
large scale cohort study of 267,153 men
and women aged 45 and over in New
South Wales, Australia. Participants
were randomly selected fromthe Austra-
lian Medicare Database, which provides
near complete coverage of the popula-
tion, and they were enrolled into the
study by completing a baseline question-
naire (available at www.45andUp.org.
au) and providing a signed consent form.
People aged 80 years and over, and resi-
dents of rural and remote areas were over-
sampled. Study recruitment commenced
in 2006 and was completed in 2009. The
methods for the45andUpStudyhavebeen
described elsewhere.
16
The 45 and Up
Study received ethics approval from the
University of NSW Human Ethics Com-
mittee, and the current study was ap-
proved by the University of Western Syd-
ney Human Research Ethics Committee.
Exposure-outcome relationships estima-
ted from the 45 and Up Study data have
been shown to be consistent with another
large studyof the same population, regard-
less of the underlying response rate or
mode of questionnaire administration.
17
All of the data used in this study were
acquired fromthe 45 and Up Study base-
line questionnaire. Women were in-
cluded in this study if: they were age 45
years or more; had never given birth or
had given birth after 18 years of age and
before 45 years of age; had not had a hys-
terectomy or both ovaries removed; and
had responded “No” to the question
“Has a doctor ever told you that you
have: high blood pressure–when preg-
nant?” (Figure 1).
Women were defined as having high
blood pressure if they answered “Yes” to
the question “In the last month have you
been treated for: high blood pressure.”
Women were excluded if: they answered
“Yes” to the question “Has a doctor ever
told you that you have: high blood pres-
sure – when not pregnant?” and the “Age
when condition was first found” was
younger than, the age reported on the
question “How old were you when you
gave birth to your FIRST child?”; an-
swered “Yes” to “Has a doctor ever told
you that you have: high blood pressure –
when not pregnant?”, but were not being
treated for high blood pressure; they
failed to provide an age of onset for high
blood pressure; they provided invalid
data for family history; or they provided
invalid data for the number of children
they had given birth to in their specified
age range (Figure 1). Classificationof de-
mographic and lifestyle characteristics
have been described elsewhere.
18
Women were classified as never hav-
ing given birth if they answered “0’ to the
question “How many children have you
given birth to?”, with the further instruc-
tion to “please include stillbirths but do
not include miscarriages, please write ‘0’
if you have not had any children.” Total
breastfeeding duration was obtained
from the response to the question “For
how many months, in total, have you
breastfed?”. Average breastfeeding dura-
tion was obtained by dividing the total
breastfeeding duration by the reported
number of children for each woman.
Odds ratios (ORs) and 99% confi-
dence intervals (CIs) for the association
between giving birth, breastfeeding, life-
time breastfeeding duration, andaverage
breastfeeding per child with high blood
pressure were estimatedusing logistic re-
gression. For the analysis of whether giv-
ing birth is associated with having high
blood pressure, women who had never
FIGURE 1
Participants included in the study
Flow chart of participant inclusion.
Lupton. Parity, breastfeeding, and high blood pressure. AmJ Obstet Gynecol 2013.
www.AJOG.org Obstetrics Research
JUNE 2013 American Journal of Obstetrics &Gynecology 454.e2
given birth were the reference group.
Analysis of lifetime breastfeeding and
breastfeeding duration included only
women who had given birth, with
women who had never breastfed as the
reference group. Both crude and ad-
justed OR were calculated and descrip-
tions refer to adjusted OR unless other-
wise specified. OR were adjusted for
demographic and lifestyle factors using
the categories in Table 1, with an addi-
tional category for missing values. There
was a significant interaction between
whether a woman breastfed and current
age, with having high blood pressure. As
a result, womenwere stratifiedaccording
to current age and divided into 3 groups
(45 to Ͻ54 years, 54 to Ͻ64 years, 64
years or older) when testing the associa-
tion between lifetime breastfeeding and
breastfeeding duration with high blood
pressure status. All statistical tests were
2-sided, using a significance level of P Ͻ
.01 to partially account for multiple test-
ing issues.
19,20
All statistical analyses
were carried out using SPSS software
(version 20; SPSS, Inc, Chicago, IL).
RESULTS
A total of 74,785 women aged 45 and
over were included in the analysis of
which 64,199 gave birth (85.8%), and
12,456 (16.7%) reported current treat-
ment for high blood pressure. Of the
women who had given birth, 57,097
(88.9%) reported they had breastfed,
with the youngest women in the cohort
(45 to Ͻ54 year olds) having the highest
prevalence of breastfeeding (92.7%)
(Figure 1).
Demographic and lifestyle character-
istics of women who had given birth are
shown in Table 1. Women who were
born in Australia, had an income greater
than $30,000, consumed greater than 1
alcoholic drink per week, never smoked,
had sufficient physical activity levels and
had a current body mass index (BMI) of
less than 25, had higher odds of having
breastfed. Increasing number of children
was also associated with increased odds
of having breastfed.
There was an association between par-
ity and high blood pressure, with women
who had given birth having significantly
lower odds of high blood pressure when
compared with women who had never
given birth (adjusted OR, 0.91; 99% CI,
0.84–0.99; P ϭ .004). Further analysis,
stratifying mothers according towhether
they had breastfed, found mothers who
breastfed had significantly lower odds of
having high blood pressure, compared
with women who had never given birth
(adjusted OR, 0.89; 99% CI, 0.82–0.97;
P Ͻ .001), whereas the odds of having
high blood pressure for mothers who did
TABLE 1
Sociodemographic factors associated with past breastfeeding behavior
Characteristics Groups
Cases
a
(% column) % BF
a
OR
c
(99% CI)
Current age, y 45 to Ͻ54 22,361 (35) 93 1.00
..........................................................................................................................................................................
54 to Ͻ64 21,454 (33) 87 0.58 (0.53–0.64)
d
..........................................................................................................................................................................
64ϩ 20,384 (32) 87 0.60 (0.54–0.66)
d
..............................................................................................................................................................................................................................................
Country of origin Australia 48,291 (75) 90 1.00
..........................................................................................................................................................................
Other 15,368 (24) 86 0.78 (0.72–0.84)
d
..............................................................................................................................................................................................................................................
Income Ͻ$30K 16,416 (26) 86 1.00
..........................................................................................................................................................................
$30–$70K 15,984 (25) 90 1.29 (1.17–1.42)
d
..........................................................................................................................................................................
$70Kϩ 15,472 (24) 94 2.09 (1.86–2.35)
d
..........................................................................................................................................................................
Not disclosed 16,327 (25) 86 0.94 (0.86–1.02)
..............................................................................................................................................................................................................................................
Family history of HBP No 31,098 (48) 89 1.00
..........................................................................................................................................................................
Yes 33,101 (52) 89 1.01 (0.94–1.08)
..............................................................................................................................................................................................................................................
BMI Ͻ25 29,344 (46) 90 1.00
..........................................................................................................................................................................
25-30 18,868 (29) 89 0.88 (0.81–0.95)
d
..........................................................................................................................................................................
30ϩ 10,839 (17) 86 0.69 (0.63–0.75)
d
..............................................................................................................................................................................................................................................
Smoking status Never 41,733 (65) 90 1.00
..........................................................................................................................................................................
Past 17,909 (28) 89 0.86 (0.80–0.93)
d
..........................................................................................................................................................................
Current 4272 (7) 83 0.57 (0.50–0.64)
d
..............................................................................................................................................................................................................................................
Alcohol (drinks/wk) Ͻ1 24,191 (38) 86 1.00
..........................................................................................................................................................................
1-5 17,760 (28) 91 1.55 (1.42–1.69)
d
..........................................................................................................................................................................
6-10 12,990 (20) 91 1.52 (1.37–1.67)
d
..........................................................................................................................................................................
11ϩ 7963 (12) 90 1.36 (1.22–1.53)
d
..............................................................................................................................................................................................................................................
Physical activity Insufficient 19,792 (31) 87 1.00
..........................................................................................................................................................................
Sufficient 44,407 (69) 90 1.19 (1.11–1.28)
d
..............................................................................................................................................................................................................................................
Oral contraceptive
use
Never 11,277 (18) 87 1.00
..........................................................................................................................................................................
Ever 51,964 (81) 90 1.02 (0.93–1.12)
..............................................................................................................................................................................................................................................
HRT use Never 44,261 (69) 90 1.00
..........................................................................................................................................................................
Ever 18,674 (29) 87 0.93 (0.87–1.01)
..............................................................................................................................................................................................................................................
Number of children 1 6908 (11) 79 1.00
..........................................................................................................................................................................
2 26,371 (41) 88 1.90 (1.73–2.09)
d
..........................................................................................................................................................................
3 19,078 (30) 92 2.94 (2.65–3.27)
d
..........................................................................................................................................................................
4ϩ 11,842 (18) 92 3.66 (3.24–4.13)
d
..............................................................................................................................................................................................................................................
BF, breastfed; BMI, body mass index; CI, confidence interval; HBP, high blood pressure; HRT, hormone replacement therapy;
OR, odds ratio.
a
Percentages do not consistently total to 100% because of missing values;
b
The percentage of women who responded yes to
having breastfed;
c
Analysis adjusted for current age, country of origin, income level, family history of HBP, BMI, smoking status,
alcohol consumption, physical activity, oral contraceptive use, HRT use, and number of children;
d
P Ͻ.01.
Lupton. Parity, breastfeeding, and high blood pressure. AmJ Obstet Gynecol 2013.
Research Obstetrics www.AJOG.org
454.e3 American Journal of Obstetrics &Gynecology JUNE 2013
not breastfeed were not significantly dif-
ferent fromwomen who had never given
birth (adjusted OR, 1.06; 99% CI, 0.95–
1.18; P ϭ.195) (Table 2).
Analysis including only women who
had given birth, stratified by current age,
found no association between the num-
ber of children a woman gave birth to
and having high blood pressure. There
was a significant association between
lifetime breastfeeding duration and hav-
ing high blood pressure. Lifetime breast-
feeding duration of 6 months or greater
was associated with lower odds of having
highblood pressure inwomenaged 45 to
Ͻ64 years, when compared with parous
women who did not breastfeed. The
odds of having high blood pressure de-
creased with longer durations of breast-
feeding. The lowest odds were observed
in women aged 45 to Ͻ54 years whose
lifetime breastfeeding duration was 24
months or greater (adjusted OR, 0.58;
99%CI, 0.44–0.77; PϽ.001). No signif-
icant association between lifetime
breastfeeding duration and high blood
pressure was observed in women aged 64
years and over (Figure 2).
The average breastfeeding duration
per child was also associated with having
high blood pressure, with 3 months or
more breastfeeding per child associated
with lower odds of having high blood
pressure, in women aged 45 to Ͻ64
years, when compared with parous
womenwhonever breastfed. The odds of
having high blood pressure within these
women decreased with longer durations
of breastfeeding per child. Within the 64
years and over age group, there was a sig-
nificant association between average
breastfeeding duration per child and
having high blood pressure, only for
womenwhohadbreastfedfor 18 months
or more per child (adjusted OR, 0.38;
99%CI, 0.17–0.84; P ϭ.002), compared
with parous women who did not breast-
feed (Figure 3).
A final analysis including only partici-
pants with a family history of high blood
pressure, stratified by age, found that
breastfeeding is significantly associated
with reduced odds of having high blood
pressure in women aged 45 to 64 years
(Table 3).
COMMENT
This study showed the combination of
giving birth and breastfeeding was asso-
ciated with lower odds of having high
blood pressure in later life, compared
with women who had never given birth.
There was no significant difference in
odds of having high blood pressure in
women who had given birth and did not
breastfeed, compared with women who
had never given birth. We also showed
that within parous women, the number
of children a woman gave birth to was
not associated with her odds of having
high blood pressure. In addition, 6
months or more lifetime breastfeeding
duration, and 3 months or more average
breastfeeding per child, were associated
with significantly lower odds of having
high blood pressure in later life. The as-
sociation between breastfeeding dura-
tion and high blood pressure diminished
with increasing age, demonstrating age
as a significant predictor for having high
blood pressure.
Previous studies examining the associ-
ation between parity and high blood
pressure have been inconclusive, with
some studies showing no association
8,9
and others showing decreased odds of
having high blood pressure with increas-
ing numbers of pregnancies.
7
Our large
cohort study, which included 74,785
women, showed that the number of chil-
dren a woman gave birth to was not as-
sociated with having high blood pres-
sure. Previous studies did not account
for breastfeeding duration among the
mothers whenexamining the association
between parity and high blood pressure
and this may explain the inconsistent re-
sults between studies, because of varying
rates of breastfeeding in different popu-
lations. Our study had a breastfeeding
rate of 88.9% with women born outside
Australia having lower odds of having
breastfed (adjusted OR, 0.78; 99% CI,
0.72–0.84; P Ͻ .001) compared with
women born in Australia. Only parous
women who breastfed had significantly
lower odds of having high blood pres-
sure, when compared with nulliparous
women. The reduced odds of having
high blood pressure in these women are
therefore more likely to be a result of
breastfeeding, rather than parity alone.
Breastfeeding may modify the risk of
having high blood pressure through al-
terations in vessel structure or in the ma-
ternal hormonal andlipidprofiles. These
alterations may induce changes in the
maternal cardiovascular system because
of the repeated oxytocin exposure pro-
duced by each feeding.
21
Exposure to
oxytocin has an inhibitory effect on ad-
renocorticotropic hormones and corti-
sol secretion, reducing sympathetic ner-
vous system stimulation and reducing
blood pressure.
22
Within rats there is ev-
idence that repeated oxytocin exposure
affects central ␣
2
-adrenergic activity, de-
TABLE 2
Parity, breastfeeding history, and the odds of having high blood pressure
Variable Cases, n
Crude
OR (99% CI)
Adjusted
OR (99% CI)
a
Given birth
.....................................................................................................................................................................................................................................
No 10,586 1.00 (reference)
.....................................................................................................................................................................................................................................
Yes 64,199 1.00 (0.93–1.07) 0.91 (0.84–0.99)
b
..............................................................................................................................................................................................................................................
Given birth stratified by
breastfeeding
.....................................................................................................................................................................................................................................
No 10,586 1.00 (reference)
.....................................................................................................................................................................................................................................
Yes, never breastfed 7102 1.31 (1.18–1.45)
b
1.06 (0.95–1.18)
.....................................................................................................................................................................................................................................
Yes, breastfed 57,097 0.96 (0.89–1.03) 0.89 (0.82–0.97)
b
..............................................................................................................................................................................................................................................
CI, confidence interval; OR, odds rstio.
a
Analysis adjusted for current age, country of origin, income level, body mass index, smoking status, alcohol consumption,
physical activity, family history of high blood pressure, history of oral contraceptive use, and history of hormone replace-
ment therapy use;
b
P Ͻ.01.
Lupton. Parity, breastfeeding, and high blood pressure. AmJ Obstet Gynecol 2013.
www.AJOG.org Obstetrics Research
JUNE 2013 American Journal of Obstetrics &Gynecology 454.e4
creasing sympathetic nervous system
drive on both the heart and arteries, low-
ering blood pressure.
23
The positive so-
cial interactions and emotions induced
in the mother by breastfeeding, includ-
ing the touching sensation and warmth
created by the offspring, may also have
long-term benefits to the mother’s car-
diovascular health because of the psy-
chologic antistress effects produced by
breastfeeding.
21
The relationship between breastfeed-
ing duration and blood pressure has
been reported in 4 large cohort studies to
date.
2-5
All studies have found an associ-
ation between breastfeeding and mater-
nal high blood pressure, with increased
durations of breastfeeding associated
with reduced likelihood of having high
blood pressure. The WHI study was the
only study to include women over 60
years of age,
4
and reported that the asso-
ciation between increased duration of
breastfeeding and reduced cardiovascu-
lar risk diminished as women aged. The
WHI study did not specifically examine
the interaction between age and high
blood pressure. Our study supports the
above mentioned studies, and extends
the research by showing that the associ-
ation between breastfeeding duration
(both lifetime and per child) and having
high blood pressure is only significant in
women up to 64 years of age. The 1 ex-
ception being women aged 64 years and
over had significantly lower odds of hav-
ing high blood pressure if they breastfed
each child for an average of 18 months or
more (OR, 0.38; 99%CI, 0.17–0.84; P ϭ
.002), compared with parous women of
the same age who never breastfed. The
per child breastfeeding duration is re-
ported in the present paper to make the
results more accessible for physicians
and midwifes when discussing the bene-
fits of breastfeeding to a mother after a
single pregnancy. A recommendation of
at least 3 months of breastfeeding per
child is advocated by the authors and is
more meaningful to a mother than a rec-
ommendation about how long she
should breastfeed in her lifetime.
A family history of high blood pres-
sure is known to increase an individu-
al’s risk of having high blood pressure,
possibly because of the inheritance of a
number of genetic polymorphisms that
make the individual susceptible to high
blood pressure.
24
We showed that
breastfeeding significantly reduces the
odds of having high blood pressure in
women with a family history of high
blood pressure (Table 3), up to 64 years
of age. Women who have a family his-
tory of high blood pressure could be
encouraged to breastfeed their chil-
dren to help delay the onset of high
blood pressure.
FIGURE 2
Association of lifetime breastfeeding with high blood pressure
A, 45 to Ͻ54 years of age, B, 54 to Ͻ64 years of age, C, 64 or more years of age.
Lupton. Parity, breastfeeding, and high blood pressure. AmJ Obstet Gynecol 2013.
Research Obstetrics www.AJOG.org
454.e5 American Journal of Obstetrics &Gynecology JUNE 2013
Ageing is the single largest risk factor for
highbloodpressure because of the stiffening
of elastane in the internal lamina of arteries
andcalcificationofthearterial intima.
25
Both
of these factors cause an increase in periph-
eral resistance, leading to an increase in the
pressure wave reflectionanda rise insystolic
blood pressure as individuals age.
25,26
Our
results showthat the benefits affordedtothe
cardiovascular system by breastfeeding are
no longer present in the majority of older
women.
The current WHO recommendations
for breastfeeding encourage breastfeed-
ing for a minimum of 6 months per
child.
27
This study provides further sup-
port for these recommendations, as both
the lifetime and per child durations of
breastfeeding were associated with sig-
nificant reduction in the odds of future
maternal high blood pressure. Our study
showed that 3 months or more of breast-
feeding per child, and 6 months or more
lifetime breastfeeding, significantly de-
creased a woman’s odds of having high
blood pressure, and the odds continued
to lower with longer breastfeeding dura-
tions. Women should therefore be en-
couraged to breastfeed for as long as pos-
sible to reduce the likelihood of high
blood pressure before 64 years of age. A
woman’s breastfeeding history is also
important when assessing her likelihood
of having high blood pressure in later
life.
The key strength of this study is the
large cohort size, which enabled us to ex-
amine the duration of breastfeeding in
different age groups. This study used
self-reported data, which is prone to re-
call bias, and may have led to under- or
overreporting of breastfeeding duration.
It has been reported in the literature that
womenwhobreastfeedare more likely to
have a healthy BMI
28
andare less likely to
smoke.
29
Our study showed that women
who currently had a lower BMI, had
never smoked, had sufficient levels of ex-
ercise, and had a higher income were
more likely to have breastfed. Women
who breastfeed may therefore represent
a healthier cohort. Fromour data it is not
possible to determine whether women
who breastfed were a healthier cohort
during their childbearing years, or
whether breastfeeding results in health-
ier behaviors beyond a woman’s child-
bearing years. Either way, there is no dif-
ference in odds of having high blood
pressure in women over 64 years of age
when comparing women who breastfed
with women who never breastfed.
In conclusion, women who breastfed
their children had significantly reduced
odds of having high blood pressure, com-
pared with women who had never given
birth and varying rates of breastfeeding in
different populations may account for in-
consistent reporting of the association be-
tween parity and high blood pressure.
Women who breastfed for longer than 6
months in their lifetime, or greater than 3
FIGURE 3
Breastfeeding per child associated with high blood pressure
A, 45 to Ͻ54 years of age, B, 54 to Ͻ64 years of age, C, 64 or more years of age.
Lupton. Parity, breastfeeding, and high blood pressure. AmJ Obstet Gynecol 2013.
www.AJOG.org Obstetrics Research
JUNE 2013 American Journal of Obstetrics &Gynecology 454.e6
months per child, had significantly lower
odds of having high blood pressure when
compared with parous women who had
never breastfed. This held true in women
with a family history of high blood pressure.
The odds were lower withlonger breastfeed-
ingdurationsandtheassociationdiminished
in women over 64 years of age. Women
should be encouraged to breastfeed for as
long as possible, and a woman’s breastfeed-
ing history should be taken into account
when assessing her likelihood of high blood
pressure inlater life. f
ACKNOWLEDGMENTS
The 45 and Up Study is managed by the Sax
Institute in collaboration with major partner
Cancer Council NewSouth Wales; and partners
the National Heart Foundation of Australia
(NSWDivision); NSWMinistry of Health; beyon-
dblue: the national depression initiative; Ageing,
Disability and Home Care, NSW Family and
Community Services; and Australian Red Cross
Blood Service. We thank the many thousands
of people participating in the 45 and Up Study.
J.M.L. is supported by a National Health and
Medical Research Council - Australian Biomed-
ical Fellowship. S.J.L. is the recipient of a Uni-
versity of Western Sydney Postgraduate Re-
search Award and an Ingham Health Research
Institute scholarship.
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TABLE 3
Breastfeeding history and high blood pressure among women with
reported family history of blood pressure, stratified by age
Age group, y Cases, n
Crude
OR (99% CI)
Adjusted
OR (99% CI)
a
45 to Ͻ54 12,730 0.59 (0.46–0.76)
b
0.68 (0.52–0.89)
b
..............................................................................................................................................................................................................................................
54 to Ͻ64 11,721 0.69 (0.59–0.82)
b
0.80 (0.67–0.95)
b
..............................................................................................................................................................................................................................................
64ϩ 8650 1.00 (0.84–1.18) 1.00 (0.84–1.18)
..............................................................................................................................................................................................................................................
CI, confidence interval; OR, odds ratio.
a
Odds ratios refer to the odds of high blood pressure among breastfeeding compared with nonbreastfeeding women, adjusted for
country of origin, income level, body mass index, smoking status, alcohol consumption, physical activity, history of oral
contraceptive use, history of hormone replacement therapy use, and number of children;
b
P Ͻ.01.
Lupton. Parity, breastfeeding, and high blood pressure. AmJ Obstet Gynecol 2013.
Research Obstetrics www.AJOG.org
454.e7 American Journal of Obstetrics &Gynecology JUNE 2013