Preeclampsia and Breastfeeding: Challenges, Impacts, and Best Practices

Helen Sutherland RN, RM
Global Medical Affairs and Education Manager at Medela

Introduction

Preeclampsia is a hypertensive disorder affecting 3–5% of pregnancies worldwide, it remains a leading cause of maternal morbidity and mortality.¹ Beyond delivery, women with preeclampsia face an elevated risk of chronic hypertension and cardiovascular disease. The postpartum period offers a critical window for interventions that improve maternal and neonatal outcomes. Breastfeeding is one such intervention offering protective benefits, including reduced maternal risk of hypertension, diabetes, and heart disease later in life, in addition to providing immediate nutritional benefits for infants.² 

As clinicians we must provide proactive lactation support to women with preeclampsia by prioritizing timely initiation of lactation and supportive pumping practices to help mothers establish a sufficient milk supply and realization of breastfeeding goals.

Impact of preeclampsia on lactation

Hypertension and preeclampsia can negatively impact lactation, leading to delayed milk production and lower breastfeeding rates.³

Women with preeclampsia often experience delayed secretory activation (onset of copious milk production ≥ 72 hours postpartum), early formula supplementation, and reduced breastfeeding rates. The disease itself is compounded by other associated risk factors which include cesarean delivery, maternal obesity, stressful labor, preterm birth and mother–infant separation, all common in preeclampsia cases.^4,5

Adding to the issue is a lack of clarity around medication safety and breastfeeding. For example, magnesium sulfate therapy, while essential for seizure prophylaxis, can be a factor associated with a delay in breastfeeding initiation but does not contraindicate breastfeeding.^{6-8, 16}

Research suggests that only 51% of women with severe preeclampsia, initiated breastfeeding successfully, a major contributory factor being maternal-infant separation and infant NICU admission, rather than a biologic inability to produce milk.⁹

If direct breastfeeding is not possible, early frequent and effective pumping in the first postpartum days and weeks is critical for achieving secretory activation and adequate milk volume. Yet, mothers with pre-eclampsia pump far less often than those without, which may result in delayed secretory activation and reduced milk supply. 
Targeted interventions to support optimum pumping during this early critical window could improve outcomes and advance clinical practice.¹⁰

Benefits of breastfeeding for mothers with preeclampsia

Breastfeeding, even for a short time, can help lower blood pressure and reduce long-term cardiac risks.¹¹ For women with preeclampsia, who already face higher chances of future hypertension, this makes breastfeeding especially important. It should be part of routine discussions before and after birth.

Breastfeeding is associated with improved metabolic profiles and glucose regulation, lower blood pressure, favorable lipid profiles (cholesterol) and reduced lifetime risk of cardiovascular disease. These benefits position lactation as a preventative health measure for women at high cardiovascular risk.¹²

Best Practices for supporting lactation

Early Initiation and Skin-to-Skin Contact: When clinically feasible, initiate breastfeeding or expression within the first hour after birth. Skin-to-skin contact promotes oxytocin release, stabilizes blood pressure, and supports milk production.¹³ 
Individualized Care Plans: Assess maternal condition and tailor lactation support. For patients on antihypertensive therapy, provide education on medication safety, most commonly used drugs (labetalol, nifedipine, enalapril) are compatible with breastfeeding, while diuretics should be used cautiously.^8,14-16

NICU Integration: If infants require NICU care, encourage early pumping (within 3-6 hours postpartum) and ensure access to hospital-grade pumps with initiation technology. Expressed colostrum/milk is critical for vulnerable infants. In cases where the mother is medically unstable, donor human milk may be considered as a bridge until she recovers.

Consistent Education and Emotional Support: High-risk patients often experience anxiety and fatigue. Ongoing counseling from lactation consultants and nursing/midwifery staff across labor postpartum and NICU units helps families achieve their breastfeeding goals. Collaborative Care: Optimal outcomes require seamless coordination among labor and delivery, postpartum, NICU, and lactation teams. Evidence-based protocols and interprofessional communication are key to success.

Conclusion

Supporting breastfeeding in patients with preeclampsia is more than a feeding choice, it is a strategic intervention that improves maternal and neonatal outcomes and reduces future cardiovascular risk.^12,17 Through education, advocacy, and collaborative care, healthcare professionals can help high-risk families thrive.​​

In summary:

• Be proactive: Identify patients with hypertensive disorders early and collaborate on a plan to support lactation initiation.¹⁸
• Encourage early and frequent expression when direct breastfeeding is not possible in order to achieve secretory activation and adequate milk volumes.^10,19
• Medication: Be aware of medication safety profiles during lactation.
• Advocate for moms: Support policies that minimize maternal-infant separation, even in intensive care settings.
• Educate: Reinforce that breastfeeding may reduce long-term cardiovascular