Associations of Breastfeeding with American Heart Association Defined Maternal Cardiovascular Health Behaviors: A Scoping Review

Introduction: Cardiovascular disease remains the leading cause of maternal mortality in the United States. While breastfeeding offers long-term protection against maternal cardiovascular disease, its influence on cardiovascular health (CVH) behaviors during the postpartum period remains less understood. Objective: To conduct a scoping review to understand the extent and nature of evidence regarding infant feeding methods (including direct and indirect breastfeeding) and their relationship to maternal CVH behaviors (i.e., physical activity, sleep, diet, and nicotine exposure) within 2 years postpartum from peer-reviewed quantitative primary research. Methods: Electronic bibliographic databases searched were MEDLINE (PubMed), Scopus, and CINAHL (EBSCO) on January 2, 2025. Source selection, data charting, and data presentation were conducted according to Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review checklist. No restrictions were placed on year, language, or geographical region. Results: This review included 60 studies and 57,489 participants. Postpartum sleep (n = 27) was the most frequently examined CVH behavior, followed by diet (n = 19), nicotine exposure (n = 15), and physical activity (n = 7). Breastfeeding was associated with longer and better quality sleep, higher intake of energy and dietary quality, and a lower likelihood of smoking or smoking relapse. Associations between breastfeeding and sleep efficiency as well as breastfeeding and physical activity were mixed. Conclusions: Breastfeeding was associated with favorable sleep duration and quality, better diet quality, and healthier smoking behaviors in the postpartum period, whereas significant gaps in knowledge remain regarding breastfeeding and maternal physical activity. The available data suggest infant feeding practices should be considered when promoting CVH during postpartum.