Maternal Intensive Care Admission, Unplanned Peripartum Hysterectomy, and Breast Milk Feeding by Hospital Discharge: A Population Based Repeated Cross‐Sectional Study

OBJECTIVE: Characterize trends and factors associated with breast milk feeding among patients undergoing maternal ICU admission or peripartum unplanned hysterectomy. DESIGN: Population-level repeated cross-sectional study. SETTING: United States National Vital Statistics System data between 2016 and 2023. POPULATION: Liveborn singleton, non-anomalous deliveries from 34 + 0 to 42 + 6 weeks. METHODS: Temporal trends were assessed using Joinpoint regression reported as annual average percentage change (AAPC). Multivariable logistic regression models were fit to assess the association between morbidity and breast milk feeding by hospital discharge. MAIN OUTCOMES AND MEASURES: Temporal trends in severe morbidity defined as maternal ICU admission and/or unplanned hysterectomy and associated breast milk feeding by hospital discharge. RESULTS: Of the 23 589 073 births included, 33 121 (0.14%) were complicated by severe morbidity. Any severe morbidity increased from 102 to 157 per 100 000 (AAPC 4.1%, 95% CI: 1.3% to 7.2%) with increased hysterectomy only from 15 to 24 per 100 000 (AAPC 4.2%, 95% CI: 0.7% to 8.2%), ICU admission only from 75 to 117 per 100 000 (AAPC 4.5%, 95% CI: 1.5% to 7.8%), and no change in concurrent hysterectomy and ICU admission. Patients with any severe morbidity had lower breast milk feeding by hospital discharge (65.2% vs. 84.1%, adjusted OR 0.46, 95% CI 0.45-0.47). Despite temporal increases in breast milk feeding by hospital discharge for patients without severe morbidity, the same was not seen for those with severe morbidity. CONCLUSION: These findings identify a population in whom additional support and services would help individuals who wish to breastfeed or provide expressed breast milk, when clinically appropriate.