Addressing maternal cardiovascular risk: The impact of lactation, adverse pregnancy outcomes, and racial disparities.

Pregnancy functions as a cardiopulmonary stress test, revealing underlying cardiovascular disease (CVD) or heightening future CVD risk following adverse pregnancy outcomes (APOs). Studies consistently demonstrate strong associations between APOs, higher mortality rates, and increased risk of cardiometabolic diseases in women from racial and ethnic underrepresented groups (UREG). Social determinants of health, particularly in UREGs, contribute to increasing allostatic load, potentially driving poorer pregnancy outcomes. Breastfeeding has a protective effect on allostatic load and is linked to improved maternal cardiometabolic health. In the United States, UREGs have lower rates of breastfeeding initiation, retention, and duration-potentially influenced by both cultural factors and systemic biases within healthcare. Interventions must extend beyond healthcare settings to engage key stakeholders, including community leaders and families, to create sustainable change and reduce disparities. As maternal CVD prevalence rises among UREG populations, a collaborative, multidisciplinary approach to improving breastfeeding rates is essential to improving maternal and infant health outcomes.