Do You Have Prenatal Risk Factors That Could Impact Breastfeeding?
By Jessica Anderson, IBCLC and Advocate for Informed Choices
If you’re preparing for your baby and planning to breastfeed or pump, one of the most powerful things you can do before birth is to learn about your personal lactation risk factors.
Breastfeeding is biologically normal—but not automatically easy. Some parents experience a smooth start, while others face preventable supply delays and early challenges that catch them off guard. Knowing your risk profile allows you to prepare thoughtfully, advocate confidently, and avoid the all-too-common "wait and see" approach that can damage early milk production.
This guide walks you through key prenatal risk factors that may influence how your milk supply develops—so you can make proactive decisions that support your feeding goals.
Why Risk Factors Matter
Lactation is a hormone-driven system that responds to:
Your medical and metabolic history
Hormonal and nutritional balance
Breast and nipple anatomy
The birth process itself
How early and consistently milk removal happens postpartum
When one or more of these variables are affected, supply can be delayed, reduced, or harder to sustain. That doesn’t mean you’ll have problems—it means you deserve a plan in case they arise.
Top Prenatal Risk Factors for Lactation Challenges
🔹 First-Time Parents
Your body hasn't lactated before, so there's no known baseline for how it will respond. I refer to these as “unproven boobs” in my office—not as an insult, but as an invitation to approach lactation with curiosity, support, and preparation. Many first-time parents do beautifully—but if support is needed, having a plan matters.
🔹 Advanced Maternal Age (35+)
The term may feel outdated, but this classification is used because age often correlates with increased risk of metabolic disruption—especially insulin resistance, which can delay or impair lactation. Age isn’t the problem; it’s the physiology that may come with it.
🔹 Gestational Diabetes & Insulin Resistance
Even when well-managed, these conditions often delay the onset of milk production (lactogenesis II). Some parents are lucky and transition smoothly—but others benefit from early and frequent milk removal to overcome the delay.
🔹 Polycystic Ovary Syndrome (PCOS)
PCOS can result in a wide range of lactation outcomes: oversupply, undersupply, or a fragile “just enough” supply. These unpredictable patterns are due to hormonal imbalance and insulin resistance—hallmarks of PCOS.
🔹 Maternal Obesity
It’s not about body size—it’s about underlying health. If your weight has remained elevated despite balanced eating and movement, that may suggest metabolic or hormonal issues that could impact lactation. Many people in larger bodies lactate just fine—but some benefit from added early support.
🔹 Hypertension (High Blood Pressure)
Chronic or pregnancy-induced hypertension can disrupt lactation until it stabilizes. The earlier your body receives milk stimulation after birth, the better your chances of establishing a robust supply.
🔹 Thyroid Disorders
Both hypo- and hyperthyroidism are associated with low milk supply, oversupply, or volatile production. If you've ever had thyroid concerns—even if they're currently managed—it's worth being proactive.
🔹 History of Eating Disorders
Past or current restrictive eating patterns, purging, or disordered body image can lead to lingering nutrient deficiencies, and may make it harder to meet the caloric and hydration demands of milk production.
🔹 Gastric Bypass or Bariatric Surgery
These surgeries improve many health outcomes but can cause long-term nutrient malabsorption. Even if you’re eating well now, reduced absorption of key vitamins and minerals can silently impact lactation.
🔹 Infertility or Recurrent Pregnancy Loss
Even when fertility concerns were thought to be on your partner’s side, hormonal or metabolic issues on your side may have gone undiagnosed. Many of these same factors interfere with lactation—sometimes more than they interfered with conception.
🔹 History of Breast or Chest Surgery
This includes:
Breast reductions or augmentations
Lumpectomies or biopsies
Chest trauma or unrelated surgeries in the upper torso
These procedures may disrupt nerves, ducts, or blood supply, which are essential for lactation signaling and flow.
🔹 Hypoplastic Breast Tissue
Sometimes referred to as “insufficient glandular tissue,” this may present as widely spaced breasts, tubular shape, or a significant size difference between breasts. Not every person with this anatomy has a problem—but it’s a known marker of risk, often tied to hormonal changes during puberty.
🔹 Flat or Inverted Nipples
These can make latching difficult, especially in sleepy or premature babies. If latch isn’t consistent and effective in the first 24–48 hours, milk supply may be compromised without early intervention.
Final Thoughts
If any of these risk factors sound familiar, you are not alone—and you are not doomed.
Most of these challenges can be navigated successfully with early support, the right equipment, and a well-informed care team. But too often, families are caught off guard by supply issues that were predictable and preventable.
The biggest risk I see to breastfeeding success is mismanagement by unskilled or unavailable support.
With good support, we can typically make it work.
You don’t need to panic—you just need a plan.
If you have one or more of these risk factors, don’t panic.
More often than not, breastfeeding works beautifully—even in the presence of risk. What makes the biggest difference is having a skilled prenatal lactation consultant by your side who can help you understand your body, make informed decisions, and confidently navigate the early days of breastfeeding.
Want help creating your personalized lactation plan?
Book a prenatal consultation with Genuine Lactation or explore these resources:
📖 Yes, You Need a Prenatal Breastfeeding Consult
📖 The 411 on Prenatal Flange Sizing
📅 When to Schedule Your Prenatal Visit
Knowledge is not fear—it’s freedom. Let’s get you started on the strongest foot possible.
🍼💪
—Jessica Anderson, IBCLC
