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Sausjord IK, Acton LW, White KO, O'Connor SK, Lerner NM. Breastfeeding and Hormonal Contraception: A Scoping Review of Clinical Guidelines, Professional Association Recommendations, and the Literature. Breastfeed Med 2023; 18:645-665. [PMID: 37672571 DOI: 10.1089/bfm.2023.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background: Postpartum contraceptive use can help prevent short-interval pregnancies, which have been associated with adverse neonatal and maternal health outcomes. Many contraceptive methods are safe for postpartum use, but patients and providers may be confused as to what impact hormonal contraception has on lactation. We performed a scoping review of the most recent U.S.-based guidelines regarding hormonal contraception on lactation to provide synthesis and recommendations to aid providers in counseling their patients. Methods: We conducted a scoping review by identifying the most recent clinical recommendations and guidelines from the Centers for Disease Control and Prevention (CDC) and three maternal and child health professional associations (American College of Obstetricians and Gynecologists [ACOG], Society for Maternal-Fetal Medicine [SMFM], and Academy of Breastfeeding Medicine [ABM]). We also reviewed the citations in these guidelines used in their development. We then conducted an updated literature review to capture studies published since the most recent systematic reviews were conducted. Results: We reviewed 1 clinical guideline from the CDC and 2 systematic reviews cited in its references, 6 professional association recommendations, and 28 publications identified through the updated literature review. Progestin-only contraceptive methods continue to demonstrate safety in breastfeeding patients, while low-quality evidence supports concerns of decreased milk supply with combined hormonal contraception. Discussion: Organizations should consider updating counseling recommendations regarding progestin-only contraceptives and lactation. Further research is needed to examine new contraceptive methods as well as the effect of hormonal contraception on lactation in the setting of preterm birth.
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Affiliation(s)
- Isabel K Sausjord
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lillian W Acton
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Katharine O White
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Sarah K O'Connor
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Natasha M Lerner
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
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Reproductive Women’s Knowledge on Possibility of Pregnancy after Birth but before Resumption of Menstruation and Its Associated Factors in Ethiopia: A Population-Based Study Using the 2016 Ethiopian Demographic Health Survey. Int J Reprod Med 2022; 2022:8520323. [PMID: 36035449 PMCID: PMC9410953 DOI: 10.1155/2022/8520323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Worldwide, specifically in developing countries, women believe that a woman cannot become pregnant unless she sees her first postpartum menstruation. Due to this knowledge gap, most women did not use any contraceptives till their 1st postpartum menstruation. Hence, about 44% of women were susceptible to unintended pregnancy in the postpartum period. Assessing women knowledge on possibility of pregnancy after giving birth but before returning of menses and its associated factors will help to increase women's recognition on the issue and for early commencement of appropriate postpartum family planning methods to reduce burden of unintended pregnancy. Objective To assess the level of knowledge on possibility of pregnancy after giving birth but before returning of menses and its associated factors among reproductive women in Ethiopia. Methods A secondary data analysis using the 2016 Ethiopian Demographic Health Survey was employed. Samples were selected using two-stage stratified sampling technique. Descriptive statistics and logistic regressions were used. Adjusted odds ratio (AOR) with 95% confidence interval was used to interpret associations, and a significant association was declared at a p value of <0.05. Result A total of 15,683 reproductive women aged from 15 to 49 years were included. Of them, about 53% did not know that a woman can get pregnant after giving birth but before resumption of her menstruation. Age being 35 years and above (AOR = 1.50; 95%CI = 1.34, 1.67), educational status of secondary and above (AOR = 1.18; 95%CI = 1.06, 1.32), being ever married (AOR = 1.67; 95%CI = 1.47, 1.89), knowledge of any family planning method (AOR = 1.81; 95%CI = 1.52, 2.16), getting counseling on family planning methods (AOR = 1.41; 95%CI = 1.28, 1.55), and being knowledgeable on their ovulatory cycle (AOR = 1.68; 95%CI = 1.55, 1.82) were found to be significantly associated with being knowledgeable on the issue. Conclusion Reproductive women's level of knowledge on the possibility of pregnancy after giving birth but before returning of menses was low. Factors associated with being knowledgeable on the issue were identified. Therefore, strategies should be developed to increase their level of knowledge for reducing unintended pregnancy and its complications by integrating family planning counseling with infant immunization services.
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Allen A, Mallahan S, Ortega A, Miller H, Saleh A, Bonny AE. Administration of Exogenous Hormones and the Implications for Cigarette Smoking-Related Behaviors. Curr Psychiatry Rep 2020; 22:70. [PMID: 33089443 DOI: 10.1007/s11920-020-01197-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Preclinical evidence indicates progesterone and estrogen influence drug-taking behaviors, including nicotine/tobacco. However, clinical research on this relationship is less clear. This lack of clarity may be due to measuring naturally occurring endogenous hormones to examine this relationship, which introduces substantial error. Therefore, the goal of this review is to examine the link between the delivery of exogenous hormones and cigarette smoking-related behavior. RECENT FINDINGS Exogenous progesterone may have favorable effects on cognition, symptomatology, consumption, and smoking cessation. Hormonal replacement therapy does not have a clear relationship with smoking-related behaviors. Oral contraceptive use may have adverse effects on stress response, nicotine metabolism, and symptomatology. Additional research is needed to explore how the administration of exogenous hormones may (a) strengthen research methodology on this topic, (b) enhance our understanding of the role of progesterone/estrogen on smoking-related behaviors, and (c) improve smoking cessation outcomes.
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Affiliation(s)
- Alicia Allen
- Department of Family and Community Medicine, College of Medicine, Tucson, University of Arizona, Tucson, AZ, 85721, USA.
| | - Stephanie Mallahan
- Department of Family and Community Medicine, College of Medicine, Tucson, University of Arizona, Tucson, AZ, 85721, USA
| | - Alexis Ortega
- Office of Equity, Diversity, and Inclusion, Health Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Heather Miller
- Department of Obstetrics and Gynecology, College of Medicine, University of Arizona, Tucson, AZ, 85721, USA
| | - Ahlam Saleh
- Health Sciences Library, University Libraries, University of Arizona, Tucson, AZ, 85721, USA
| | - Andrea E Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, 43215, USA
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Mogeni R, Mokua JA, Mwaliko E, Tonui P. Predictors of contraceptive implant uptake in the immediate postpartum period: a cross-sectional study. EUR J CONTRACEP REPR 2019; 24:438-443. [PMID: 31566415 DOI: 10.1080/13625187.2019.1670344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The aim of the study was to investigate how to improve access to family planning and address unmet contraceptive need in postpartum women, by determining the predictors of contraceptive implant uptake in the immediate postpartum period.Methods: A descriptive cross-sectional study was conducted among women who had given birth up to 6 d earlier at the Riley Mother and Baby Hospital, which is part of the Moi Teaching and Referral Hospital in Eldoret, Kenya. Participants were systematically sampled and data collected using pre-tested interviewer-administered questionnaires. Statistical analyses were performed to determine associations between variables. Logistic regression was used to determine the relationship between variables and contraceptive implant uptake.Results: The study comprised 353 women. Most (92%) were Christians and were married (74%). More than 76% had received secondary education or above; 9% were HIV-positive. Most (87%) had heard of the contraceptive implant and almost half (46%) had ever used it before their current pregnancy. Older women (p = .036), those who had reached their desired family size (p = .003), those who had planned for the current pregnancy (p = .027), those who had used the implant before (p < .001) and those who were HIV-positive (p = .001) were more likely to agree to use the contraceptive implant.Conclusions: Older age, achievement of family size, previous use of the same method, HIV positivity and planned pregnancy positively predicted uptake of the contraceptive implant.
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Affiliation(s)
- Richard Mogeni
- Division of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Juley-Anne Mokua
- Department of Health Services, County Government of Uasin Gishu, Eldoret, Kenya
| | - Emily Mwaliko
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Philip Tonui
- Department of Reproductive Health, Moi University, Eldoret, Kenya
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Krashin JW, Lemani C, Nkambule J, Talama G, Chinula L, Flax VL, Stuebe AM, Tang JH. A Comparison of Breastfeeding Exclusivity and Duration Rates Between Immediate Postpartum Levonorgestrel Versus Etonogestrel Implant Users: A Prospective Cohort Study. Breastfeed Med 2019; 14:69-76. [PMID: 30508390 PMCID: PMC6352553 DOI: 10.1089/bfm.2018.0165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study compares breastfeeding outcomes after immediate postpartum initiation of single-rod etonogestrel (ENG) versus two-rod levonorgestrel (LNG) contraceptive implants. Outcomes assessed include the following: (1) breastfeeding continuation through 24 months after delivery and (2) exclusive breastfeeding until 6 months after delivery, at Kasungu District Hospital, Malawi. METHODS We used Kaplan-Meier survival analysis to compare breastfeeding continuation through 24 months and exclusive breastfeeding through 6 months after delivery for ENG versus LNG implant users. We described infant feeding practices up to 6 months after delivery. RESULTS We analyzed 140 women: 28 (20%) ENG and 112 (80%) LNG impalnt users. Eighty-seven percent (n = 122) of women completed the 24-month study visit. Twenty-four months breastfeeding continuation proportions were 54.2% (95% confidence interval [CI] = 32.7-71.4) and 74.7% (95% CI = 64.9-82.2) for ENG and LNG implant users, respectively (p = 0.10). Breastfeeding continuation was high in both groups at 21 months: 100% and 93.2% (95% CI = 86.2-96.7) for ENG and LNG implant users, respectively (p = 0.18). Seventy-one percent (20/28, 95% CI = 51.0-84.6) of ENG and 72% (78/108, 95% CI = 62.4-79.7) of LNG implant users exclusively breastfed their infants until 6 months postpartum (p = 0.89). CONCLUSIONS Continuation of breastfeeding until 24 months and exclusive breastfeeding until 6 months were high among users of both types of progestin implant initiated immediately postpartum and similar to proportions among the general population of postpartum women in the Central region of Malawi.
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Affiliation(s)
- Jamie W Krashin
- 1 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,2 Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
| | | | - Jerome Nkambule
- 4 Kasungu District Hospital, Kasungu, Malawi.,5 Kamuzu Central Hospital, Lilongwe, Malawi
| | - George Talama
- 4 Kasungu District Hospital, Kasungu, Malawi.,6 Partners in Health, Neno, Malawi
| | - Lameck Chinula
- 1 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,3 UNC Project-Malawi, Lilongwe, Malawi
| | - Valerie L Flax
- 7 RTI International, Research Triangle Park, North Carolina
| | - Alison M Stuebe
- 1 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,8 Department of Maternal and Child Health, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jennifer H Tang
- 1 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,3 UNC Project-Malawi, Lilongwe, Malawi
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Sodhi NK, Nelson AL. Prevalence of glucose intolerance and metabolic syndrome within one year following delivery of a pregnancy complicated by gestational diabetes. Contracept Reprod Med 2018; 3:27. [PMID: 30505460 PMCID: PMC6258433 DOI: 10.1186/s40834-018-0080-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/02/2018] [Indexed: 01/12/2023] Open
Abstract
Background Women with a history of gestational diabetes (GDM) are at risk for development of both overt Type 2 diabetes (T2DM) and cardiovascular disease (CVD) at higher rates and at earlier ages than control women. Current guidelines recommend longitudinal testing of glucose tolerance for women with prior GDM, but no formal assessments of cardiovascular disease are suggested. This study estimated the prevalence of metabolic syndrome in women with GDM in recent pregnancy who were followed for at least 1 year postpartum to quantify their cardiovascular risks. Methods This is a retrospective study of women who were diagnosed with GDM in a public hospital and followed for at least 1 year after delivery and who had tests performed at a minimum 4–12 weeks postpartum and 6 and 12 months postpartum. Primary outcomes were prevalence of glucose tolerance abnormalities and metabolic syndrome (MetS) defined by two prevailing sets of diagnostic criteria. Results One hundred fifty-one indigent, primarily Latina women who had been diagnosed in their last pregnancy with GDM comprised the study population. At the first visit postpartum, 4.7% were found to have overt diabetes and between 24 and 31% met the criteria for MetS. By the end of 12 months, another 14.5% were diagnosed with overt diabetes, and 38.5% had prediabetes. An additional 12–25% of the woman who had not had MetS at baseline developed MetS by the end of the 1-year follow-up. Conclusions Given the high prevalence of MetS among women with recent history of GDM immediately postpartum and its rapid development in the following year, further research is needed to enable the development of practice guidelines that will define appropriate short and long-term evaluations needed to assess risk for cardiovascular disease in these women.
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Affiliation(s)
- Neetu K Sodhi
- Bloom Obstetrics and Gynecology, 18555 Ventura Blvd, Suite C, Tarzana, CA 91356 USA
| | - Anita L Nelson
- Los Angeles BioMedical Research Institute at Harbor UCLA Medical Center, 1457 3rd Street, Manhattan Beach, Torrance, CA 90266 USA
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Abstract
When addressing the compatibility of breastfeeding with certain maternal conditions, we need to differentiate between "contraindication" and "obstacle." Failure to distinguish between the two confuses new mothers and their families, and engenders misconceptions about breastfeeding advice by health professionals. Health conditions that may simply impede the initiation and duration of breastfeeding are often wrongly referred to as true contraindications to breastfeed, under the assumption that they might harm the health of the mother and/or that of the nursing infant. Here, we discuss several topics, including breast surgery, prolactinoma, concurrent new pregnancy, hormonal contraception, and use of medications and contrast agents, that continue to raise controversy. While most conditions appear to be compatible with breastfeeding, the major determinants of a woman's final choice of whether to nurse her infant or not are the attitude of health professionals and the state of mind of being an informed mother.
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Affiliation(s)
- Riccardo Davanzo
- Division of Pediatrics and Neonatology, Department of Mother and Child Health, Ospedale Madonna delle Grazie, Matera, Italy.,Task Force on Breastfeeding, Ministry of Health, Rome, Italy
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Turok DK, Leeman L, Sanders JN, Thaxton L, Eggebroten JL, Yonke N, Bullock H, Singh R, Gawron LM, Espey E. Immediate postpartum levonorgestrel intrauterine device insertion and breast-feeding outcomes: a noninferiority randomized controlled trial. Am J Obstet Gynecol 2017; 217:665.e1-665.e8. [PMID: 28842126 PMCID: PMC6040814 DOI: 10.1016/j.ajog.2017.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. OBJECTIVE This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes. STUDY DESIGN We conducted this noninferiority randomized controlled trial at the University of Utah and the University of New Mexico Health Sciences Centers from February 2014 through March 2016. Eligible women were pregnant and planned to breast-feed, spoke English or Spanish, were aged 18-40 years, and desired a levonorgestrel intrauterine device. Enrolled women were randomized 1:1 to immediate postpartum insertion or delayed insertion at 4-12 weeks' postpartum. Prespecified exclusion criteria included delivery <37.0 weeks' gestational age, chorioamnionitis, postpartum hemorrhage, contraindications to levonorgestrel intrauterine device insertion, and medical complications of pregnancy that could affect breast-feeding. We conducted per-protocol analysis as the primary approach, as it is considered the standard for noninferiority studies; we also report the alternative intent-to-treat analysis. We powered the study for the primary outcome, breast-feeding continuation at 8 weeks, to detect a 15% noninferiority margin between groups, requiring 132 participants in each arm. The secondary study outcome, time to lactogenesis, used a validated measure, and was analyzed by survival analysis and log rank test. We followed up participants for ongoing data collection for 6 months. Only the data analysis team was blinded to the intervention. RESULTS We met the enrollment target with 319 participants, but lost 34 prior to randomization and excluded an additional 26 for medical complications prior to delivery. The final analytic sample included 132 in the immediate group and 127 in the delayed group. Report of any breast-feeding at 8 weeks in the immediate group (79%; 95% confidence interval, 70-86%) was noninferior to that of the delayed group (84%; 95% confidence interval, 76-91%). The 5% difference in breast-feeding continuation at 8 weeks between the groups fell within the noninferiority margin (95% confidence interval, -5.6 to 15%). Time to lactogenesis (mean ± SD) in the immediate group, 65.3 ± 25.7 hours, was noninferior to that of the delayed group, 63.6 ± 21.6 hours. The mean difference between groups was 1.7 hours (95% confidence interval, -4.8 to 8.2 hours), noninferior by log-rank test. A total of 24 intrauterine device expulsions occurred in the immediate group compared to 2 in the delayed group (19% vs 2%, P < .001), consistent with the known higher expulsion rate with immediate vs delayed postpartum intrauterine device insertion. No intrauterine device perforations occurred in either group. CONCLUSION Our results of noninferior breast-feeding outcomes between women with immediate and delayed postpartum levonorgestrel intrauterine device insertion suggest that immediate postpartum intrauterine device insertion is an acceptable option for women planning to breast-feed and use the levonorgestrel intrauterine device. Expulsion rates are higher with immediate postpartum levonorgestrel intrauterine device insertion compared to delayed insertion, but this disadvantage may be outweighed by the advantages of immediate initiation of contraception. Providers should offer immediate postpartum intrauterine device insertion to breast-feeding women planning to use the levonorgestrel intrauterine device.
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Affiliation(s)
- David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Lauren Thaxton
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Nicole Yonke
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Holly Bullock
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Rameet Singh
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
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9
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Taub RL, Jensen JT. Advances in contraception: new options for postpartum women. Expert Opin Pharmacother 2017; 18:677-688. [DOI: 10.1080/14656566.2017.1316370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Loewenberg Weisband Y, Keder LM, Keim SA, Gallo MF. Postpartum intentions on contraception use and method choice among breastfeeding women attending a university hospital in Ohio: a cross-sectional study. Reprod Health 2017; 14:45. [PMID: 28320478 PMCID: PMC5360022 DOI: 10.1186/s12978-017-0307-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 03/13/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Few postpartum women use effective contraception and those who use less effective methods have increased rates of unintended pregnancy. Little is known about postpartum contraception intentions among breastfeeding women. Our objectives were to measure the extent of prenatal contraceptive counseling, to assess contraceptive intentions, and to identify correlates of both among postpartum women who were planning to breastfeed. METHODS We conducted a cross-sectional study using a convenience sample of 100 breastfeeding women before their discharge following delivery at a large university hospital in 2015. We used logistic regression to assess three outcomes of interest: not intending to use contraception before 6 months postpartum, reporting receiving counseling on postpartum contraception during prenatal care, and considering the effects of contraception methods on the breastfeeding mother-infant dyad when choosing a postpartum contraception method. RESULTS Most women (91%) intended to use contraception. Prior history of no contraception use was the sole factor related to not intending to use contraception. The most commonly cited reason for the intended choice of contraceptive method was convenience (35%). Few women (21%) reported considering the effects of contraception methods on the breastfeeding dyad when choosing a postpartum contraception method. Nearly half of women reported never discussing postpartum contraception options with their healthcare provider during prenatal care. In the multivariate analysis, receiving public assistance was the only factor that remained statistically significantly associated with reporting having received contraception counseling during prenatal care. CONCLUSIONS Although most women intended to use contraception, they did not appear to have received adequate prenatal counseling on postpartum contraception.
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Affiliation(s)
| | - Lisa M. Keder
- The Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH 43210 USA
| | - Sarah A. Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Maria F. Gallo
- The Ohio State University, College of Public Health, 1841 Neil Ave, Columbus, OH 43210-1351 USA
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Sridhar A, Salcedo J. Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing. Matern Health Neonatol Perinatol 2017; 3:1. [PMID: 28101373 PMCID: PMC5237348 DOI: 10.1186/s40748-016-0040-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/18/2016] [Indexed: 12/11/2022] Open
Abstract
Postpartum contraception is important to prevent unintended pregnancies. Assisting women in achieving recommended inter-pregnancy intervals is a significant maternal-child health concern. Short inter-pregnancy intervals are associated with negative perinatal, neonatal, infant, and maternal health outcomes. More than 30% of women experience inter-pregnancy intervals of less than 18 months in the United States. Provision of any contraceptive method after giving birth is associated with improved inter-pregnancy intervals. However, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have led to discrepant recommendations by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention. In this review, we discuss current recommendations for the use of hormonal contraception in the postpartum period. We also discuss details of the lactational amenorrhea method and effects of hormonal contraception on breastfeeding. Given the paucity of high quality evidence on the impact on hormonal contraception on breastfeeding outcomes, and the strong evidence for improved health outcomes with achievement of recommended birth spacing intervals, the real risk of unintended pregnancy and its consequences must not be neglected for fear of theoretical neonatal risks. Women should establish desired hormonal contraception before the risk of pregnancy resumes. With optimization of postpartum contraception provision, we will step closer toward a healthcare system with fewer unintended pregnancies and improved birth outcomes.
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Affiliation(s)
- Aparna Sridhar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, California, USA
| | - Jennifer Salcedo
- Department of Obstetrics, Gynecology & Women's Health, University of Hawaii John A. Burns School of Medicine, Hawaii, USA
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12
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Phillips SJ, Tepper NK, Kapp N, Nanda K, Temmerman M, Curtis KM. Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception 2016; 94:226-52. [PMID: 26410174 PMCID: PMC11376434 DOI: 10.1016/j.contraception.2015.09.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes. OBJECTIVES We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs. SEARCH STRATEGY We searched the PubMed database for all articles published from database inception through December 2014. SELECTION CRITERIA We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, injectables, implants or hormonal intrauterine devices (IUDs). The main outcomes were breastfeeding performance (as measured by initiation, continuation, frequency and exclusivity of breastfeeding) and infant health (as measured by growth, development or adverse health effects). RESULTS Forty-nine articles reporting on 47 different studies were identified that investigated the use of POCs in breastfeeding women and reported clinically relevant outcomes of infant growth, health or breastfeeding performance. Studies ranged from poor to fair methodological quality and generally failed to show negative effects of the use of POCs on breastfeeding outcomes or on infant growth or development. One randomized controlled trial (RCT) raises concerns that immediate insertion of the levonorgestrel IUD postpartum may be associated with poorer breastfeeding performance when compared with delayed insertion, although two other RCTs evaluating early etonogestrel implants compared with delayed initiation of implants or depot medroxyprogesterone acetate failed to find such an association. CONCLUSION The preponderance of evidence fails to demonstrate adverse breastfeeding outcomes or negative health outcomes in infants such as restricted growth, health problems or impaired development. Evidence newly added to this review was largely consistent with previous evidence.
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Affiliation(s)
- Sharon J Phillips
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Naomi K Tepper
- Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Marleen Temmerman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kathryn M Curtis
- Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tepper NK, Phillips SJ, Kapp N, Gaffield ME, Curtis KM. Combined hormonal contraceptive use among breastfeeding women: an updated systematic review. Contraception 2016; 94:262-74. [PMID: 26002804 PMCID: PMC11064971 DOI: 10.1016/j.contraception.2015.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/13/2015] [Accepted: 05/13/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contraception is important for women who are postpartum, including those who are breastfeeding. Use of combined hormonal contraceptives (CHCs) may affect breastfeeding performance and infant health outcomes. OBJECTIVE The objective was to identify evidence examining clinical outcomes for breastfeeding and infant health among breastfeeding women using CHCs compared to nonusers. SEARCH STRATEGY We searched the PubMed database for all articles published from database inception through September 30, 2014. SELECTION CRITERIA We included primary research studies that compared breastfeeding women using CHCs with breastfeeding women using nonhormonal or no contraception, or compared breastfeeding women initiating combined hormonal contraception at early versus later times postpartum. Breastfeeding outcomes of interest included duration, rate of exclusive breastfeeding and timing of supplementation. Infant outcomes of interest included growth, health and development. RESULTS Fifteen articles describing 13 studies met inclusion criteria for this review. Studies ranged from poor to fair methodological quality and demonstrated inconsistent effects of combined oral contraceptives (COCs) on breastfeeding performance with COC initiation before or after 6 weeks postpartum; some studies demonstrated greater supplementation and decreased breastfeeding continuation among COC users compared with nonusers, and others demonstrated no effect. For infant outcomes, some studies found decreases in infant weight gain for COC users compared with nonusers when COCs were initiated at <6 weeks postpartum, while other studies found no effect. None of the studies found an effect on infant weight gain when COCs were started after 6 weeks postpartum, and no studies found an effect on other infant health outcomes regardless of time of COC initiation. CONCLUSION Limited evidence of poor to fair quality demonstrates an inconsistent impact of COCs on breastfeeding duration and success. The evidence also demonstrated conflicting results on whether early initiation of COCs affects infant outcomes but generally found no negative impact on infant outcomes with later initiation of COCs. The body of evidence is limited by older studies using different formulations and doses of estrogen and poor methodologic quality. Given the significant limitations of this body of evidence, the importance of contraception for postpartum women and the theoretical concerns that have been raised about the use of combined hormonal contraception by women who are breastfeeding, rigorous studies examining these issues are needed. In addition, postpartum women should be counseled about the full range of safe alternative contraceptive methods, particularly during the first 6 weeks postpartum when the risk of venous thromboembolism is highest and use of estrogen may exacerbate this risk.
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Affiliation(s)
- Naomi K Tepper
- Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, GA 30341.
| | - Sharon J Phillips
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland (prior affiliation for Dr. Phillips and Dr. Kapp)
| | - Nathalie Kapp
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland (prior affiliation for Dr. Phillips and Dr. Kapp); Current affiliation: Independent reproductive health consultant, Paris, France
| | - Mary E Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland (prior affiliation for Dr. Phillips and Dr. Kapp)
| | - Kathryn M Curtis
- Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, GA 30341
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Goldsmith C, Nelson AL. Urgent need to change clinical practices about postpartum contraception. World J Obstet Gynecol 2015; 4:52-57. [DOI: 10.5317/wjog.v4.i3.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/26/2015] [Accepted: 05/11/2015] [Indexed: 02/05/2023] Open
Abstract
In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device - has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.
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Abstract
As birth spacing has demonstrated health benefits for a woman and her children, contraception after childbirth is recognized as an important health issue. The potential risk of pregnancy soon after delivery underscores the importance of initiating postpartum contraception in a timely manner. The contraceptive method initiated in the postpartum period depends upon a number of factors including medical history, anatomic and hormonal factors, patient preference, and whether or not the woman is breastfeeding. When electing a contraceptive method, informed choice is paramount. The availability of long-acting reversible contraceptive methods immediately postpartum provides a strategy to achieve reductions in unintended pregnancy.
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Nelson AL. Prenatal contraceptive counseling and method provision after childbirth. Open Access J Contracept 2015; 6:53-63. [PMID: 29386923 PMCID: PMC5683142 DOI: 10.2147/oajc.s52925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Postpartum contraception is undergoing major changes, not only in timing, but also in content. Failure to provide immediate postpartum contraception contributes to the problems of unintended pregnancies and rapid repeat pregnancy because often the highest-risk women do not return for postpartum care. If they do attend that visit, they have often lost the insurance coverage that would enable them to use the most effective forms of birth control. Most of the issues surrounding early initiation of progestin-only methods and breastfeeding have been favorably resolved. In some cases, insurance coverage for delivery has been expanded to cover the costs of providing intrauterine devices and implants before the woman is discharged home. All of these new opportunities shift the burden of counseling about postpartum contraception onto the shoulders of the prenatal care provider. This article provides information about the advantages and disadvantages of providing immediate postpartum contraception with each of the eligible methods so clinicians can provide the needed counseling both during pregnancy and during hospitalization for delivery. It also provides guidance for initiation of bridging contraception, if needed, to initiate a method for a woman later in the postpartum period.
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Affiliation(s)
- Anita L Nelson
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
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Brownell EA, Lussier MM, Dozier AM, Howard CR, Fisher SG, Duckett JW, Lawrence RA, Fernandez ID. The discordance between planned use and actual receipt of immediate postpartum depot medroxyprogesterone among low-income women. Breastfeed Med 2014; 9:290-3. [PMID: 24893264 DOI: 10.1089/bfm.2013.0112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study describes the patterns of planned use and actual receipt of immediate postpartum depot medroxyprogesterone (DMPA) prior to hospital discharge among low-income breastfeeding initiators. MATERIALS AND METHODS Bivariate analyses among DMPA recipients by prenatal planned/unplanned use and the sensitivity of DMPA self-report relative to pharmacologic record were calculated. RESULTS Among immediate postpartum DMPA recipients (n=58), 72.4% (n=42) did not plan to use DMPA. The sensitivity of self-reported DMPA use was 89.7% (95% confidence interval, 85.2, 94.2). CONCLUSIONS Clinically, it is unclear if the immediate postpartum period is the appropriate time to obtain consent and administer a long-acting contraceptive method. In our sample, women accurately recalled receiving DMPA in the immediate postpartum period. However, the majority did not plan to use this contraceptive method. Further high-quality qualitative and quantitative research regarding women's contraceptive plans and perception of the postpartum DMPA consent process and the healthcare provider's attitudes regarding consent and prescription of immediate postpartum DMPA are warranted.
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Affiliation(s)
- Elizabeth A Brownell
- 1 Connecticut Human Milk Research Center, Division of Neonatology, Connecticut Children's Medical Center , Hartford, Connecticut
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Dozier AM, Nelson A, Brownell EA, Howard CR, Lawrence RA. Patterns of postpartum depot medroxyprogesterone administration among low-income mothers. J Womens Health (Larchmt) 2014; 23:224-30. [PMID: 24443831 PMCID: PMC3996992 DOI: 10.1089/jwh.2012.4016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Depot medroxyprogesterone acetate (DMPA) is often administered immediately postpartum to reduce the risk of short-interval repeat or unintended pregnancies, but little is known about the actual patterns of postpartum DMPA use. This article examines the patterns of DMPA administered among low-income new mothers in an upstate New York State community. METHODS Mothers attending urban pediatric practices (births 2009-2011) completed a mailed survey approximately 5 months after delivery. Among 83 survey items were questions about breastfeeding and timing of DMPA receipt. RESULTS Unintended pregnancy was reported by 48.8% of the subjects. Their deliveries occurred across four local hospitals. Among the 31.3% of subjects who received postpartum DMPA, 62.6% received it prior to hospital discharge. Those receiving in-hospital DMPA (n=127) were significantly more likely than other mothers to be black, older, urban dwelling, non-high school graduates, multiparous, and planning to formula feed. Administration patterns differed by hospital. CONCLUSIONS This study of postpartum DMPA administration among a convenience sample of low-income mothers demonstrated rates of 26% overall, but there was between-hospital variability. Additional study may identify approaches to ensure timely administration to appropriate candidates.
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Affiliation(s)
- Ann M. Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Alice Nelson
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Elizabeth A. Brownell
- Departments of Research and Neonatology, Connecticut Children's Medical Center; Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Cynthia R. Howard
- Department of Pediatrics, University of Rochester, Rochester, New York; Rochester General Hospital
| | - Ruth A. Lawrence
- Departments of Pediatrics and Obstetrics and Gynecology, University of Rochester, Rochester, New York
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Nelson AL. Postpartum contraception: a new frontier (again). J Womens Health (Larchmt) 2014; 23:193-4. [PMID: 24559240 DOI: 10.1089/jwh.2014.4735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anita L Nelson
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center , Manhattan Beach, California
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Bahamondes L, Bahamondes MV, Modesto W, Tilley IB, Magalhães A, Pinto e Silva JL, Amaral E, Mishell DR. Effect of hormonal contraceptives during breastfeeding on infant's milk ingestion and growth. Fertil Steril 2013; 100:445-50. [DOI: 10.1016/j.fertnstert.2013.03.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/25/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
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Lactogenesis after early postpartum use of the contraceptive implant: a randomized controlled trial. Obstet Gynecol 2013; 117:1114-1121. [PMID: 21508750 DOI: 10.1097/aog.0b013e3182165ee8] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate lactogenesis after early postpartum insertion of the etonogestrel contraceptive implant. METHODS Healthy peripartum women with healthy, term newborns who desired the etonogestrel implant for contraception were randomly assigned to early (1-3 days) or standard (4-8 weeks) postpartum insertion. The primary outcomes, time to lactogenesis stage II and lactation failure, were documented by a validated measure. The noninferiority margin for the mean difference in time to lactogenesis stage II was defined as 8 additional hours. Secondary data (device continuation and contraceptive use, breast milk analysis, supplementation rates, side effects, and bleeding patterns) were collected at periodic intervals for 6 months. RESULTS Sixty-nine women were enrolled. Thirty-five were randomly assigned to early insertion and 34 to standard insertion. There were no statistically significant differences between the groups in age, race, parity, mode of delivery, use of anesthesia, or prior breastfeeding experience. Early insertion was demonstrated to be noninferior to standard insertion in time to lactogenesis stage II (early: [mean±standard deviation] 64.3±19.6 hours; standard: 65.2±18.5 hours, mean difference, -1.4 hours, 95% confidence interval [CI] -10.6 to 7.7 hours). Early insertion was also demonstrated to be noninferior to standard insertion in incidence of lactation failure (1/34 [3%] in the early insertion group, 0/35 [0%] in the standard insertion group [risk difference, 0.03, 95% CI -0.02 to 0.08]). Use of formula supplementation was not significantly different between the groups. Milk composition at 6 weeks was not significantly different between the groups. CONCLUSION Breastfeeding outcomes were similar in women who underwent early compared with standard postpartum insertion of the etonogestrel implant. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00847587.
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Brownell EA, Fernandez ID, Fisher SG, Howard CR, Ternullo SR, Lawrence RA, Duckett JW, Dozier AM. The effect of immediate postpartum depot medroxyprogesterone on early breastfeeding cessation. Contraception 2013; 87:836-43. [PMID: 23153897 PMCID: PMC4038903 DOI: 10.1016/j.contraception.2012.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/23/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study evaluated the effect of immediate postpartum depot medroxyprogesterone (DMPA) on breastfeeding cessation within 6 weeks postpartum. STUDY DESIGN At low-income-serving obstetric and pediatric clinics, eligible mothers within 1 year postpartum were recruited to participate in a retrospective cohort study. The 183 participants completed a self-administered survey. Surveys were merged with birth certificate data and perinatal maternal/infant medical records. Kaplan-Meier distributions assessed the relationship between DMPA use and breastfeeding cessation. A multivariable Cox proportional hazards model estimated hazard ratios (HRs) and included five known risk factors (age, education, race, parity and parental cohabitation) and identified potential confounders. RESULTS Consistent with the biologic model, the Kaplan-Meier results raised the possibility of a detrimental effect of DMPA on duration of any breastfeeding, but differences in these distributions did not achieve statistical significance (p=.24); after adjustment for potential confounders, this nonstatistically significant association remained (HR: 1.22; confidence interval: 0.75-1.98). CONCLUSION Given the state of the evidence, it is unclear whether a causal effect does or does not exist. However, if there is a causal effect of DMPA on breastfeeding duration, it is minimal. Additional well-designed research is warranted.
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Affiliation(s)
- Elizabeth A Brownell
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
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24
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Effect of progestin compared with combined oral contraceptive pills on lactation: a randomized controlled trial. Obstet Gynecol 2012; 119:5-13. [PMID: 22143258 DOI: 10.1097/aog.0b013e31823dc015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate the effect of progestin-only compared with combined hormonal contraceptive pills on rates of breastfeeding continuation in postpartum women. Secondary outcomes include infant growth parameters, contraceptive method continuation, and patient satisfaction with breastfeeding and contraceptive method. METHODS Postpartum breastfeeding women who desired oral contraceptives were randomly assigned to progestin-only and combined hormonal contraceptive pills. At 2 and 8 weeks postpartum, participants completed in-person questionnaires that assessed breastfeeding continuation and contraceptive use. Infant growth parameters including weight, length, and head circumference were assessed at 8 weeks postpartum. Telephone questionnaires assessing breastfeeding, contraceptive continuation, and satisfaction were completed at 3-7 weeks and 4 and 6 months. Breastfeeding continuation was compared between groups using Cox proportional hazards regression. Differences in baseline demographic characteristics and in variables between the two intervention groups were compared using χ tests, Fisher exact test, or two-sample t tests as appropriate. RESULTS Breastfeeding continuation rates at 8 weeks (progestin-only 63.5%; combined hormonal 64.1%), contraceptive continuation, and infant growth parameters did not differ between users of progestin-only and combined hormonal contraceptive pills. Infant formula supplementation and maternal perception of inadequate milk supply were associated with decreased rates of breastfeeding in both groups. CONCLUSION Choice of combined hormonal or progestin-only contraceptive pills administered 2 weeks postpartum did not adversely affect breastfeeding continuation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT01465022.
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Nelson AL. New frontiers in female contraception (and male condoms): 2012. Expert Opin Investig Drugs 2012; 21:677-93. [DOI: 10.1517/13543784.2012.679342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anita L Nelson
- Harbor UCLA Medical Center,
1457 3rd Street, Manhattan Beach, CA 90266, USA ;
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Brownell EA, Fernandez ID, Howard CR, Fisher SG, Ternullo SR, Buckley RJJ, Dozier AM. A systematic review of early postpartum medroxyprogesterone receipt and early breastfeeding cessation: evaluating the methodological rigor of the evidence. Breastfeed Med 2012; 7:10-8. [PMID: 22085201 PMCID: PMC3270056 DOI: 10.1089/bfm.2011.0105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Breastfeeding has numerous maternal and infant benefits. Progesterone contraception after birth is frequently recommended, but because a decrease in progesterone is required to initiate lactation, early postpartum progesterone contraception use could inhibit lactation. The purpose of this article is to critically evaluate the scientific basis for conflicting clinical recommendations related to postpartum medroxyprogesterone use among breastfeeding women. METHODS Relevant peer-reviewed literature was identified through a comprehensive search of PubMed through December 2010. The search was restricted to clinical trials, randomized clinical trials, or comparative studies written in English and conducted among humans. The studies included in this review addressed the effect of medroxyprogesterone administration at <6 weeks postpartum on breastfeeding exclusivity and/or duration and measured breastfeeding outcomes at ≥ 6 weeks postpartum. RESULTS Of the 20 articles identified, only three studies satisfied the inclusion criteria. However, all three studies were of low-quality methodological rigor, and none accounted for potential confounders. CONCLUSION Current evidence is methodologically weak and provides an inadequate basis for inference about a possible causal relationship between early postpartum medroxyprogesterone use and poor breastfeeding outcomes. However, given the presence of a strong biological model describing the potential deleterious effect of postpartum medroxyprogesterone use on lactation, further research that improves on current literature is warranted. Meanwhile, we recommend that potential breastfeeding risks associated with early (<6 weeks) postpartum medroxyprogesterone use be disclosed to allow for a fully informed consent and decision-making process.
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Affiliation(s)
- Elizabeth A Brownell
- Department of Community and Preventive Medicine, University of Rochester, Rochester, New York 14642-0644, USA.
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Matias SL, Nommsen-Rivers LA, Dewey KG. Determinants of exclusive breastfeeding in a cohort of primiparous periurban peruvian mothers. J Hum Lact 2012; 28:45-54. [PMID: 22058120 DOI: 10.1177/0890334411422703] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors aimed to identify factors associated with exclusive breastfeeding (EBF) among 117 Peruvian mothers planning to breastfeed exclusively. Data were collected on days 0 and 3, and months 1, 3, and 6. Exclusive breastfeeding status was evaluated with a 24-hour recall of infant diet. Exclusive breastfeeding rates were 74%, 72%, and 35% at 1, 3, and 6 months, respectively. At 3 months, lower maternal education, greater breastfeeding frequency (day 3), greater breast pain (day 3), and depot medroxyprogesterone acetate use (3 months) were associated with EBF, after adjusting for EBF intentions. At 6 months, greater infant birth weight and mother-not employed were associated with EBF, after controlling for EBF intentions. More educated and working mothers, and infants with lower birth weight should be targeted in interventions to promote EBF in urban Peru. Research is also warranted to explore the factors linking depot medroxyprogesterone acetate use and breast pain with EBF duration.
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Affiliation(s)
- Susana L Matias
- Department of Nutrition, University of California, Davis, California 95616, USA.
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Jackson E. Controversies in postpartum contraception: when is it safe to start oral contraceptives after childbirth? Thromb Res 2011; 127 Suppl 3:S35-9. [PMID: 21262436 DOI: 10.1016/s0049-3848(11)70010-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The timely initiation of contraception postpartum is an important consideration for breastfeeding and non-breastfeeding women; many women prefer oral contraceptive pills to other methods. In breastfeeding women, combined hormonal pills are not recommended prior to 6 weeks postpartum, due to effects on milk production. Although progestogen-only pills do not adversely affect milk, lack of data regarding possible effects on infants exposed to progestogens in breastmilk renders timing of initiation of this method controversial. In non-breastfeeding women, elevated risk of venous thromboembolism restricts use of combined hormonal pills prior to 21 days postpartum. From 21 to 42 days, use of combined hormonal pills should be assessed based on a woman's personal venous thromboembolism risk profile; after 42 days postpartum there is no restriction in the use of combined hormonal pills for otherwise healthy women. Non-breastfeeding women may safely use progestogen-only pills at any time during the postpartum.
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Affiliation(s)
- Emily Jackson
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Chen BA, Reeves MF, Creinin MD, Schwarz EB. Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration. Contraception 2011; 84:499-504. [PMID: 22018124 DOI: 10.1016/j.contraception.2011.01.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/28/2011] [Accepted: 01/28/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND The objective of this study was to assess the effect of timing of postpartum levonorgestrel-releasing intrauterine device (IUD) insertion on breast-feeding continuation. STUDY DESIGN Women interested in using a levonorgestrel IUD postpartum were randomized to immediate postplacental insertion (postplacental group) or insertion 6-8 weeks after vaginal delivery (delayed group). Duration and exclusivity of breast-feeding were assessed at 6-8 weeks, 3 months, and 6 months postpartum. Only women who received an IUD were included in this analysis. RESULTS Breast-feeding was initiated by 32 (64%) of 50 of women receiving a postplacental IUD and 27 (58.7%) of 46 of women receiving a delayed IUD (p=.59). More women in the delayed group compared with the postplacental group continued to breast-feed at 6-8 weeks (16/46 vs. 15/50, p=.62), 3 months (13/46 vs. 7/50, p=.13), and 6 months postpartum (11/46 vs. 3/50, p=.02). The results did not differ when only women who initiated breast-feeding or only primiparous women with no prior breast-feeding experience were analyzed. CONCLUSIONS Immediate postplacental insertion of the levonorgestrel IUD is associated with shorter duration of breast-feeding and less exclusive breast-feeding. Further studies on the effects of early initiation of progestin-only methods on women's lactation experience are needed.
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Affiliation(s)
- Beatrice A Chen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Nelson AL. Safety, Efficacy, and Patient Acceptability of the Copper T-380A Intrauterine Contraceptive Device. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2011. [DOI: 10.4137/cmwh.s5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ParaGard Copper T 380A intrauterine device (CuT380A) provides reversible contraception that is as effective as sterilization for up to 20 years. The CuT380A is a mainstream, first-line contraceptive option for most healthy women, including nulligravid women, as well as many women who have serious medical problems. Because it is the most cost-effective method of birth control, the CuT380A is the preferred IUD, except for women who desire lighter or no menstrual blood loss. Surveys reveal that 95% of US CuT380A users are “very” or “somewhat” satisfied with their method. This article describes current candidates for IUD use, discusses the mechanisms of action of the CuT380A, provides guidance to reduce barriers to IUD access, suggests counseling points for patients, and outlines techniques to reduce the risks and side effects that can be associated with use of the CuT380A.
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Affiliation(s)
- Anita L. Nelson
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA, USA
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Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception 2010; 82:17-37. [DOI: 10.1016/j.contraception.2010.02.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/02/2010] [Indexed: 11/20/2022]
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Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns NE. Improving the use of human milk during and after the NICU stay. Clin Perinatol 2010; 37:217-45. [PMID: 20363457 PMCID: PMC2859690 DOI: 10.1016/j.clp.2010.01.013] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The feeding of human milk (milk from the infant's own mother; excluding donor milk) during the newborn intensive care unit (NICU) stay reduces the risk of costly and handicapping morbidities in premature infants. The mechanisms by which human milk provides this protection are varied and synergistic, and appear to change over the course of the NICU stay. The fact that these mechanisms include specific human milk components that are not present in the milk of other mammals means that human milk from the infant's mother cannot be replaced by commercial infant or donor human milk, and the feeding of human milk should be a NICU priority. Recent evidence suggests that the impact of human milk on improving infant health outcomes and reducing the risk of prematurity-specific morbidities is linked to specific critical exposure periods in the post-birth period during which the exclusive use of human milk and the avoidance of commercial formula may be most important. Similarly, there are other periods when high doses, but not necessarily exclusive use of human milk, may be important. This article reviews the concept of "dose and exposure period" for human milk feeding in the NICU to precisely measure and benchmark the amount and timing of human milk use in the NICU. The critical exposure periods when exclusive or high doses of human milk appear to have the greatest impact on specific morbidities are reviewed. Finally, the current best practices for the use of human milk during and after the NICU stay for premature infants are summarized.
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Affiliation(s)
- Paula P Meier
- Department of Women, Children and Family Nursing, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Brito MB, Ferriani RA, Quintana SM, Yazlle MEHD, Silva de Sá MF, Vieira CS. Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study. Contraception 2009; 80:519-26. [PMID: 19913145 DOI: 10.1016/j.contraception.2009.05.124] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 04/17/2009] [Accepted: 05/21/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effects of etonogestrel (ETG)-releasing contraceptive implant during the immediate postpartum period on maternal safety are unknown. STUDY DESIGN Forty healthy women exclusively breastfeeding were randomized to receive either ETG-releasing implant 24-48 h after delivery (n=20) or depot medroxyprogesterone acetate (DMPA group; n=20) at the sixth week postpartum. We measured blood pressure, maternal and neonatal weight, body mass index (BMI; kg/m(2)), waist circumference (WC), complete blood count, C-reactive protein, interleukin-6, tumor necrosis factor (TNF-alpha), lipid profile, fasting serum glucose and maintenance of exclusive lactation up to the 12th week postpartum. RESULTS Decreases in mean maternal weight, BMI (kg/m(2)) and WC were significantly greater in the ETG-releasing implant group than in the DMPA group during the first 6 weeks postpartum (-4.64+/-2.71 kg vs. -2.6+/-2.45 kg mean+/-SD, p=.017; -1.77+/-1.06 kg/m(2) vs. -0.97+/-0.95 kg/m(2), p=.026; -15.3+/-6.72 cm vs. -9.05+/-5.84 cm, p=.003, respectively). In addition, total cholesterol and HDL, were lower in DMPA users, and TNF-alpha and leukocytes were higher in DMPA users compared to in the implant group, between 6 and 12 weeks after delivery. The newborns of implant users showed a trend towards gaining more weight, as compared with the infants of the DMPA mothers during the first 6 weeks of life (implant group: +1460.50+/-621.34 g vs. DMPA group: +1035.0+/-562.43 g, p=.05). The remaining variables, including the duration of exclusive breastfeeding, were similar between the groups. CONCLUSION The insertion of ETG-releasing contraceptive implant during the immediate postpartum period was not associated with deleterious maternal clinical effects or with significant maternal metabolic alterations or decreased infant weight gain.
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Affiliation(s)
- Milena Bastos Brito
- Department of Obstetrics and Gynecology, University of São Paulo, Ribeirão Preto, School of Medicine, Ribeirão Preto, SP, 14049-900, Brazil
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Rodriguez MI, Kaunitz AM. An evidence-based approach to postpartum use of depot medroxyprogesterone acetate in breastfeeding women. Contraception 2009; 80:4-6. [PMID: 19501209 DOI: 10.1016/j.contraception.2008.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/04/2008] [Accepted: 12/04/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Maria Isabel Rodriguez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco General Hospital-6D, San Francisco, CA 94110, USA.
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Wlodek ME, Ceranic V, O'Dowd R, Westcott KT, Siebel AL. Maternal Progesterone Treatment Rescues the Mammary Impairment Following Uteroplacental Insufficiency and Improves Postnatal Pup Growth in the Rat. Reprod Sci 2009; 16:380-90. [DOI: 10.1177/1933719108327592] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mary E. Wlodek
- Department of Physiology, The University of Melbourne, Victoria, Australia,
| | - Veselin Ceranic
- Department of Physiology, The University of Melbourne, Victoria, Australia
| | - Rachael O'Dowd
- Department of Physiology, The University of Melbourne, Victoria, Australia
| | - Kerryn T. Westcott
- Department of Physiology, The University of Melbourne, Victoria, Australia
| | - Andrew L. Siebel
- Department of Physiology, The University of Melbourne, Victoria, Australia
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Speroff L, Mishell DR. The postpartum visit: it's time for a change in order to optimally initiate contraception. Contraception 2008; 78:90-8. [PMID: 18672108 DOI: 10.1016/j.contraception.2008.04.005] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 02/27/2008] [Indexed: 01/07/2023]
Affiliation(s)
- Leon Speroff
- Oregon Health and Science University, UHN 70, Portland, OR 97230, USA
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La contraception du post-partum : état des connaissances. ACTA ACUST UNITED AC 2008; 36:603-15. [DOI: 10.1016/j.gyobfe.2008.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 02/14/2008] [Indexed: 11/15/2022]
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Bakry S, Merhi ZO, Scalise TJ, Mahmoud MS, Fadiel A, Naftolin F. Depot-medroxyprogesterone acetate: an update. Arch Gynecol Obstet 2008; 278:1-12. [PMID: 18470526 DOI: 10.1007/s00404-007-0497-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 10/16/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Depo-Provera is a contraceptive approved by the US Food and Drug Administration (FDA) since 1992 and used worldwide by more than 90 million women. AIM OF STUDY Despite the fact that progestins are endogenous hormones that are secreted by the body, its excess might lead to detrimental health effects. Whether progestins as contraceptives are friends or foes is a questionable matter. In this manuscript, we drive the attention to both usage and side effects Depo-Provera. RESULTS Depot-medroxyprogesterone acetate (DMPA) is a highly effective, convenient non-daily hormonal contraceptive option that has been available worldwide for many years. The experience with DMPA provides a large body of long-term data regarding the efficacy and safety of this contraceptive method; this long-term experience has established that the use of DMPA does not increase the risk of cardiovascular events, breast cancer, other gynecologic malignancy, or postmenopausal fracture; however, patients are often more concerned about the relatively immediate effects of contraceptives such as potential changes in menstrual cycle, body weight, and mood disturbances. CONCLUSION Concerns about such issues may lead to reluctance to initiate therapy or premature discontinuation. Counseling and understanding of women's concerns and experiences using Depo-Provera is important and could help health care providers redesign counseling strategies to improve contraceptive continuation and improve patient adherence.
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Affiliation(s)
- Sayed Bakry
- Center for Genetic Engineering and Embryo Culture, Al Azhar University, Cairo 11884, Egypt.
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Newberry YG. Implanon: a new implantable contraceptive. Nurs Womens Health 2007; 11:607-611. [PMID: 18088298 DOI: 10.1111/j.1751-486x.2007.00252.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Yvonne G Newberry
- School of Nursing at the University of Virginia, Charlottesville, VA, USA
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Wadsworth P. Plan B: Dual Label. J Nurse Pract 2007. [DOI: 10.1016/j.nurpra.2007.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Uncontrolled fertility results in significant infant and maternal mortality and morbidity. Contraception has the potential to reduce this disease burden. Although a rich array of reversible contraceptive methods exists, the need for more effective and user-friendly methods remains. Access to methods and affordability are major barriers in many parts of the world. However, in other areas, successful utilization is limited by convenience factors or a lack of appreciation of fertility risk. To address these issues, new products that require little user effort have been developed. To encourage correct and consistent use of other methods, noncontraceptive benefits are being popularized and new protocols to initiate contraceptive use immediately are being introduced. This review briefly discusses existing contraceptive methods and new developments that are under investigation.
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Affiliation(s)
- Anita L Nelson
- Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA 90266-6335, USA.
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Abstract
Contraceptive implants are safe, highly effective, and long-term methods of contraception that are widely applicable to any reproductive-aged woman. Implants require minimal user compliance and are cost-effective. The new single-rod system simplifies insertion and removal, making implants more accessible for both providers and patients. Specifically, progestin-only implants are safe options for various women including adolescents, postpartum, breast-feeding, those who are medically complicated, or those who have contraindications to or intolerance of estrogen-containing contraceptives.
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Affiliation(s)
- Michelle M Isley
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239, USA.
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Espey E, Ogburn T, Leeman L, Reddy S, Lee C, Qualls C. Conformity with current guidelines on oral contraceptive prescribing for breastfeeding women: a New Mexico survey. Contraception 2006; 74:389-93. [PMID: 17046380 DOI: 10.1016/j.contraception.2006.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 06/13/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND National and international contraceptive guidelines reflect expert opinion that recommends against the use of estrogen-containing hormonal contraception in the early postpartum period. This study was undertaken to estimate providers' practices in prescribing hormonal contraception to breastfeeding women. METHODS A 19-item survey was mailed to 397 obstetrician gynecologists, midwives and family physicians in the state of New Mexico. The survey included items covering attitudes about the impact of hormonal contraception on breastfeeding and prescribing practices. One hundred ninety-nine (50%) providers completed the survey. RESULTS The majority (70%) of providers prescribe progestin-only contraceptive methods to breastfeeding women within the first 6 weeks. Despite these recommendations, a sizable minority of providers prescribe combined pills in the early postpartum period: 27% of providers have prescribed combined pills and 13% of providers, mostly those in a university setting, routinely recommend them within the first 6 weeks postpartum. CONCLUSION Most providers follow expert recommendations regarding the initiation of hormonal contraception for breastfeeding women.
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Affiliation(s)
- Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA.
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Shaamash AH, Sayed GH, Hussien MM, Shaaban MM. A comparative study of the levonorgestrel-releasing intrauterine system Mirena versus the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development. Contraception 2005; 72:346-51. [PMID: 16246660 DOI: 10.1016/j.contraception.2005.04.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 04/13/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND Mirena is a levonorgestrel-releasing intrauterine system (LNG-IUS) that provides highly effective and long-acting progestogen-only contraception. OBJECTIVE The objective of this study was to analyze the possible effects of using LNG-20 microg IUS on breast-feeding performance, infant growth and infant development during the first postpartum year as compared with the Copper T380A intrauterine device (Cu T380A IUD). DESIGN This study is a prospective, controlled and randomized trial. SETTING The study was conducted at the Department of Obstetrics and Gynecology, Assiut University Hospital, Egypt. METHODS Three hundred twenty lactating women asking for initiation of contraception during the early postpartum stage were assigned randomly into two groups, the LNG-20 microg IUS group (n=163) and the Cu T380A group (n=157). The insertions were done 6-8 weeks postpartum. Each participant was followed up at three monthly intervals after insertion and until the first birthday of her baby. During these visits, the breast-feeding pattern was assessed, certain infant physical growth parameters were measured and a set of infant development tests was performed. RESULTS No pregnancy occurred in both groups. There were no significant differences in the net continuation rates between the two groups (89.3 for LNG-IUS vs. 90.9 for Cu T380A). The LNG-20 microg IUS group had comparable rates of breast-feeding continuation, complete weaning, full breast-feeding and partial breast-feeding, with the Cu-IUD group. No statistically significant differences were found between groups with regard to all infant physical growth parameters and various infant development tests. CONCLUSION The findings of the current study confirm that the use of LNG-20 microg IUS during the first postpartum year in lactating women provides highly effective and acceptable contraception and does not negatively influence breast-feeding or the growth and development of breast-fed infants.
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Affiliation(s)
- Ayman H Shaamash
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Archivée: Consensus Canadien sur la Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004. [DOI: 10.1016/s1701-2163(16)30364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Consensus canadien sur la contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004. [DOI: 10.1016/s1701-2163(16)30261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Glasier A, Brechin S, Raine R, Penney G. A consensus process to adapt the World Health Organization selected practice recommendations for UK use. Contraception 2003; 68:327-33. [PMID: 14636935 DOI: 10.1016/j.contraception.2003.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The nominal group technique for consensus development was used to consider the World Health Organization Selected Practice Recommendations for Contraceptive Use for adoption or adaptation in the United Kingdom. The nominal group comprised 11 opinion leaders who agreed that 74% of the WHO recommendations were consistent with current UK practice. Of 63 recommendations considered by the group to be at odds with current practice, 23 were adopted with advice that United Kingdom practice should change in line with WHO. Twenty-five were adopted because, although the group felt that the WHO recommendation differed from practice in the UK, it was unable to reach a consensus on an alternative recommendation. Thirteen WHO recommendations underwent minor revision for UK use. The group rejected two further WHO recommendations [on the timing of starting low-dose progestogen-only contraception (POC) during lactation] but was unable to reach consensus on any alternative guidance. It was agreed clinicians should be left to decide for themselves how to advise breastfeeding women about when to start low-dose POC. A UK version of the WHO Selected Practice Recommendations should help to standardize practice and improve the quality of care for couples using contraception.
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Affiliation(s)
- Anna Glasier
- Lothian Primary Care NHS Trust and University of Edinburgh, 18 Dean Terrace, EH4 1NL Edinburgh, UK.
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