We aimed to compare 3-month postdelivery breastfeeding and infant growth parameters between women who underwent immediate postpartum implant or copper intrauterine device (Cu-IUD) insertion. Methods: This is a secondary analysis of a prospective cohort study of 171 Malawian women who underwent immediate postpartum insertion of the implant or Cu-IUD between September 2014 and March 2015. The study's primary objective was to compare contraceptive continuation rates between implant and Cu-IUD users 1 year postdelivery. For this secondary analysis, we used Fisher's Exact Test and t tests to compare the breastfeeding and infant growth parameters of women with a singleton pregnancy and live infant at their 3-month postdelivery survey. Results: Some 122 women (71%) completed the 3-month postdelivery survey, and 108 women (61%) were eligible for this secondary analysis: 10 Cu-IUD and 98 implant users. All women (100%) reported that they were breastfeeding, with no significant difference in exclusive breastfeeding (90% for Cu-IUD vs. 93% for implant, p=.55). There were also no significant differences in infant weight (6.3 kg for Cu-IUD vs. 6.2 kg for implant, p=.69), length (60.8 cm for Cu-IUD vs. 59.6 cm for implant, p=.42) or head circumference (40.9 cm for Cu-IUD vs. 41.2 cm for implant, p=.74). Conclusions: Almost all women were still exclusively breastfeeding at 3 months postdelivery, with no differences in infant growth between implant and Cu-IUD users, although sample size limited our power. The high rate of exclusive breastfeeding at 3 months in both groups suggests that both options should be offered to postpartum women who want to prevent short interpregnancy intervals.
Objectives: Progestin-only pills (POPs) prevent pregnancy through a combination of mechanisms including ovarian suppression and cervical mucus changes. In this study, we sought to evaluate the potential contraceptive efficacy of a norgestrel 75 mcg POP based on cervical mucus and ovulatory effect changes during a 28 day cycle. Methods: We recruited persons ages 18-35 with normal cycles from two US academic medical centers. Participants took norgestrel 75 mcg daily for 28 days at the same time each day (within 3 hours of previous dosing), recorded through a text message based e-diary. We evaluated participants on the day of pill initiation and then at least every 3-4 days for cervical mucus scoring using a 4-category/12-point Insler scale [score ≥9 (favoring fertility), 5-8 (intermediate), and ≤4 (unfavorable to fertility)], ultrasound assessment of follicular activity, and serum hormone levels. Results: Of the 52 participants who enrolled, 49 contributed complete data for this analysis with an overall pill compliance of 97.5%. No participants had Insler mucus scores ≥9 and 32 (65%) had scores ≤4. Based on follicular assessments and serum progesterone, 14 (35%) participants ovulated; 3 (21%) had mucus scores between 5-8 and 11 (79%) had scores ≤4. Conclusions: Norgestrel 75 mcg demonstrated consistent cervical mucus changes throughout a 28-day cycle that represent non-ideal fertility. Although ovulation occurs in about one-third of norgestrel POP users, cervical mucus changes are likely to provide the desired contraceptive effect.
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