Effect of Progestin Compared With Combined Oral Contraceptive Pills on Lactation

Abstract

Objective To estimate the effect of progestin-only vs. 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 In this randomized controlled trial, postpartum breastfeeding women who desired oral contraceptives were assigned to progestin-only vs. combined hormonal contraceptive pills. At two and eight 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 eight 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 chi-square tests, Fisher’s Exact test, or two-sample t-tests as appropriate. Results Breastfeeding continuation rates, 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. Conclusions Choice of combined or progestin-only birth control pills administered two weeks postpartum did not adversely affect breastfeeding continuation.

Maternal Medication, Drug Use, and Breastfeeding

“…79 A recently published double-blind randomized trial compared the effect of initiating progesterone-only contraceptives (0.35 mg norethindrone) with COCs (0.035 mg ethinyl estradiol 1 1 mg norethindrone) at 2 weeks postpartum. 80 This study found that there was no difference in continuation of breastfeeding between the 2 groups at 8 weeks (64.1% combined pills vs 63.5% progestin only) or 6 months. 80 In both groups, women who supplemented their infants with formula or had concerns of inadequate milk supply were more likely to stop breastfeeding.…”

“…80 This study found that there was no difference in continuation of breastfeeding between the 2 groups at 8 weeks (64.1% combined pills vs 63.5% progestin only) or 6 months. 80 In both groups, women who supplemented their infants with formula or had concerns of inadequate milk supply were more likely to stop breastfeeding. 80 It should be noted that there was no comparison of discontinuation rates of breastfeeding with a placebo group, so it is unknown whether progesterone itself increased the rates of discontinuation, and only the mother's perception of changes in milk volume, not actual volume measurements, were analyzed.…”

“…80 It should be noted that there was no comparison of discontinuation rates of breastfeeding with a placebo group, so it is unknown whether progesterone itself increased the rates of discontinuation, and only the mother's perception of changes in milk volume, not actual volume measurements, were analyzed. 80 Although this new study is interesting, an older study with 330 women who used nonhormonal contraceptives (NHC), COCs, and copper intrauterine devices (Cu IUDs) found more infants were weaned at 6 and 8 months in the oral contraceptive group (16.3% COC, 9% NHC, 4.7% Cu IUD at 6 months). 81 However, by the end of 1 year an equivalent number of women (w40%) in each of the 3 groups were no longer breastfeeding.…”

Prevention of Unintended Pregnancy Among Sexually Active Adolescents in the United States

“…33 Newer studies show that combined oral contraceptives may be initiated in low-risk, breast-feeding women as early as four weeks postpartum without compromising lactation. 82 However, availability of contraceptive methods immediately following pregnancy may not be sufficient; intensive counseling may be needed to enhance their uptake. 85 …”

“…47,77 Similarly, the safety, efficacy, and acceptability of implant placement during the delivery hospitalization and high continuation rates have been well documented, 47,75,[77][78][79][80][81] even in women who plan to breastfeed their infants. 82,83 Recognizing these benefits, Medicaid programs in over a dozen states now provide full coverage for provision of both implants and IUDs as inpatient procedures.…”