Injected Progestogen and Lactation

Karim, M.; Ammar, R; Mahgoub, S. El; Ganzoury, B. El; Fikri, Faisal; I, Abdou

doi:10.1097/00006254-197109000-00016

Cited by 11 publications

(16 citation statements)

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“…in fact, some of the multiparous women reported an improved lactation with depot medroxy progesterone acetate usage. Similarly no detrimental effect of depot medroxy progesterone acetate on duration of lactation, frequency of lactation and timing of introduction of formula milk was observed in previous studies [8,11,12].…”

Section: Discussionsupporting

confidence: 67%

Impact of Injectable Progestogen Contraception in Early Puerperium on Lactation and Infant Health

Singhal

Sarda

Gupta

et al. 2014

JCDR

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IntrOductIOnIn developing countries, 17% women of reproductive age have unmet needs for family planning [1,2] and 20.6% of pregnancies are reported to occur during previous lactation [3]. The incidence of unintended pregnancy during the first year postpartum was found to be 12.8 per 100 women years and 86% had resulted from non use of contraception [3]. Delaying contraception until first visit to hospital or sixth week postpartum increase the risk of unintended pregnancy. Progesterone only contraceptives in form of injectable depot medroxy progesterone acetate (DMPA) is a highly effective method for contraception especially in postpartum period.Progesterone contraception after birth is frequently recommended but the timing of initiation of depot medroxy progesterone acetate (DMPA) after delivery is controversial. Product labelling recommends initiating depot medroxy progesterone acetate (DMPA) four to six weeks postpartum regardless of breastfeeding status [4]. WHO recommends depot medroxy progesterone acetate (DMPA) in breastfeeding women should be initiated at 6 weeks [5]. ACOG recognizes the need for clinical judgement and weighing the need for contraception against theoretical risks and endorses the earlier initiation of DMPA postpartum in certain clinical situations, such as high risk of being lost to follow-up postpartum [6]. Theoretical concerns of infant safety and premature inhibition of lactation remain with early postpartum administration of depot medroxy progesterone acetate (DMPA). It is thought that newborn's system is immature to metabolize steroid hormones and therefore early initiation could affect the new born adversely [5]. However studies obstetrics and gynaecology Section indicate that infants are neither able to metabolize nor absorb progestin effectively until three months of age and the amount of hormone transferred is 0.05% of the maternal dose [7]. Another issue of interference with milk quality and production is also addressed and it has been shown that Progesterone only contraception may not impair lactation [8][9][10].Thus there exist a gap between existent evidence regarding early initiation of postpartum medroxy progesterone use and its impact on infant health and breast feeding. In present study we aimed to evaluate impact of short term use of inj DMPA in early postpartum period on infant health and breast feeding performance. MAterIAls And MethOdsA prospective case control study was conducted in department of Obstetrics and Gynaecology in a tertiary care teaching hospital. A total of 250 women who wanted some form of reversible contraception immediately after delivery were recruited in the study. All the women who were included were apparently healthy, 20-35-year-old women and had delivered a baby of gestational age ≥ 36 weeks and birth weight ≥ 2.5 kg. The recruited subjects had no medical or surgical illness including local abscess/ inverted nipple or breast pathology. Baby was with mother since birth and women were ready to follow-up. Grand multiparous women or those who had ...

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Section: Discussionsupporting

confidence: 67%

Impact of Injectable Progestogen Contraception in Early Puerperium on Lactation and Infant Health

Singhal

Sarda

Gupta

et al. 2014

JCDR

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“…In one, infant weight gain was the same for NET-EN, DMPA and Cu-IUD users up to month 3, after which weight gain was greater in both the DMPA and NET-EN groups [36]. No physical, mental or radiological differences were seen through 18 months.…”

Section: Rctsmentioning

confidence: 87%

“…One found that no women using NET-EN, DMPA or nonhormonal methods supplemented breastfeeding in the 6-month study period [36]. Another found that women using DMPA breastfed for longer than a historical control group, although no difference was noted compared with IUD users [37].…”

Section: Randomized Clinical Trialsmentioning

confidence: 99%

“…Three observational studies (one new) were identified. The new study did not find supplementation among infants of mothers receiving injectables nor among those who received no method [36]. Among the studies included in the previous review, one found no difference between DMPA and nonhormonal users in breastfeeding discontinuation or initiation of complementary foods [57].…”

Section: Observational Studiesmentioning

confidence: 99%

“…Three observational studies (none new) assessed the impact of maternal use of POIs initiated at 6 weeks postpartum or later; none is new. One found increased weight gain among infants of DMPA and NET-EN users compared with nonhormonal users and also found no physical, mental or radiological differences over 18 months [36]. Another similarly found no difference in mean weight between DMPA users and nonhormonal users through 24 months [57].…”

Section: Rctsmentioning

confidence: 99%

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Progestogen-only contraceptive use among breastfeeding women: a systematic review

2010

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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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Experience with Medroxyprogesterone Acetate (Depo‐Provera®) as an Injectable Contraceptive

Ellinas

1977

Intl J Gynecology & Obste

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Depo-Provera injections appear to be a safe and effective alternative for women who cannot tolerate the estrogenic side effects associated with oral contraceptives or the pain and bleeding associated with IUDs. However, women considering the method should be fully aware of the possible risks: (a) inability to withdraw the drug promptly in the event of a serious reaction, (b) disruption of menstrual patterns, and (c) delayed return of fertility after discontinuing therapy. Some women may consider the required trip to the doctor every 3 months an additional disadvantage. For women in developing countries where anemia and nutritional problems are prevalent, Depo-Provera has additional advantages in relation to IUDs and OCs: it causes less bleeding than IUDs or OCs and, unlike oral contraceptives, it does not suppress vitamin levels (4-8). Since it requires a trip to the doctor every 3 months, it also provides a better opportunity for medical supervision and care. For postpartum women who which to breastfeed their babies, Depo-Provera has the additional advantage of causing no adverse effect on lactation (1, 2, 13, 14, 16, 18, 19, 25, 32, 36).

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Injected Progestogen and Lactation

Cited by 11 publications

References 0 publications

Impact of Injectable Progestogen Contraception in Early Puerperium on Lactation and Infant Health

Impact of Injectable Progestogen Contraception in Early Puerperium on Lactation and Infant Health

Progestogen-only contraceptive use among breastfeeding women: a systematic review

Experience with Medroxyprogesterone Acetate (Depo‐Provera®) as an Injectable Contraceptive

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