Premature introduction of progestin-only contraceptive methods during lactation

Kennedy, Kathy I.; Short, R. V.; Tully, Mary Rose

doi:10.1016/s0010-7824(97)00042-5

Cited by 43 publications

(34 citation statements)

References 13 publications

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“…Theoretical concerns also have been raised regarding the impact of exposure to progestogens on neonates, particularly in the first 6 weeks of life [7]. Studies identified in this review showed no consistent adverse effects of exposure to progestogens through breast milk on infant health outcomes such as growth, development and health through the first few years of life.…”

Section: Discussionmentioning

confidence: 88%

“…They are highly effective when used as directed [6]. The use of progestogen-only methods of contraception [progestogen-only contraceptives (POCs)] during the period of lactation has raised concerns for negative effects [7]. Progestogens could interfere with lactogenesis, especially immediately postpartum [8], and have been shown to be transferred to breast milk [9].…”

Section: Introductionmentioning

confidence: 99%

“…It is therefore possible that POCs may affect infant health or development [11]. The large loading dose of progestogens found in the injectable depot medroxyprogesterone acetate (DMPA) has been particularly called into question [7].…”

Section: Introductionmentioning

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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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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

2010

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“…5 Data regarding medroxyprogesterone use in the early postpartum period (<6 weeks) were not available for inclusion in the Food and Drug Administration application, and consequently no such data are included in the package insert. 6,7 Moreover, the package insert does not provide guidance for postpartum use among non-exclusively breastfeeding women.…”

mentioning

confidence: 99%

“…8,10 The action of infant suckling increases prolactin levels, causing alveolar cells to produce milk. 6,9 The combination of suckling and heightened prolactin levels prompts oxytocin levels to increase, causing contractions around the alveoli that release milk into the ductal system. 9,11 If a breastfeeding woman receives medroxyprogesterone in the immediate (prior to hospital discharge) or early (<6 weeks) postpartum period, the artificially elevated progesterone levels may prevent the homeostatic increase in prolactin levels required to establish lactation and ultimately may interfere with milk production prior to the transition from an endocrine to an autocrine process.…”

mentioning

confidence: 99%

A Systematic Review of Early Postpartum Medroxyprogesterone Receipt and Early Breastfeeding Cessation: Evaluating the Methodological Rigor of the Evidence

Brownell

Fernandez

Howard

et al. 2012

Breastfeeding Medicine

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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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