The Influence of Medroxyprogesterone on the Duration of Breast-feeding in Mothers in an Urban Community

Poor production of breast milk is the most frequent cause of breast lactation failure. Often, physician prescribe medications or other substances to solve this problem. The use of galactogogues should be limited to those situations in which reduced milk production from treatable causes has been excluded. One of the most frequent indication for the use of galactogogues is the diminution of milk production in mothers using indirect lactation, particularly in the case of preterm birth. The objective of this review is to analyze to the literature relating to the principal drugs used as galactogogues (metoclopramide, domperidone, chlorpromazine, sulpiride, oxytocin, growth hormone, thyrotrophin releasing hormone, medroxyprogesterone). Have been also analyzed galactogogues based on herbs and other natural substances (fenugreek, galega and milk thistle). We have evaluated their mechanism of action, transfer to maternal milk, effectiveness and potential side effects for mother and infant, suggested doses for galactogogic effect, and recommendation for breastfeeding.

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“…Clinical data: Limited clinical studies suggest that the drug is moderately effective in increasing milk production (34,75,29) .…”

Section: Mechanism Of Action: It Is Unknownmentioning

confidence: 99%

Safety and Efficacy of Galactogogues: Substances that Induce, Maintain and Increase Breast Milk Production

Zuppa¹,

Sindico²,

Orchi³

et al. 2010

J Pharm Pharm Sci

165

168

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“…[22][23][24][25][26][27][28][29] For completeness, the literature represented in the U.S. MEC report was cross-checked with the PubMed literature search, and this produced an additional three articles. [30][31][32] Lastly, after we read those 11 documents and hand-searched references, an additional nine articles were identified that potentially met the study's inclusion criteria. [33][34][35][36][37][38][39][40][41] In total, 20 articles were evaluated, and three articles 22,29,32 satisfied the systematic review inclusion criteria; the reasons for exclusion included review article (n = 3), medroxyprogesterone not administered in the immediate postpartum period (n = 9), medroxyprogesterone not administered ever (n = 4), and no measure of breastfeeding cessation (n = 1).…”

Section: Resultsmentioning

confidence: 99%

“…Hannon et al 32 reported no significant difference in early breastfeeding cessation between early postpartum medroxyprogesterone recipients and nonrecipients, but they discussed a nonstatistically significant trend toward favorable breastfeeding outcomes in the medroxyprogesterone group. The authors conducted a prospective cohort study of 95 women in Baltimore, MD to assess the effect of medroxyprogesterone administered prior to hospital discharge (compared with nonhormonal contraceptive methods) on breastfeeding duration and exclusivity.…”

Section: Resultsmentioning

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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“…Another found that NET-EN and (presumably nonhormonal) IUD users had no difference in time to first supplementary feeding, but infants of IUD users weaned earlier [40]. Mothers who received either DMPA or a nonhormonal method at hospital discharge had no differences in breastfeeding exclusivity, supplementation or duration [41]. Finally, when DMPA initiated at hospital discharge was compared with nonhormonal method use, no differences were found in breastfeeding at 2 or 6 weeks, although fewer DMPA users were breastfeeding at 4 weeks [42].…”

Section: Randomized Clinical Trialsmentioning

confidence: 99%

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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The Influence of Medroxyprogesterone on the Duration of Breast-feeding in Mothers in an Urban Community

Cited by 27 publications

References 24 publications

Safety and Efficacy of Galactogogues: Substances that Induce, Maintain and Increase Breast Milk Production

Safety and Efficacy of Galactogogues: Substances that Induce, Maintain and Increase Breast Milk Production

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

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

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