"A systematic review concluded that existing evidence is of 'low' methodologic quality, and consequently, inferences drawn from these studies may be invalid; the authors suggested that the evidence is not adequate to either accept or reject a causal relationship between immediate postpartum DMPA use and early breastfeeding cessation . A biologic model describing an alteration in the inverse homeostatic relationship between prolactin and progesterone in the presence of postpartum DMPA use has been discussed in detail elsewhere   . The Centers for Disease Control and Prevention used these studies of 'low' methodologic rigor as the basis for their recommendation supporting the use of immediate postpartum DMPA use among lactating women   . "
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: This study evaluated the effect of immediate postpartum depot medroxyprogesterone (DMPA) on breastfeeding cessation within 6 weeks postpartum. STUDY DESIGN: At low-income-serving obstetric and pediatric clinics, eligible mothers within 1 year postpartum were recruited to participate in a retrospective cohort study. The 183 participants completed a self-administered survey. Surveys were merged with birth certificate data and perinatal maternal/infant medical records. Kaplan-Meier distributions assessed the relationship between DMPA use and breastfeeding cessation. A multivariable Cox proportional hazards model estimated hazard ratios (HRs) and included five known risk factors (age, education, race, parity and parental cohabitation) and identified potential confounders. RESULTS: Consistent with the biologic model, the Kaplan-Meier results raised the possibility of a detrimental effect of DMPA on duration of any breastfeeding, but differences in these distributions did not achieve statistical significance (p=.24); after adjustment for potential confounders, this nonstatistically significant association remained (HR: 1.22; confidence interval: 0.75-1.98). CONCLUSION: Given the state of the evidence, it is unclear whether a causal effect does or does not exist. However, if there is a causal effect of DMPA on breastfeeding duration, it is minimal. Additional well-designed research is warranted.
"Its use immediately postpartum in women who are intending to fully breastfeed remains controversial strictly due to theoretical concerns about adverse neonatal outcomes and impact on initiation of lactogenesis. Available data conclude that DMPA has beneficial effects on quantity and duration of breastfeeding    . The limited data which assesses immediate DMPA use and neonatal outcomes have not observed adverse effects    . "
[Show abstract][Hide abstract] ABSTRACT: In the absence of significant, unpreventable risks, breastfeeding should be the norm for the nourishment of human infants and should, therefore, be encouraged for populations in all countries. Continued efforts of international and national agencies and healthcare professionals to aid and abet breastfeeding, reduce the risks that occur in some women during breastfeeding, provide the safest substitutes for human milk when that is necessary, and encourage further research into the posed questions should considerably improve the health of many children.
Advances in Pediatrics 02/2007; 54:275-304. DOI:10.1016/j.yapd.2007.03.014
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