"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.
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.
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).
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    . "
"Out of concern for protecting the normal drop in progesterone following delivery of the placenta, necessary for successful lactation, progesterone-only contraception should not be started prior to three weeks postpartum . On the other hand, there is a risk of decreased milk volume with use of combined hormonal contraceptives . For the breastfeeding woman, use of combined hormonal contraceptive should be discouraged or at least delayed until six months postpartum so as not to disturb exclusive breastfeeding. "
[Show abstract][Hide abstract] ABSTRACT: Breast milk has been shown to have multiple benefits to infant health and development. Therefore, it is important that maternal contraceptive choices consider the effects on lactation. Women who observe traditional Jewish law, halakha, have additional considerations in deciding the order of preference of contraceptive methods due to religious concerns including the use of barrier and spermicidal methods. In addition, uterine bleeding, a common side effect of hormonal methods and IUD, can have a major impact on the quality of intimacy and marital life due to the laws of niddah. This body of Jewish laws prohibits any physical contact from the onset of uterine bleeding until its cessation and for an additional week. Health care professionals should understand the issues of Jewish law involved in modern contraceptive methods in order to work in tandem with the halakha observant woman to choose a contraceptive method that preserves the important breastfeeding relationship with her infant and minimizes a negative impact on intimacy with her husband.
International Breastfeeding Journal 02/2007; 2:1. DOI:10.1186/1746-4358-2-1
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