Lactogenisis not impaired by early postpartum contraceptive implant

January 01, 0001

Lactogenisis not impaired by early postpartum contraceptive implant

These US investigators compared lactogenesis after early (1-3 days)vs standard (4-8 weeks) postpartum insertion of the etonogestrel contraceptive implant. Healthy peripartum women with healthy, term newborns who desired the etonogestrel implant for contraception were enrolled and randomized. The primary outcomes, time to lactogenesis stage II and lactation failure, were documented by a validated measure. The noninferiority margin for the mean difference in time to lactogenesis stage II was defined as 8 additional hours. Secondary data (device continuation and contraceptive use, breast milk analysis, supplementation rates, side effects, and bleeding patterns) were collected at periodic intervals for 6 months.

They found: "Sixty-nine women were enrolled. Thirty-five were randomly assigned to early insertion and 34 to standard insertion. There were no statistically significant differences between the groups in age, race, parity, mode of delivery, use of anesthesia, or prior breastfeeding experience. Early insertion was demonstrated to be noninferior to standard insertion in time to lactogenesis stage II (early: 64.3 hours; standard: 65.2 hours, mean difference). Early insertion was also demonstrated to be noninferior to standard insertion in incidence of lactation failure (1/34 {3%} in the early insertion group, 0/35 {0%} in the standard insertion group. Use of formula supplementation was not significantly different between the groups. Milk composition at 6 weeks was not significantly different between the groups."

The authors concluded: "Breastfeeding outcomes were similar in women who underwent early compared with standard postpartum insertion of the etonogestrel implant."

Early insertion would be advisable when there are concerns regarding follow-up care.

For the full abstract, click here.

Obstet Gynecol 117(5):1114-1121, May 2011 © 2011 to the American College of Obstetricians and Gynecologists
Lactogenesis After Early Postpartum Use of the Contraceptive Implant: A Randomized Controlled Trial. Shawn E. Gurtcheff, David K. Turok, Greg Stoddard, Patricia A. Murphy, Mark Gibson, Kirtly P. Jones.

Category: W. Pregnancy, Family Planning, X. Female Genital System, Breast. Keywords: contraception, etonogestrel implant, postpartum, lactogenesis, breastfeeding, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 31 May 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.