1
|
Cooper M, Black K, Cameron S. Expanding access to postpartum contraception. Curr Opin Obstet Gynecol 2024; 36:331-337. [PMID: 39109628 PMCID: PMC11361352 DOI: 10.1097/gco.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW Women are particularly vulnerable to unintended pregnancy in the 12 months following a birth. Improving access to postpartum contraception within maternity settings can prevent unintended and closely spaced births, improving the health of mother and child. This review will summarize the recent research in postpartum contraception (PPC), building on existing knowledge and developments in this field. RECENT FINDINGS Current models of postpartum contraceptive provision may not adequately meet women's needs. The COVID-19 pandemic led to changes in postpartum contraceptive provision, with an increasing emphasis placed on maternity services. Antenatal contraceptive discussion is associated with increased postpartum contraceptive planning and uptake of methods after birth. Digital health interventions may be a useful tool to support information about contraception. The most effective long-acting reversible contraceptive (LARC) methods, such as the intrauterine device (IUD) and implant, can be challenging to provide in the maternity setting because of availability of trained providers. Postpartum IUD insertion remains relatively under-utilized, despite evidence supporting its safety, efficacy and cost-effectiveness. SUMMARY Antenatal information needs to be partnered with access to the full range of methods immediately after birth to reduce barriers to PPC uptake. Training and education of maternity providers is central to successful implementation of PPC services.
Collapse
Affiliation(s)
- Michelle Cooper
- Chalmers Sexual Health Centre, NHS Lothian & Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Kirsten Black
- Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Sydney, Australia
| | - Sharon Cameron
- Chalmers Sexual Health Centre, NHS Lothian & Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Nguyen AT, Curtis KM, Tepper NK, Kortsmit K, Brittain AW, Snyder EM, Cohen MA, Zapata LB, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep 2024; 73:1-126. [PMID: 39106314 PMCID: PMC11315372 DOI: 10.15585/mmwr.rr7304a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1-103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.
Collapse
Affiliation(s)
- Antoinette T. Nguyen
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kathryn M. Curtis
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Naomi K. Tepper
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Anna W. Brittain
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Emily M. Snyder
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Megan A. Cohen
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Lauren B. Zapata
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Maura K. Whiteman
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| |
Collapse
|
3
|
Laing A, Thomas L, Hillard T, Panay N, Briggs P. Exploring the potential for a set of UK hormone replacement therapy eligibility guidelines: A suggested proposal on the topic of venous thromboembolism. Post Reprod Health 2024; 30:39-54. [PMID: 38149845 DOI: 10.1177/20533691231223682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To explore the feasibility for a set of hormone replacement therapy (HRT) eligibility guidelines that follow a similar structure and appearance to the UKMEC guidance for contraception. To enable non-specialists to feel confident in safely prescribing HRT and to aid selection of the most appropriate first line treatment. METHODS A literature review was undertaken with evidence summarised on the topic of venous thromboembolism (VTE) which is an area frequently considered a barrier to prescribing. Medical eligibility tables which separated HRT by type were then produced for a set of VTE-related topics. RESULTS The literature search confirmed the importance of distinguishing between different types and routes of administration when considering the suitability of HRT. Much of the evidence has been based on older synthetic types of HRT and whilst they still have a role in management, these medications carry different risks to the now more accepted use of body identical types. The search also highlighted the nuances involved, increasing the complexity of forming guidelines, with the need for consideration to be given to an individual's own perception of risks and benefits. CONCLUSION The demand for HRT has risen in recent years and there is a need for this to be managed effectively, particularly for patients in primary care. The production of this type of guidance will enable the non-specialist to feel confident in safe and evidence-based prescribing. The guidelines are also designed to demonstrate to prescribers which complex patients should be referred onto menopause specialists.
Collapse
Affiliation(s)
- Abbie Laing
- Poole Menopause Centre University Hospitals Dorset, Poole, UK
| | - Lindsey Thomas
- Leeds Menopause Service, Meanwood Health Centre, Leeds, UK
| | - Tim Hillard
- Poole Menopause Centre University Hospitals Dorset, Poole, UK
| | - Nick Panay
- Imperial College Healthcare NHS Trust, UK
| | | |
Collapse
|
4
|
Grandi G, Del Savio MC, Tassi A, Facchinetti F. Postpartum contraception: A matter of guidelines. Int J Gynaecol Obstet 2024; 164:56-65. [PMID: 37334892 DOI: 10.1002/ijgo.14928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding patients between 6 weeks and 6 months after delivery (Medical Eligibility Criteria category 3). On the contrary, the Faculty of Sexual and Reproductive Healthcare and the Centers for Disease Control and Prevention guidelines do not contraindicate their use in women who breastfeed from 6 weeks to 6 months postpartum. New combined hormonal contraceptives with natural estrogens have never been studied in this setting. Guidelines agree on the prescription of the progestin-only pill postpartum in non-breastfeeding women (category 1). Differences are found in women who breastfeed. In non-breastfeeding women, an implant is considered safe (category 1) by all guidelines, without any distinction in time. Regarding postpartum breastfeeding women, the guidelines for implants give quite different indications but are still permissive. Intrauterine devices are viable options for postpartum contraception but guidelines give different indications about the timing of insertion. Postplacental intrauterine device placement can reduce the subsequent unintended pregnancy rate, particularly in settings at greatest risk of not having recommended postpartum controls. However, it has yet to be understood whether this approach can really have an advantage in high-income countries. Postpartum contraception is not a 'matter of guidelines': it is the best customization for each woman, as early as possible but at the ideal timing.
Collapse
Affiliation(s)
- Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Maria C Del Savio
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Alice Tassi
- Clinic of Obstetrics and Gynecology, DAME, University Hospital of Udine, Udine, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| |
Collapse
|
5
|
Jin X, Perrella SL, Lai CT, Taylor NL, Geddes DT. Causes of Low Milk Supply: The Roles of Estrogens, Progesterone, and Related External Factors. Adv Nutr 2024; 15:100129. [PMID: 37832920 PMCID: PMC10831895 DOI: 10.1016/j.advnut.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Low milk supply (LMS) poses a significant challenge to exclusive and continued breastfeeding, affecting ∼10% to 15% of mothers. Milk production is intricately regulated by both endocrine and autocrine control mechanisms, with estrogens and progesterone playing pivotal roles in this process. In addition to endogenously produced hormones, external substances capable of interfering with normal hormonal actions, including phytoestrogens, mycoestrogens, synthetic estrogens, and hormonal contraceptives, can influence milk production. The effects of these extrinsic hormones on milk production may vary based on maternal body mass index. This comprehensive review examines the multifaceted causes of LMS, focusing on the involvement of estrogens, progesterone, and related external factors in milk production. Furthermore, it investigates the interplay between hormonal factors and obesity, aiming to elucidate the endocrine mechanisms underlying obesity-associated LMS. Insights from this review provide valuable perspectives for developing interventions to improve milk production and address the challenges associated with LMS.
Collapse
Affiliation(s)
- Xuehua Jin
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Sharon L Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Nicolas L Taylor
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia; ARC Training Centre in Biomedical Analysis, The University of Western Australia, Crawley, Western Australia, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia; ARC Training Centre in Biomedical Analysis, The University of Western Australia, Crawley, Western Australia, Australia. donna@
| |
Collapse
|
6
|
Segev L, Weitzman G, Katz-Samson G, Samson AO, Shrem G, Srebnik N. Combined Hormonal Contraception during Breastfeeding-A Survey of Physician's Recommendations. J Clin Med 2023; 12:7110. [PMID: 38002722 PMCID: PMC10671995 DOI: 10.3390/jcm12227110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Until breastfeeding is established, progesterone-only pill (POP) use is preferable over combined hormonal contraception (CHC), as the latter potentially reduces milk production. Yet, POPs are often associated with breakthrough bleeding (BTB), and irregular spotting is often a reason for their cessation. Conversely, CHC is less associated with BTB but is not usually prescribed, even if breastfeeding has been established, despite its verified safety profile. Here, we surveyed physicians' perception of CHC safety during breastfeeding through an online questionnaire (N = 112). Physicians were asked if they would prescribe CHC to a woman three months postpartum, breastfeeding fully, and suffering from BTB while using POPs. Half of the physicians responded they would, 28% would not until six months postpartum, while 14% would not during breastfeeding. Of the physicians that would prescribe CHC, 58% would without any reservation, 24% would only after discussing milk reduction with the patient, 9% would use a pill with a lower hormonal dose, and 9% would only prescribe CHC 3 months postpartum. The main risk associated with CHC during breastfeeding, as perceived by physicians, is a potential decrease in breast milk production (88%). While some physicians consider CHC unsafe during breastfeeding, most health organizations consider CHC compatible with breastfeeding 5-6 weeks after birth. Thus, there is a gap in the attitude and knowledge of physicians about the safety profile of CHC, and only half acknowledge that the risk of BTB justifies the use of CHC instead of POPs while breastfeeding three months postpartum. We highlight the importance of physician's education, advocate CHC breastfeeding compatibility if breastfeeding has been established (i.e., 30 days postpartum), and underline the importance of discussing the option of CHC with patients in case POPs have unwanted side effects.
Collapse
Affiliation(s)
- Lior Segev
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel;
- PUAH Institute: Fertility, Medicine, Halacha, Jerusalem 9547735, Israel
| | - Gideon Weitzman
- PUAH Institute: Fertility, Medicine, Halacha, Jerusalem 9547735, Israel
| | - Goldie Katz-Samson
- Nishmat: The Jeanie Schottenstein Center for Advanced Torah Study for Women, Jerusalem 9328249, Israel
| | - Abraham O. Samson
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel;
| | - Guy Shrem
- IVF Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot 7610001, Israel;
| | - Naama Srebnik
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel;
- IVF Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| |
Collapse
|
7
|
Sausjord IK, Acton LW, White KO, O'Connor SK, Lerner NM. Breastfeeding and Hormonal Contraception: A Scoping Review of Clinical Guidelines, Professional Association Recommendations, and the Literature. Breastfeed Med 2023; 18:645-665. [PMID: 37672571 DOI: 10.1089/bfm.2023.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background: Postpartum contraceptive use can help prevent short-interval pregnancies, which have been associated with adverse neonatal and maternal health outcomes. Many contraceptive methods are safe for postpartum use, but patients and providers may be confused as to what impact hormonal contraception has on lactation. We performed a scoping review of the most recent U.S.-based guidelines regarding hormonal contraception on lactation to provide synthesis and recommendations to aid providers in counseling their patients. Methods: We conducted a scoping review by identifying the most recent clinical recommendations and guidelines from the Centers for Disease Control and Prevention (CDC) and three maternal and child health professional associations (American College of Obstetricians and Gynecologists [ACOG], Society for Maternal-Fetal Medicine [SMFM], and Academy of Breastfeeding Medicine [ABM]). We also reviewed the citations in these guidelines used in their development. We then conducted an updated literature review to capture studies published since the most recent systematic reviews were conducted. Results: We reviewed 1 clinical guideline from the CDC and 2 systematic reviews cited in its references, 6 professional association recommendations, and 28 publications identified through the updated literature review. Progestin-only contraceptive methods continue to demonstrate safety in breastfeeding patients, while low-quality evidence supports concerns of decreased milk supply with combined hormonal contraception. Discussion: Organizations should consider updating counseling recommendations regarding progestin-only contraceptives and lactation. Further research is needed to examine new contraceptive methods as well as the effect of hormonal contraception on lactation in the setting of preterm birth.
Collapse
Affiliation(s)
- Isabel K Sausjord
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lillian W Acton
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Katharine O White
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Sarah K O'Connor
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Natasha M Lerner
- Boston University SchooI of Medicine, Boston, Massachusetts, USA
- Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Eglash A. Re: "The Risk of Breakthrough Bleeding Justifies the Use of Combined Hormonal Contraception Over Progesterone-Only Pills While Breastfeeding" by Segev et al: Combined Hormonal Contraception During Lactation Is Not Without Risk and Requires Shared Decision Making. Breastfeed Med 2023; 18:400-401. [PMID: 37126775 DOI: 10.1089/bfm.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Anne Eglash
- University of Wisconsin System, Madison, Wisconsin, USA
| |
Collapse
|
9
|
Mirafzali S, Akbari Sari A, Iranpour A, Alizadeh S. Breastfeeding Duration and Its Effective Factors in Kerman Province, Iran. Glob Pediatr Health 2022; 9:2333794X221133019. [PMID: 36420453 PMCID: PMC9677159 DOI: 10.1177/2333794x221133019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/28/2022] [Indexed: 07/29/2024] Open
Abstract
INTRODUCTION Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers' ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors. METHODS This analytical cross-sectional study was conducted in 2020. This study was performed at all health centers and health homes affiliated to Kerman University of Medical Sciences, in Kerman province, Iran. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach's alpha of 85%. Data were analyzed using SPSS software version 16. RESULTS The mean time of breastfeeding was 19.23 ± 7.09 months and the median was 22-month-year. About 41% of children were breastfed until 24-month. There was a significant relationship between the time of CCB with contraception, number of households, place of residence, and weight at 6-month at the level of 0.05. CONCLUSION Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB is near to the suggestions of the World Health Organization (WHO) and religious teachings.
Collapse
Affiliation(s)
| | - Ali Akbari Sari
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abedin Iranpour
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Alizadeh
- Health education & Promotion, Department of Health Education and Promotion, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
10
|
Agula C, Henry EG, Asuming PO, Obeng-Dwamena A, Toprah T, Agyekum MW, Shah I, Bawah AA. Postpartum contraceptive initiation and use: Evidence from Accra, Ghana. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221141290. [PMID: 36476194 PMCID: PMC9742708 DOI: 10.1177/17455057221141290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postpartum contraceptive use reduces unintended pregnancies and results in better health outcomes for children and women. However, there is a dearth of knowledge on postpartum contraceptive use in Ghana, particularly among women in low-income urban settings. To shed light on strategies that might enhance access to postpartum family planning services in low-income urban settings, we examined contraceptive use among postpartum women in Accra, Ghana, at 1, 3, 6, and 12 months following the birth and the methods used. The predictors of modern contraceptive use in the 12-month postpartum period were also examined. METHODS Data come from a cross-sectional survey conducted in 2018 among 624 women aged 16-44 years who reported giving birth in the past 13-31 months prior to the interview. We generated descriptive statistics to examine the prevalence of contraceptive use among postpartum women at 1, 3, 6, and 12 months after birth. We further estimated a binary logistic regression to examine the predictors of modern contraceptive use at 12 months postpartum. RESULTS Forty percent of postpartum women never used any contraceptive method during 1 year after birth and of those who used a method, 40% relied on traditional methods. Moreover, 29% of women started using a method the immediate 1 month post-birth. Results further show that postpartum modern contraceptive uptake was positively associated with higher education, having more live births, and being currently in a union. CONCLUSIONS Findings highlight that there may be opportunities to improve the quality of counseling during antenatal and postnatal care visits by clients to ensure fully informed choices regarding postpartum contraception. Community outreach by health providers/promoters or similar models should be promoted in low-income population settings to educate postpartum women on modern contraceptive use. Women who plan to use traditional methods should be provided with information on the consistent and correct use of these methods.
Collapse
Affiliation(s)
- Caesar Agula
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Elizabeth G Henry
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Patrick O Asuming
- University of Ghana Business School, University of Ghana, Accra, Ghana
| | - Akua Obeng-Dwamena
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Theophilus Toprah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | | | - Iqbal Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ayaga A Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| |
Collapse
|
11
|
Anim T, Na’Allah R, Griebel C. Postpartum Care. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Impact of subchronic variable stress on ovariectomy and dendritic spine density in prefrontal cortex in mice. Neuroreport 2021; 31:213-219. [PMID: 31895742 DOI: 10.1097/wnr.0000000000001384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Major depressive disorder affects both women and men but females are two times more susceptible to the incidence of depression. The majority of stress models used male rodents, whereas fewer studies included females. Volumetric reductions have been reported in brain areas critical for the stress response, such as prefrontal cortex, and remodeling of dendritic spines has been proposed as an underlying factor. The aim of this study was to determine the effects of subchronic variable stress (SCVS) in males, sham, and specifically in ovariectomized (OVX) female mice. Here, we used 6 days SCVS model to induce depressive-like behavior, and only the OVX female mice showed the depressive-like behavior, while males showed resilient type behavior. Only OVX female mice showed significant increase in dendritic spine density in SCVS paradigm. Overall, this study suggests that (1) the effects SCVS produced on the behavior of males and OVX females and (2) SCVS may induce rapid and sustained changes of PL neurons, which highlights the importance of gonadal hormones in studying depression.
Collapse
|
13
|
Postpartum Care. Fam Med 2021. [DOI: 10.1007/978-1-4939-0779-3_15-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Abstract
In the context of medically complicated pregnancies, a "high risk patient" is an individual who is at increased risk for having a complicated pregnancy. These patients often experience limited contraceptive counseling and access, despite the fact that most effective contraceptive methods are associated with less risk than that of pregnancy. Free evidence-based resources are available to assist healthcare providers in discerning fact from myth about the risks of contraception. This review covers all available contraceptive methods, with particular focus on the benefits, risks, and attributes most relevant to high risk patients as well as the benefits and risks of initiating contraception post-pregnancy.
Collapse
|
15
|
ACOG Practice Bulletin No. 206: Use of Hormonal Contraception in Women With Coexisting Medical Conditions. Obstet Gynecol 2019; 133:e128-e150. [PMID: 30681544 DOI: 10.1097/aog.0000000000003072] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Although numerous studies have addressed the safety and effectiveness of hormonal contraceptive use in healthy women, data regarding women with underlying medical conditions or other special circumstances are limited. The U.S. Medical Eligibility Criteria (USMEC) for Contraceptive Use, 2016 (), which has been endorsed by the American College of Obstetricians and Gynecologists, is a published guideline based on the best available evidence and expert opinion to help health care providers better care for women with chronic medical problems who need contraception. The goal of this Practice Bulletin is to explain how to use the USMEC rating system in clinical practice and to specifically discuss the rationale behind the ratings for various medical conditions. Contraception for women with human immunodeficiency virus (HIV) (); the use of emergency contraception in women with medical coexisting medical conditions, including obesity, (); and the effect of depot medroxyprogesterone acetate (DMPA) on bone health () are addressed in other documents from the American College of Obstetricians and Gynecologists.
Collapse
|
16
|
Mayhew A, Ermias Y, Zapata LB, Pagano HP, Tepper NK. Health Care Provider Attitudes Toward Safety of Selected Hormonal Contraceptives in Breastfeeding Women. Matern Child Health J 2019; 23:1079-1086. [PMID: 31069600 PMCID: PMC10983027 DOI: 10.1007/s10995-019-02743-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Little is known about provider attitudes regarding safety of selected hormonal contraceptives among breastfeeding women. METHODS Using a nationwide survey, associations were analyzed between provider characteristics and perception of safety of combined oral contraceptives (COCs) in breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors and depot medroxyprogesterone acetate (DMPA) in breastfeeding women < 1 month postpartum and ≥ 1 month postpartum. RESULTS Approximately 68% of public-sector providers considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among non-physicians versus physicians (adjusted odds ratios [aOR] range 0.34-0.51) and those with a focus on adolescent health/pediatrics versus reproductive health (aOR 0.68, 95% confidence interval [CI] 0.47-0.99). Most public-sector providers considered DMPA safe for breastfeeding women during any time postpartum, with lower odds among non-physicians versus physicians (aOR range 0.20-0.54) and those with primary clinical focus other than reproductive health (aOR range 0.26-0.65). The majority of office-based physicians considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among those who did not use, versus those who used, CDC's contraceptive guidance (aOR 0.40, 95% CI 0.21-0.77). Most office-based physicians also considered DMPA safe for breastfeeding women during any time postpartum. CONCLUSIONS FOR PRACTICE A high proportion of providers considered use of selected hormonal contraceptives safe for breastfeeding women, consistent with evidence-based guidelines. However, certain provider groups might benefit from education regarding the safety of these methods for breastfeeding women.
Collapse
Affiliation(s)
- Allison Mayhew
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Yokabed Ermias
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - H Pamela Pagano
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA.
| |
Collapse
|
17
|
Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman WV, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. No. 329-Canadian Contraception Consensus Part 4 of 4 Chapter 9: Combined Hormonal Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:229-268.e5. [PMID: 28413042 DOI: 10.1016/j.jogc.2016.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. OUTCOMES Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, safety, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the availability of cited contraceptive methods in Canada. EVIDENCE Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1994 to December 2015 in order to update the Canadian Contraception Consensus published February-April 2004. Relevant Canadian government publications and position papers from appropriate health and family planning organizations were also reviewed. VALUES The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice are ranked according to the method described in this report. SUMMARY STATEMENTS RECOMMENDATIONS.
Collapse
|
18
|
Dean J, Kramer KJ, Akbary F, Wade S, Hüttemann M, Berman JM, Recanati MA. Norethindrone is superior to combined oral contraceptive pills in short-term delay of menses and onset of breakthrough bleeding: a randomized trial. BMC WOMENS HEALTH 2019; 19:70. [PMID: 31138184 PMCID: PMC6537409 DOI: 10.1186/s12905-019-0766-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/13/2019] [Indexed: 12/03/2022]
Abstract
Background To determine whether oral norethindrone acetate is superior to combined oral contraceptives (OCP) in delaying menstruation and preventing breakthrough bleeding when started late in the cycle. Methods This article comprises of a case control study followed by a pilot randomized controlled study. In the first study, four women who presented late in their cycle and desired avoiding vaginal bleeding within 10 days before a wedding were started on norethindrone 5 mg three times daily and compared to age matched controls started on OCPs. Subsequently, a randomized controlled pilot study (n = 50) comparing OCPs to norethindrone for the retiming of menses was conducted. Percentage of women reporting spotting were compared with level of statistical significance set at p < 0.05. Results Of the norethindrone treated group, only 2 women (8%) reported spotting compared with 10 women (43%) in the control group (p < 0.01). Norethindrone recipients experienced significant weight gain, which resolved after cessation of therapy and had heavier withdrawal bleed (p < 0.04) when compared to controls. Patient satisfaction was significantly higher in the norethindrone group, with 80% willing to choose this method again. Time to conceive was significantly shorter in the norethindrone group (p < 0.03). Conclusions Norethindrone, begun on or before cycle day 12, is superior for women who desire to avoid breakthrough bleeding and maintain fertility when compared to OCPs. It is an ideal approach in patients presenting late in their cycle and who desire delaying menses as well as in circumstances when even minute amounts of breakthrough bleeding cannot be tolerated. Trial registration Clinicaltrials.gov NCT03594604, July 2018. Retrospectively registered.
Collapse
Affiliation(s)
- Joshua Dean
- School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Katherine J Kramer
- Department of Obstetrics and Gynecology, St. Vincent's Catholic Medical Centers, New York, NY, 10011, USA
| | - Fauzia Akbary
- Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Shaunte Wade
- School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Maik Hüttemann
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Jay M Berman
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48201, USA
| | - Maurice-Andre Recanati
- NIH-Women's Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48201, USA.
| |
Collapse
|
19
|
Bryant AG, Bauer AE, Muddana A, Wouk K, Chetwynd E, Yourkavitch J, Stuebe AM. The Lactational Effects of Contraceptive Hormones: an Evaluation (LECHE) Study. Contraception 2019; 100:48-53. [PMID: 30898657 DOI: 10.1016/j.contraception.2019.03.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the proportion of women for whom use of hormonal contraception was associated with reporting a decreased breast milk supply. STUDY DESIGN The Lactational Effects of Contraceptive Hormones: an Evaluation ("LECHE") Study was an anonymous, internet-based, exploratory, cross-sectional survey of postpartum women using approximately 70 questions. Women were eligible to participate in the survey if they were 18 years or older, had a singleton infant between 3 and 9 months of age, had breastfed this infant for any amount of time and could read English. The survey included questions about breastfeeding, reproductive health, demographic characteristics and the timing of postpartum events. RESULTS A total of 3971 participants clicked on the survey. Our final study population included 2922 participants. Overall, 1201 (41%) reported having had milk supply concerns at some point in the first 12 weeks postpartum. The median time from birth until milk supply concerns was 3 weeks (IQR 1-7). Eight hundred fifty-two women (29%) started hormonal contraception in the first 12 weeks postpartum. Fifteen percent (127/852) of women reported new or additional milk supply concerns after starting hormonal contraception. Reported milk supply concerns were higher for women who used hormonal contraception than those who did not (44% vs. 40%; p=.05) Adjusted hazard ratios (HRs) assessing the association between contraceptive use and time to milk supply concerns were not statistically significant (HR 1.18, 95% confidence interval 0.94-1.47 for any type of hormonal contraception). CONCLUSIONS This study found a slightly increased proportion of reported milk supply concerns among women who started hormonal contraception. IMPLICATIONS It is important for caregivers in the postpartum period to recognize the potential for multiple factors, including initiation of hormonal contraception, to affect breastfeeding. Patient-centered counseling can help elicit women's values and preferences regarding breastfeeding and pregnancy prevention.
Collapse
Affiliation(s)
- Amy G Bryant
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Division of Family Planning, Gillings School of Public Health Department of Maternal and Child Health.
| | - Anna E Bauer
- University of North Carolina School of Medicine, Department of Psychiatry, UNC Center for Women's Mood Disorders
| | - Anitha Muddana
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, North Carolina Womens Hospital, Department of Lactation
| | - Kathryn Wouk
- University of North Carolina Gillings School of Global Public Health, Maternal and Child Health Department, Carolina Global Breastfeeding Institute
| | - Ellen Chetwynd
- North Carolina State University, College of Agriculture and Life Sciences, Food, Bioprocessing & Nutrition Sciences
| | - Jennifer Yourkavitch
- University of North Carolina Gillings School of Global Public Health, Maternal and Child Health Department
| | - Alison M Stuebe
- University of North Carolina School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Carolina Global Breastfeeding Institute, Gillings School of Public Health
| |
Collapse
|
20
|
Horibe M, Hane Y, Abe J, Matsui T, Kato Y, Ueda N, Sasaoka S, Motooka Y, Hatahira H, Hasegawa S, Kinosada Y, Hara H, Nakamura M. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open 2018; 5:131-138. [PMID: 29599988 PMCID: PMC5867283 DOI: 10.1002/nop2.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
Abstract
Aim Postpartum depression is a mood disorder that commonly affects women during the early postpartum period. The objective of this study was to analyse the association of postpartum depression with drugs (including contraceptive devices and implants) with spontaneously reported adverse events reported in the US Food and Drug Administration Adverse Event Reporting System database. Design Retrospective study. Method Reports of postpartum depression events between 2004–2015 were analysed with a reporting odds ratio (ROR) algorithm. The Medical Dictionary for Regulatory Activities was used to identify postpartum depression. Results The reporting odds ratios (95% confidence intervals, CI) of levonorgestrel (an intrauterine device with progestogen), etonogestrel (a hormonal contraceptive implant), sertraline and drospirenone (an oral contraceptive) were 12.5 (8.7–18.0), 14.0 (8.5–22.8), 12.2 (6.5–23.1) and 5.4 (2.7–10.9) respectively. Among the drugs in the US Food and Drug Administration Adverse Event Reporting System database, the use of contraceptives or an intrauterine device with progestogen might convey risk for postpartum depression.
Collapse
Affiliation(s)
- Megumi Horibe
- Department of Nursing School of Health Sciences Asahi University Gifu Japan.,Molecular Pharmacology Department of Biofunctional Evaluation Gifu Pharmaceutical University Gifu Japan
| | - Yuuki Hane
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Junko Abe
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan.,Medical Database Co., LTD Tokyo Japan
| | - Toshinobu Matsui
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Yamato Kato
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan.,Present address: Department of Environmental Affairs and Citizen Support Gifu Prefectural Government Gifu Japan
| | - Natsumi Ueda
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan.,Present address: Division of Pharmacy Ehime University Hospital Shitsukawa, Toon Ehime Japan
| | - Sayaka Sasaoka
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Yumi Motooka
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Haruna Hatahira
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Shiori Hasegawa
- Laboratory of Drug InformaticsGifu Pharmaceutical University Gifu Japan
| | - Yasutomi Kinosada
- United Graduate School of Drug Discovery and Medical Information Sciences Gifu University Graduate School of Medicine Gifu Japan
| | - Hideaki Hara
- Molecular Pharmacology Department of Biofunctional Evaluation Gifu Pharmaceutical University Gifu Japan
| | | |
Collapse
|
21
|
Goulding AN, Wouk K, Stuebe AM. Contraception and Breastfeeding at 4 Months Postpartum Among Women Intending to Breastfeed. Breastfeed Med 2018; 13:75-80. [PMID: 29091478 DOI: 10.1089/bfm.2017.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To estimate the association between postpartum contraception and breastfeeding among women intending to breastfeed. METHODS We analyzed data from the Infant Feeding Practices Study II, a prospective cohort study of U.S. mothers (2005-2007). Among 1,349 women with prenatal intention to breastfeed at least 4 months who reported contraception use 3 months postpartum, we used multivariable logistic regression to estimate odds and predicted probabilities of breastfeeding by contraceptive category. We considered prenatal breastfeeding intention, age, race, education, income, marital status, region, depressive symptoms, parity, and timing of return to work as potential confounders, using standard statistical methods to determine model covariates. RESULTS At 3 months postpartum, contraception was reported as follows: 720 (53%) nonhormonal contraceptives (NHCs), 256 (19%) combined hormonal contraceptives (CHCs), 217 (16%) progestin-only pills (POPs), 92 (7%) intrauterine devices, and 64 (5%) depot medroxyprogesterone acetate. Compared with NHCs, adjusted odds ratio (aOR) for any breastfeeding at 4 months postpartum among women using POPs was 3.15 (95% confidence interval [CI] 1.42-7.02), and for women using CHCs aOR was 0.17 (95% CI 0.10-0.29). For women using NHCs, predicted probability of any breastfeeding at 4 months postpartum was 90% (95% CI 85-94); it was 97% (95% CI 92-99) among those using POPs and 61% (95% CI 46-74) among those using CHCs. CONCLUSION In a cohort of women intending to breastfeed at least 4 months, women using POPs were most likely, and women using CHCs were least likely, to achieve their breastfeeding intentions.
Collapse
Affiliation(s)
- Alison N Goulding
- 1 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine , Chapel Hill, North Carolina
| | - Kathryn Wouk
- 2 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Alison M Stuebe
- 1 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine , Chapel Hill, North Carolina.,2 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| |
Collapse
|
22
|
Fuell Wysong E, Tossone K, Furman L. Expectant inner-city women: attitudes about contraception given infant feeding choice. EUR J CONTRACEP REPR 2017; 22:369-374. [PMID: 29131703 DOI: 10.1080/13625187.2017.1397110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to examine whether low-income inner-city expectant women who intend to breastfeed make different contraceptive choices than those who intend to formula feed. MATERIALS AND METHODS This cross-sectional pilot study surveyed expectant women age 14 years and older receiving prenatal care at MacDonald Women's Hospital, Cleveland Ohio (01 November 2016-15 January 2017). Questions assessed knowledge and attitudes regarding infant feeding and contraception options, and postpartum feeding and contraceptive intentions. RESULTS We enrolled 223 expectant women, mean age 25.6 years at a median of 30 weeks gestation; 192 (86.5%) were African-American and 171 (75%) were multiparous. Women intending to breastfeed had 0.44 times the odds of intending to use birth control after delivery (95% CI [0.19-1.05], p = .06), while women intending to feed formula had 2.26 times the odds of intending to use birth control after delivery (95% CI [0.95-5.40]). Contraceptive attitudes significantly impacted intent to use contraception (p = .007), with every point higher on the contraception attitudes scale equating to a 7% increase in odds of postpartum contraception use. CONCLUSIONS Postpartum contraceptive intentions do not differ significantly between women intending to breastfeed and those intending formula feeding. Contraception attitudes do not significantly change this association, but were significantly related to contraceptive intent. Findings highlight the importance of providing comprehensive birth control education to all expectant mothers, regardless of feeding intention. Our study is unique in addressing interactions between maternal contraceptive and feeding intentions among expectant women at high risk for both not breastfeeding and unintended short interval pregnancy.
Collapse
Affiliation(s)
- Elena Fuell Wysong
- a Case Western Reserve University School of Medicine , Cleveland , OH , USA
| | - Krystel Tossone
- b Case Western Reserve University Jack Joseph and Morton Mandel School of Applied Social Sciences , Cleveland , OH , USA
| | - Lydia Furman
- c University Hospitals Rainbow Babies and Children's Hospital , Cleveland , OH , USA
| |
Collapse
|
23
|
Affiliation(s)
- Philip O Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California , San Diego, La Jolla, California
| |
Collapse
|
24
|
Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman WV, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. No 329-Consensus canadien sur la contraception (4e partie de 4) : chapitre 9 – contraception hormonale combinée. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:269-314.e5. [DOI: 10.1016/j.jogc.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Abstract
PURPOSE OF REVIEW Human milk is the optimal food for human infants, and provides many diverse and well described benefits for both mother and infant. Low milk supply, whether perceived or actual, is one of the most common reasons why mothers stop breastfeeding. Breastfeeding mothers often seek out the guidance and support of their pediatrician in evaluating and resolving milk production concerns. RECENT FINDINGS Recent evidence supports the importance of breastfeeding for maternal and child health in both developing and developed countries. Lack of knowledge regarding optimal breastfeeding management accounts for the large majority of low milk supply concerns, but there is emerging evidence that impaired glucose tolerance may contribute to intrinsic low milk supply. SUMMARY Breastfeeding mother-infant dyads should be followed closely until lactation is well established and the infant is gaining well. Further research is needed to understand the physiologic contributors to low milk supply and to guide evidence-based interventions to optimize maternal success in reaching breastfeeding goals, particularly for women of poorer metabolic health.
Collapse
|
26
|
|
27
|
Sridhar A, Salcedo J. Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing. Matern Health Neonatol Perinatol 2017; 3:1. [PMID: 28101373 PMCID: PMC5237348 DOI: 10.1186/s40748-016-0040-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/18/2016] [Indexed: 12/11/2022] Open
Abstract
Postpartum contraception is important to prevent unintended pregnancies. Assisting women in achieving recommended inter-pregnancy intervals is a significant maternal-child health concern. Short inter-pregnancy intervals are associated with negative perinatal, neonatal, infant, and maternal health outcomes. More than 30% of women experience inter-pregnancy intervals of less than 18 months in the United States. Provision of any contraceptive method after giving birth is associated with improved inter-pregnancy intervals. However, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have led to discrepant recommendations by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention. In this review, we discuss current recommendations for the use of hormonal contraception in the postpartum period. We also discuss details of the lactational amenorrhea method and effects of hormonal contraception on breastfeeding. Given the paucity of high quality evidence on the impact on hormonal contraception on breastfeeding outcomes, and the strong evidence for improved health outcomes with achievement of recommended birth spacing intervals, the real risk of unintended pregnancy and its consequences must not be neglected for fear of theoretical neonatal risks. Women should establish desired hormonal contraception before the risk of pregnancy resumes. With optimization of postpartum contraception provision, we will step closer toward a healthcare system with fewer unintended pregnancies and improved birth outcomes.
Collapse
Affiliation(s)
- Aparna Sridhar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, California, USA
| | - Jennifer Salcedo
- Department of Obstetrics, Gynecology & Women's Health, University of Hawaii John A. Burns School of Medicine, Hawaii, USA
| |
Collapse
|
28
|
The WHO's medical eligibility criteria for contraceptive use: 20 years of global guidance. Curr Opin Obstet Gynecol 2016; 27:451-9. [PMID: 26390246 DOI: 10.1097/gco.0000000000000212] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to revisit the inception of the WHO's medical eligibility criteria for contraceptive use (MEC), particularly its objectives and methodology, and to describe its impact over the last 20 years in the field of family planning. New recommendations are summarized from the newly released fifth edition of the guidance. RECENT FINDINGS Fourteen topics, encompassing over 575 recommendations were reviewed for the MEC, fifth edition. New recommendations include: changes for combined hormonal contraceptive use among postpartum women; progestogen-only methods among breastfeeding women; and women at high risk for HIV infection, women living with HIV, and women living with HIV using antiretroviral therapy and hormonal contraception. New methods reviewed include subcutaneously administered depot medroxyprogesterone acetate, Sino-implant (II), ulipristal acetate, and progesterone-releasing vaginal ring. SUMMARY Over the past 20 years, the MEC has become a remarkably influential document for practitioners and policy makers in family planning, as it provides up-to-date, evidence-based recommendations for contraceptive use for women with various medical conditions and medically relevant characteristics.
Collapse
|