Document Detail


A systematic review of early postpartum medroxyprogesterone receipt and early breastfeeding cessation: evaluating the methodological rigor of the evidence.
MedLine Citation:
PMID:  22085201     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Elizabeth A Brownell; I Diana Fernandez; Cynthia R Howard; Susan G Fisher; Sharon R Ternullo; Ryan J J Buckley; Ann M Dozier
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2011-11-15
Journal Detail:
Title:  Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine     Volume:  7     ISSN:  1556-8342     ISO Abbreviation:  Breastfeed Med     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-07     Completed Date:  2012-04-17     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  101260777     Medline TA:  Breastfeed Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10-8     Citation Subset:  IM    
Affiliation:
Department of Community and Preventive Medicine, University of Rochester, Rochester, New York 14642-0644, USA. Elizabeth_Brownell@URMC.Rochester.edu
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MeSH Terms
Descriptor/Qualifier:
Breast Feeding* / adverse effects
Contraceptives, Oral, Hormonal / administration & dosage*,  adverse effects
Contraceptives, Oral, Synthetic / administration & dosage
Decision Making
Evidence-Based Practice
Female
Humans
Infant, Newborn
Informed Consent
Lactation / drug effects*
Medroxyprogesterone Acetate / administration & dosage
Mothers*
Postpartum Period
Pregnancy
Randomized Controlled Trials as Topic
Grant Support
ID/Acronym/Agency:
R01 1R01HD055191/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Contraceptives, Oral, Hormonal; 0/Contraceptives, Oral, Synthetic; 71-58-9/Medroxyprogesterone Acetate
Comments/Corrections
Erratum In:
Breastfeed Med. 2012 Apr;7(2):129

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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