Effects of the etonogestrel-releasing contraceptive implant (Implanon®) on parameters of breastfeeding compared to those of an intrauterine device

Reinprayoon, Damrong; Taneepanichskul, Surasak; Bunyavejchevin, Suvit; Thaithumyanon, Pimolratn; Punnahitananda, Santi; Tosukhowong, Piyaratana; Machielsen, C.; Beek, Agaath van

doi:10.1016/s0010-7824(00)00173-6

Cited by 72 publications

(44 citation statements)

References 9 publications

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“…5 Based on serum and milk levels in a prospective study of 42 mother-infant dyads, breastfed infants are expected to receive about 19.9 ng/kg of ENG daily at 1 month, 15.1 ng/kg daily at 2 months, and 10.5 ng/kg daily at 4 months after insertion. 6 Of note, doses, formulations, and serum levels vary among hormonal contraceptive methods. For example, while ENG levels decline to 202 pg/mL by 12 months after ENG implant placement, with the extended release ENG and ethinyl estradiol insert (Nuvaring), ENG levels range from 1,578 pg/ mL in week 1 to 1,374 pg/mL in week 3 of the 4-week cycle.…”

Section: Discussionmentioning

confidence: 99%

Association of Etonogestrel-Releasing Contraceptive Implant with Reduced Weight Gain in an Exclusively Breastfed Infant: Report and Literature Review

Stuebe

Bryant

Lewis³

et al. 2016

Breastfeeding Medicine

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Background: Studies have not found that hormonal contraceptive implants adversely affect breastfeeding, but theoretical concerns exist. Methods: We reported a case of reduced weight gain in an exclusively breastfed infant in association with placement of (ENG)-releasing contraceptive implant (Nexplanon) to the FDA Adverse Events Reporting System (FAERS). We further queried reports to FAERS and reviewed published studies of the ENG implant during breastfeeding. Results: A breastfeeding mother received an ENG implant at 4 weeks postpartum. Her infant was exclusively breastfeeding. One month after implant placement, the infant had lost 145 g, dropping from the 44th percentile to the 6th percentile for growth. During this period, the mother had not returned to work or decreased frequency of feeding. During a 2-year period of FAERS reports, we found one other report of reduced milk supply following ENG implant placement. Among 108 breastfeeding women studied while using the ENG implant, there was one case of lactation failure. If this were not due to chance, the estimated risk of lactation failure with the ENG implant would be 0.9% (95% confidence interval 0.2-5.1%). Conclusion: Given uncertainty regarding the true effect of ENG implants on lactation, it seems prudent for providers to counsel each woman about a possible effect on milk supply so that she can monitor her infant for signs of impaired milk transfer. Patient-centered counseling approaches are needed that allow each woman to assess her own individual tolerance of risk of unplanned pregnancy versus possible risk of lactation failure.

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Section: Discussionmentioning

confidence: 99%

Association of Etonogestrel-Releasing Contraceptive Implant with Reduced Weight Gain in an Exclusively Breastfed Infant: Report and Literature Review

Stuebe

Bryant

Lewis³

et al. 2016

Breastfeeding Medicine

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“…Users of nomegestrol implants compared with IUD users similarly had no difference in time of weaning or breastfeeding rates through 12 months [51]. Finally, breastfeeding duration did not differ between users of an etonogestrel (ETG) implant compared with Cu-IUD users over 3 years [52,53].…”

Section: Implantsmentioning

confidence: 91%

“…A study of the nomegestrol implant compared with Cu-IUD found no difference in growth or health; greater infant mortality was seen in the implant group (six deaths from gastroenteritis, seizures and pneumonia, compared with one death from gastroenteritis in the Cu-IUD group) but was not statistically significant [51]. Finally, a study of ETG implants compared with the Cu-IUD found no differences in infant growth, adverse events, respiratory or skin disorders or developmental scores [52,53].…”

Section: Rctsmentioning

confidence: 97%

Progestogen-only contraceptive use among breastfeeding women: a systematic review

2010

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Background: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes. Objectives: We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs. Search strategy: We searched the PubMed database for all articles published from database inception through December 2014. Selection criteria: We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, injectables, implants or hormonal intrauterine devices (IUDs). The main outcomes were breastfeeding performance (as measured by initiation, continuation, frequency and exclusivity of breastfeeding) and infant health (as measured by growth, development or adverse health effects). Results: Forty-nine articles reporting on 47 different studies were identified that investigated the use of POCs in breastfeeding women and reported clinically relevant outcomes of infant growth, health or breastfeeding performance. Studies ranged from poor to fair methodological quality and generally failed to show negative effects of the use of POCs on breastfeeding outcomes or on infant growth or development. One randomized controlled trial (RCT) raises concerns that immediate insertion of the levonorgestrel IUD postpartum may be associated with poorer breastfeeding performance when compared with delayed insertion, although two other RCTs evaluating early etonogestrel implants compared with delayed initiation of implants or depot medroxyprogesterone acetate failed to find such an association. Conclusion: The preponderance of evidence fails to demonstrate adverse breastfeeding outcomes or negative health outcomes in infants such as restricted growth, health problems or impaired development. Evidence newly added to this review was largely consistent with previous evidence.

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“…75,76 Utilization rates of IUDs at 6 and 12 months postpartum may be higher in those who have these methods placed immediately after delivery than those who have planned placement at their routine postpartum visit; and pregnancy rates are also lower among those who receive them promptly postpartum. 47,77 Similarly, the safety, efficacy, and acceptability of implant placement during the delivery hospitalization and high continuation rates have been well documented, 47,75,[77][78][79][80][81] even in women who plan to breastfeed their infants. 82,83 Recognizing these benefits, Medicaid programs in over a dozen states now provide full coverage for provision of both implants and IUDs as inpatient procedures.…”

Section: Approaches To Reduce Rapid Repeat Pregnancies Among Adolescementioning

confidence: 99%

Prevention of Unintended Pregnancy Among Sexually Active Adolescents in the United States

Kakaiya¹

2016

Primary Prevention Insights

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BACKGROUND: Adolescent pregnancy and birth rates in the United States have declined dramatically from their peaks in 1991, but remain much higher than those seen in most other developed countries. METHODS: Recent results from relevant clinical trials, periodic surveys of reproductive age women, and focus group work as well as professional group recommendations in the United States are presented to provide insights into the problem of unintended teen pregnancy and suggest potential solutions. RESULTS: Dramatic changes in contraceptive technologies and practices have been implemented in the past several years to reduce the barriers young women have in accessing the most effective methods of contraception. However, new reports about how young women view their risks suggest that new strategies will be needed to motivate more sexually active young women to prevent pregnancy. CONCLUSIONS: The safety and efficacy of modern methods of contraceptives are the highest they have ever been, but if unintended pregnancy rates among teens in the United States are to be more significantly reduced, young women's attitudes about contraception and pregnancy prevention need to be better understood and remaining barriers to its access need to be reduced.

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Effects of the etonogestrel-releasing contraceptive implant (Implanon®) on parameters of breastfeeding compared to those of an intrauterine device

Cited by 72 publications

References 9 publications

Association of Etonogestrel-Releasing Contraceptive Implant with Reduced Weight Gain in an Exclusively Breastfed Infant: Report and Literature Review

Association of Etonogestrel-Releasing Contraceptive Implant with Reduced Weight Gain in an Exclusively Breastfed Infant: Report and Literature Review

Progestogen-only contraceptive use among breastfeeding women: a systematic review

Prevention of Unintended Pregnancy Among Sexually Active Adolescents in the United States

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