Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact

Braga, Giordana Campos; Ferriolli, Eduardo; Quintana, Silvana Maria; Ferriani, Rui Alberto; Pfrimer, Karina; Vieira, Carolina Sales

doi:10.1016/j.contraception.2015.07.009

Cited by 42 publications

(19 citation statements)

References 20 publications

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“…Because progesterone withdrawal postpartum may contribute to the onset of lactogenesis, there is theoretical concern that early postpartum use of contraceptives containing progestins could inhibit initiation of breastfeeding and establishment of breastmilk supply [9]. Data on postpartum use of the etonogestrel-releasing contraceptive implant initiated within hours to days of delivery suggest that there is no effect on onset of lactogenesis [10], quantity or composition of breastmilk [11,12], duration of exclusive breastfeeding at 12 weeks postpartum [13] or infant growth [14]. However, data are lacking on the effect of immediate insertion of the modern two-rod levonorgestrel (LNG)-releasing subdermal contraceptive implant system on breastfeeding initiation and duration and infant growth.…”

Section: Introductionmentioning

confidence: 99%

The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: a randomized controlled trial

et al. 2019

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Objective: This study assessed whether immediate postpartum insertion of levonorgestrel contraceptive implants is associated with a difference in infant growth from birth to 6 months, onset of lactogenesis, or breastfeeding continuation at 3 and 6 months postpartum compared to delayed insertion at 6 to 8 weeks postpartum. Study design: We conducted a randomized trial of women in Uganda who desired contraceptive implants postpartum. We randomly assigned participants to receive either immediate (within 5 days of delivery) or delayed (6 to 8 weeks postpartum) insertion of a two-rod levonorgestrel contraceptive implant system. This is a prespecified secondary analysis evaluating breastfeeding outcomes. The primary outcome of this secondary analysis was change in infant weight; infants were weighed and measured at birth and 6 months. We used a validated questionnaire to assess onset of lactogenesis daily in person while participants were in the hospital, and then daily by phone after they left the hospital, until lactogenesis was documented. We used intervieweradministered questionnaires to assess breastfeeding continuation and concerns at 3 months and 6 months postpartum. Results: Among the 96 women randomized to the immediate group and the 87 women to the delayed group, the mean change in infant weight from birth to 6 months was similar between groups: 4632 g in the immediate group and 4407 g in the delayed group (p=.26). Among the 97 women who had not experienced lactogenesis prior to randomization, the median time to onset of lactogenesis did not differ significantly between the immediate and delayed groups (65 h versus 63

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Section: Introductionmentioning

confidence: 99%

The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: a randomized controlled trial

et al. 2019

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“…[63] Implants inserted within 48 hours postpartum appear not to affect lactation, growth, and neonatal and infant development. [64][65][66] In a trial in the USA, [66] as many as 90% of adolescents took up the offer of an implant after delivery, and uptake rates were also high in Uganda [62] and Kenya. [67] For postpartum LARC services to be successful, however, robust linkages are required between providers working in family planning, antenatal and labour wards.…”

Section: Cmementioning

confidence: 99%

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

et al. 2017

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“…A second small RCT (n = 24) used deuterium to index milk ingestion among healthy term newborns of mothers randomized to immediate postpartum ENG implant placement (n = 12) or 6-week placement (n = 12). 10 Participation was limited to nonobese women who had previously breastfed for at least 3 months. No differences were found in milk intake between the two groups.…”

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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Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact

Cited by 42 publications

References 20 publications

The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: a randomized controlled trial

The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: a randomized controlled trial

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

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

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