Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study

Brito, Milena Bastos; Ferriani, Rui Alberto; Quintana, Silvana Maria; Yazlle, Marta Edna Holanda Diógenes; Sá, Marcos Felipe Silva de; Vieira, Carolina Sales

doi:10.1016/j.contraception.2009.05.124

Cited by 81 publications

(66 citation statements)

References 21 publications

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“…This in turn interferes with the hypothalamic-pituitary-ovarian axis, preventing estrogen secretion and ovulation (10). No unexplained adverse maternal effects have been reported during use of Implanon® in the postpartum period (11). In clinical trials, the most common non-menstrual side effects experienced when wearing an implant are reported to range from 15-25% (12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period

Duvan

Gözdemir

Kaygusuz

et al. 2010

J Turkish German Gynecol Assoc

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Section: Discussionmentioning

confidence: 99%

Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period

Duvan

Gözdemir

Kaygusuz

et al. 2010

J Turkish German Gynecol Assoc

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“…One of the four trials suggested that early, compared with delayed, postpartum initiation of the LNG-IUD was associated with shorter breastfeeding duration and less breastfeeding exclusivity at 6 months [22]. However, two other RCTs found no differences [20,23]. The fourth new trial provides indirect evidence demonstrating no difference in outcomes between POPs compared with COCs [21].…”

Section: Discussionmentioning

confidence: 93%

“…Since this review was last updated in 2008 [13], four new randomized controlled trials (RCTs) [20][21][22][23] and five new observational studies were published [16,[24][25][26][27], and an additional five observational studies that were not included in the 2008 review were identified [28][29][30][31][32], for a total of eight reports of RCTs and 41 reports of nonrandomized clinical trials or observational studies for review (Table 1). These 49 articles reported on 47 different studies investigating the use of POCs in breastfeeding women and reported clinically relevant outcomes of infant growth, health or breastfeeding performance.…”

Section: Resultsmentioning

confidence: 99%

“…In total, eight studies address the effect of initiation of POCs before 6 weeks postpartum compared with later initiation, of which five are new [16,20,22,23,32]. The majority found no effect on breastfeeding or infant outcomes, although one RCT found that more women continued breastfeeding at 6 months in the later initiation group [22] and another found more infections in infants of DMPA users [32].…”

Section: Key Question Two: Early Versus Delayed Initiationmentioning

confidence: 99%

“…All three RCTs and one of the observational studies are new. One RCT compared women using ETG implants immediately postpartum versus DMPA initiated at 6 weeks [20]. No differences were seen between groups in the percentage of women exclusively breastfeeding at 6 or 12 weeks.…”

Section: Breastfeeding Outcomes: Rcts and Observational Studiesmentioning

confidence: 99%

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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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Combined hormonal versus nonhormonal versus progestin-only contraception in lactation

Lopez

Grey

Stuebe

et al. 2015

Cochrane Database of Systematic Reviews

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Results were not consistent across the 11 trials. The evidence was limited for any particular hormonal method. The quality of evidence was moderate overall and low for three of four placebo-controlled trials of COCs or POPs. The sensitivity analysis included six trials with moderate quality evidence and sufficient outcome data. Five trials indicated no significant difference between groups in breastfeeding duration (etonogestrel implant insertion times, COC versus POP, and LNG-IUS). For breast milk volume or composition, a COC study showed a negative effect, while an implant trial showed no significant difference. Of four trials that assessed infant growth, three indicated no significant difference between groups. One showed greater weight gain in the etonogestrel implant group versus no method but less versus DMPA.

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Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study

Cited by 81 publications

References 21 publications

Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period

Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period

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

Combined hormonal versus nonhormonal versus progestin-only contraception in lactation

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