And infant health have limited recommendations for such methods and have
And infant health have limited recommendations for such methods and have lead to Pristinamycin IA manufacturer discrepant recommendations by organizations such as the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). While both the WHO and CDC generally agree that the initiation of estrogen-containing methods should be delayed for PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28128382 3? weeks postpartum (depending on a woman’s medical risk factors) until the risk of venous thromboembolism (VTE) decreases to approximately the non-pregnant baseline, the WHO has issued more conservative recommendations than the CDC regarding use of both estrogen-containing and progestinonly methods by breastfeeding women [21, 22]. In the WHO Medical Eligibility Criteria for Contraceptive Use (MEC), Fifth Edition [23] estrogen-containing contraceptives (including combined oral contraceptives, the patch, and the vaginal ring) are considered to pose unacceptable health risks (Category 4) when used by breastfeeding women within the first 6 postpartum weeks. These methods are PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28461585 considered by the WHO to have theoretical or proven risks that usually outweigh their advantages (Category 3) until breastfeeding women are at least 6 months postpartum. In contrast, in the U.S. Centers for Disease Control and Prevention Medical Eligibility Criteria for Contraceptive Use (CDC MEC), the advantages of using such estrogen-containing methodsTable 1 Medical Eligibility Criteria [CDC/WHO]Method Breastfeeding Women Combined hormonal contraceptives Progestin-only pills DMPA Etonogestrel implant Levonorgestrel intrauterine device Copper intrauterine device Nonbreastfeeding Women Combined hormonal contraceptives Progestin-only pills DMPA Etonogestrel implant Levonorgestrel intrauterine device Copper intrauterine deviceaare stated to generally outweigh the theoretical or proven risks (Category 2) for women without complicating medical conditions starting 6 weeks after delivery [21] (Table 1). In the following sections we provide a detailed review of the impact of each hormonal contraceptive method on breastfeeding outcomes.a) Combined oral contraceptivesA CDC review of combined oral contraceptives from 2015 included 15 articles from 13 studies evaluating the impact of estrogen-containing oral contraceptive pills on breastfeeding and associated infant outcomes. Unfortunately, applicable studies were noted to be of only poor to fair methodological quality and many were from earlier decades when the estrogen-content of combined oral contraceptives was substantially higher than in modern pills [24]. In this review, no studies found significant impact on infant weight gain when combined oral contraceptives (COCs) were initiated at 6 weeks or later postpartum, and none found negative impact on other infant health outcomes regardless of the timing of COC initiation [24]. However, the results of studies examining the impact of COCs on breastfeeding performance were inconsistent [24]. A study by the WHO in 1984 assigned women to a COC containing 30 micrograms of ethinyl estradiol and 150 micrograms of levonorgestrel or a progestin-only pill containing 75 micrograms of norgestrel, started after 6 weeks postpartum. Breast milk volume was quantified following pump expression. Mean breast milk volume was lower in the COC group at 9,<10 min 4/4 2/2 2/3 2/2 2/2 1/1 4/3d 1/1 1/1 1/1 1/1 1/<48 h 4/4 2/2 2/3 2/2 2/2 2/1 4/3d 1/1 1/1 1/1 2/1 2/<21 days 4/4 2/2 2/3 2/2 2/3 2/3 4/3d 1/1 1/1 1/1 2/3 2/21 to <30 days 3/4 2/2 2/3 2/2 2 /b b30-42.
