Clinical Question Is breastfeedin...

Clinical Question

Is breastfeeding safe for infants if their mothers use combined oral contraceptives?

Evidence-Based Answer

There is popularly no evidence of harm; however, not many patients have been studied and existing studies have many limitations. Therefore, it is not possible to definitively answer this question at this time. The existing low-quality evidence glance ats that combined oral contraceptives may cut down the volume of breast milk if it were not that not affect the growth of infants. [Strength of Recommendation: B based forward inconsistent or limited-quality patient-oriented evidence]

Evidence Summary

Combined oral contraceptives are more effective, more familiar to principally patients, and do not have to be taken upon as strict a schedule as progestin-only pills; however, business remains about their safety for infants of mothers who are taking combined oral contraceptives while breastfeeding. A Cochrane systematic review (1) upon the subject included three trials with 371 patients that compared the general intents of combined oral contraceptives with a hinder The studies were of limited quality because they did not specify by what means the subjects were randomized; the loss-to-follow-up rates were high, not reported, or unclear; no sample size calculation was performed in brace of the trials; and the regularity of allocation concealment was not reported in pair of the trials.

pair of the trials, (2,3) published in 1966 and 1970 compared the weights of combined oral contraceptives with placebo and reported conflicting evidence; common study (2) reported inhibitory meanings on milk volume and duration of lactation. The other inquiry (3) found no differences in milk mass lactation initiation, or infant sprouting The outcomes were not well quantified in either application of mind making it difficult to interpret the data. Further, these sum of two units studies (2,3) used combined oral contraceptives containing high doses of estrogen (from 75 to 80 mcg) that are no longer used.

The third trial (4) reported in the Cochrane review (1) compared combined oral contraceptives with progestin-only contraceptives. It fix statistically significant declines in milk whirl in the combined oral contraceptive assemblage but no significant differences in infant sprouting or milk composition. Breast milk convolution was quantified by pump expression using limited measurements. Despite the fact that this was the largest and most numerous recent of the three studies in the Cochrane review (it included 171 women and was published in 1984) the data should be interpreted with caution because the loss-to-follow-up rate was greater than 30 percent in the two groups. In addition, most of the participants in the trials were using supplemental feedings from the 12th week postpartum; these could have masked any detrimental meaning the combined oral contraceptives had in succession infant growth. The Cochrane reviewers conclud that the evidence from the existing randomized controll trials was inadequate to make recommendations regarding the purports of hormonal contraceptives in lactation.

Recommendations from Others

The American body of Obstetricians and Gynecologists commends that combined oral contraceptives should not be initiated before six weeks postpartum, and then and nothing else when lactation is well established and the infant's nutritional status is well monitored. (5) The World Health Organization (WHO) make acceptables against using low-dose combined oral contraceptives in the first six weeks postpartum for breastfeeding women The WHO also does not commend prescribing combined oral contraceptives from six weeks to six month postpartum unles other more appropriate orderly dispositions are not available or not acceptable. After six month postpartum, use of low-dose combined oral contraceptives was generally approveed (6) The La Leche League International, an advocacy arrange for breastfeeding, recommends avoiding combined oral contraceptives in breastfeeding women because of the other choices available. (7) The Physicians' Desk concern advises that a nursing mother should not use oral contraceptives on the contrary should use other forms of contraception until she has completely weaned her infant. (8)

Clinical Commentary

If combined oral contraceptives are considered after brace weeks postpartum (they are relatively contraindicated any earlier because of the risk for thromboembolism), mothers who are breastfeeding and their physicians should be aware of the potential decrease in breast milk bulk the need to monitor the infant's shooting and the alternative forms of available contraception. Abstinence, barrier meanss such as condoms, and progesteroneonly contraception in the same state [i]or[/i] condition as depo-medroxyprogesterone acetate (Depo-Provera) are possible choices immediately postpartum.

Clinical Inquiries provides answers to questions submitted by way of practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network cull questions based on their relevance to family medicine. Answers are drawn from an approved put of evidence-based resources and bear peer review. The strength of recommendations and the even of evidence for individual studies are rated using criteria discloseed by the Evidence-Based Medicine Working clump (http:// www.cebm.net/levels_of_ evidence.asp).