Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing

Aparna Sridhar,Jennifer Salcedo

doi:10.1186/s40748-016-0040-y

Abstract

Postpartum contraception is important to prevent unintended pregnancies. Assisting women in achieving recommended inter-pregnancy intervals is a significant maternal-child health concern. Short inter-pregnancy intervals are associated with negative perinatal, neonatal, infant, and maternal health outcomes. More than 30% of women experience inter-pregnancy intervals of less than 18 months in the United States. Provision of any contraceptive method after giving birth is associated with improved inter-pregnancy intervals. However, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have led to discrepant recommendations by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention. In this review, we discuss current recommendations for the use of hormonal contraception in the postpartum period. We also discuss details of the lactational amenorrhea method and effects of hormonal contraception on breastfeeding. Given the paucity of high quality evidence on the impact on hormonal contraception on breastfeeding outcomes, and the strong evidence for improved health outcomes with achievement of recommended birth spacing intervals, the real risk of unintended pregnancy and its consequences must not be neglected for fear of theoretical neonatal risks. Women should establish desired hormonal contraception before the risk of pregnancy resumes. With optimization of postpartum contraception provision, we will step closer toward a healthcare system with fewer unintended pregnancies and improved birth outcomes.

Highlights

Postpartum contraception is important to prevent unintended pregnancies and short intervals between pregnancies
Recommendations by the World Health Organization and Centers for Disease Control and Prevention Despite evidence that early initiation of postpartum contraception increases Inter-pregnancy interval (IPI), concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have lead to 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 3–6 weeks postpartum 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]
As women spend the majority of their reproductive years attempting to avoid unintended pregnancy, contraception counseling is an important aspect women’s healthcare, especially for those who have recently experienced pregnancy

Summary

Background

Postpartum contraception is important to prevent unintended pregnancies and short intervals between pregnancies. Recommendations by the World Health Organization and Centers for Disease Control and Prevention Despite evidence that early initiation of postpartum contraception increases IPIs, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have lead to 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 3–6 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]. Mean breast milk volume was lower in the COC group at 9, 16

Method

Findings

Conclusion