Duration Of Postpartum Amenorrhea Research Articles

Literature Review: The Relationship Between Exclusive Breastfeeding and Weight Changes in Breastfeeding Mothers

Background: Exclusive breastfeeding is beneficial for mothers such as influencing the return of weight after childbirth, affecting the duration of postpartum amenorrhea, reducing the risk of breast and ovarian cancer, reducing the risk of type 2 diabetes, minimizing osteoporosis, and reducing the risk of depression in the mother, but many mothers do not do that. Some studies say exclusive breastfeeding for longer can trigger an increase in milk production, to produce breast milk the mother needs to spend more calories and can reduce weight after giving birth. The majority of studies show little or no relationship between breastfeeding and changes in body weight or body composition, but some studies show a positive relationship between the two. Objective: To examine the literature on the relationship between exclusive breastfeeding and changes in body weight in breastfeeding mothers. Methods: This type of research is a Literature Review. Review 10 journals published in the period 2011-2021 with a discussion of the relationship between exclusive breastfeeding and changes in maternal weight. Results: Seven journals showed an association between exclusive breastfeeding for 6 months and weight changes in breastfeeding mothers. However, three other journals explained that exclusive breastfeeding was not associated with weight changes in breastfeeding mothers. Conclusion: Exclusive breastfeeding and weight changes in breastfeeding mothers are interrelated.

Knowledge and use of lactational amenorrhoea as a family planning method among adolescent mothers in Uganda: a secondary analysis of Demographic and Health Surveys between 2006 and 2016

ObjectiveTo assess the level of knowledge and use of the lactational amenorrhoea method (LAM) among adolescents in Uganda between 2006 and 2016 using nationally representative data from Demographic and Health...

Determinants of the duration of lactional amenorrhea among mothers in Alexandria

A total of 300 women nursing a child aged 6 to 24 months were interviewed to determine their sociodemographic and biological characteristics, the antenatal care received, health problems encountered during pregnancy and the postpartum period, breast-feeding practices, child nutrition, and the duration of postpartum amenorrhoea. Multivariate Cox regression analysis revealed that seeking antenatal care, the time of initiation of breast-feeding, and the infant’s age at the time of supplement introduction were the only significant independent determinants of the duration of the lactational amenorrhoea. To prolong the duration of lactational amenorrhoea, health education regarding good breast-feeding practices is of crucial value

Postpartum amenorrhea duration by sex of the newborn in two natural fertility populations.

Postpartum amenorrhea (PA) affects the length of interbirth intervals and thus is intimately related to human life history strategies. PA duration appears to be influenced by maternal energetic status. In humans, as in other mammals, sons are costlier than daughters. Thus, we hypothesize that, in energetically constrained environments, a newborn's sex should be associated with PA duration. We analyzed data from two natural fertility populations in which mothers have differing energy budgets: Qom women (n = 121) from a periurban village in Argentina, who have a comparatively calorically dense diet and are sedentary (prepregnancy mean BMI = 24.8 ± 4.5 kg/m2 in 1997), and agropastoral Kaqchikel Maya women (n = 88), who have a comparatively calorically restricted diet and high physical activity levels (mean BMI = 21.8 ± 3.7 kg/m2 ). We predict that (a) mothers of sons exhibit longer PA duration than mothers of daughters and (b) this association between offspring sex and PA duration is stronger in the Maya, who have smaller energy budgets. Maya mothers with sons exhibited estimated mean and median PA durations that were 1.34 times the estimated mean and median PA duration of mothers with daughters (p = 0.02). Among the Qom, mean, and median PA duration did not differ significantly in relation to offspring sex (p = 0.94). Maya mothers with sons exhibited longer PA duration than those with daughters. This phenomenon was not observed in the well-nourished Qom, possibly due to "buffering" effects from larger energy budgets. Offspring sex may influence birth spacing and maternal life history strategies in energetically constrained environments.

Reproductive Correlates of Natural Age at Menopause: A Study on the Minyong of Arunachal Pradesh

This cross-sectional study attempts to determine the median age at menopause of 154 ever-married menopausal women belonging to the Minyong tribal community of Arunachal Pradesh. The study further attempts to see whether there is any significant association between age at menopause and the reproductive variables. The results of this study reject the association between age at menarche and menopause. Cox univariate regression of proportional risks analysis shows that the age at menopause is significantly related with age at marriage, nature of lifetime menstrual cycle, length between consecutive menstrual cycles, parity, age at last delivery, and postpartum amenorrhea (PPA). A less-studied variable, PPA, is undertaken, and a significant association is observed between the duration of PPA and the age at natural menopause. Multiparous women and later age at last delivery reported late age at natural menopause.

Demographic Survey of Married Women in Barau Dikko Specialist Hospital Kaduna State

This study undertakes a demographic survey of married women in Barau Dikko Specialist Hospital. A sample of 160 married women going for maternity (Antenatal and Postnatal care) were administered questionnaires. The analysis reveals that the mean age at menarche is 13 years; mean age of women at last delivery is 31 years and the average duration of breastfeeding for the women’s first child is 14 months. The analysis also shows that the duration of breast feeding for the women’s first child is 14 months. This research made use of correlation analysis to investigate if there is a relationship between breastfeeding and postpartum amenorrhea. We observed that there is a perfect positive correlation of 0.35 between the duration of postpartum amenorrhea (PPA) after the first life birth (months) and the duration of breastfeeding for the last but one life birth (months) at 1% level of level of significance. Also, it was observed that there is no relationship of 0.12 between the duration of postpartum amenorrhea (PPA) after the first life birth (months) and duration of breastfeeding for the first life birth (months).

Impact on post partum amenorrhoea beyond breastfeeding

Citing various studies Bongaarts (1980) has concluded that breastfeeding is the principal determinant of post partum amenorrhoea (PPA) and unrestricted breastfeeding is associated with lower fertility. On the other hand many researchers have shown opposite views by saying that other factors are also responsible in affecting the duration of PPA. In this paper, we have investigated the relationship between the two duration variables viz. PPA and breastfeeding utilizing data of NFHS-2. For this purpose, we have controlled the duration of breastfeeding and then investigated whether distribution of PPA duration shows similar pattern in different situations or it varies with the situations. This can help in deciding whether PPA duration is mainly affected by breastfeeding or some other factors are also operating in shaping its distribution. In this context, we show that even after controlling the duration of breastfeeding (keeping breastfeeding at least six months) the percentage of females having PPA duration less than four months, shows large variation according to caste, educational level, standard of living index (SLI) and body mass index (BMI) of females. If breastfeeding would have been the only principal determinant of duration of PPA, this percentage should have remained almost constant! This shows that some other factors beyond breastfeeding are responsible for shaping the distribution of PPA duration of a female.

Demographic Dynamics of Maternal and Child Health among the people of Todapur-Dasghara, Delhi

Fertility is generally used to indicate the actual reproductive performance of a woman or a group of women. The present study was conducted to study the demographic profile of Todapur and Dasghara women and children in Delhi. The data were collected from Jat dominated villages in different months of the year 2013–2014 from 900 households. The main focus of the interview was the ever married women in the reproductive age group of 15 to 55 years and their hildren. The data was collected through interviews and observations. Data on reproductive history, vital events, family planning etc was collected. The results revealed that 38.6% of people are original inhabitants of Todapur, 17.4% from Dasghara and the rest from Bihar. The age at marriage is as low that is as 15 years. More than 5.3% of the woman in the age group of 15 to 19 years have ever had a child reflecting the past pattern of relatively early marriage and child bearing. The mean duration of postpartum amenorrhoea is 4.9 months and the mean age at Menarche is 13.99 years.

Female Reproductive Parameters in Wild Geladas (Theropithecus gelada)

Accurate data on reproductive parameters are essential for evaluating the adaptive and mechanistic bases of variation within and between species. Here, we combine fecal ovarian hormone analysis with measurements of sex skin swellings and reproductive behavior to describe female reproduction in geladas living in the Simien Mountains National Park, Ethiopia. We collected 10 years of reproductive data from 197 females across 36 units, with hormone data from a subset of these females (60 females from 16 units). First, we use these data to calculate age at maturation, age at first birth, interbirth interval, menstrual cycle length, gestation length, and duration of postpartum amenorrhea. Second, we present composite profiles of ovarian hormones, i.e., estrogens, progestogens, and sex skin measures across reproductive stages. Third, we examine whether ovarian hormones, sex skin phenotypes, and/or reproductive behaviors reliably reflect fertility or pregnancy in female geladas. The reproductive parameters calculated from our data were similar to those in previous studies on geladas and within the range of those for closely-related baboon species. We were able to reliably identify fertility and pregnancy using fecal estrogens only. The tumescent sex skin phenotypes and reproductive behaviors associated with fertility were also observed across all reproductive stages. We suggest that their presence outside of fertility may be a by-product of the flexibility needed for one or more female counterstrategies to infanticide.

Determinants of interpregnancy interval among parturient in Port Harcourt, Nigeria

Background: Interpregnancy interval (IPI) offers an important period which allows the parturient to recover from the effects of pregnancy and to be in optimum health before the next pregnancy. Short IPI has serious health and economic implications. Objective: To determine the IPI among parturient attending the antenatal clinic of the University of Port Harcourt Teaching Hospital and the factors that determine this interval. Materials and Methods: This was a cross-sectional survey involving 340 eligible women who attended the antenatal clinic. A pretested interviewer-administered questionnaire was used to obtain relevant information from the participants. The Chi-square and Student's t-tests were used to determine association between predictor variables and the IPI with P < 0.05 as level of significance. Results: The mean age of respondents was 28.4 ± 3.9 years. The average IPI was 14.9 ± 8.5 months with a range of 3-28 months. The incidence of women with short IPI was 65.9% (224/340). Contraceptive use, the presence of a male child, perinatal death in the previous confinement, number of living children, previous history of infertility, duration of exclusive breastfeeding, and duration of postpartum amenorrhea showed significant association with the IPI. Conclusion: A significant proportion of our women had short IPI. Lack and failure of contraceptive use, absence of a male child, small family size, and perinatal death were among the factors that were significantly associated with short IPI. Knowledge of the of these factors would be of assistance to family planning counselors to understand the peculiar needs of our women and to offer appropriate contraceptive advice.

Explaining regional fertility variations in Ghana

Ghana’s current population is about 24.2 million, and given the current population growth rate of 2.4 %, Ghana’s population is expected to double in about 29 years. Although fertility rates in Ghana have declined from 6.4 to 4 children per woman between 1988 and 2008, this transition has not been homogenous across all regions of Ghana. Fertility rates remain higher in the northern regions of the country, compared to the southern regions. This paper examines explanations for the regional fertility variations—particularly the persistently high fertility rates observed in the northern regions—paying particular attention to the contribution of socioeconomic, cultural and religious factors, and fertility attitudes among women in explaining this phenomenon. In order to capture the most recent fertility variations in the country, the paper uses the most recent round (2008) of the Ghana Demographic and Health Survey, and employs a Poisson multivariate estimation technique. Results indicate that regional differences in fertility are largely explained by socioeconomic factors such as urbanization, child mortality, education and household wealth. Cultural and religious factors also explain some of the observed variation between the northern region and the southern regions. The inclusion of the duration of post-partum amenorrhea and other proximate determinants in the model specifications significantly explains residual differences in fertility outcomes, particularly among the three northern regions. Findings therefore indicate a need for more region-specific policy targeting in the effort to reduce high fertility rates and ease the growth in population.

Insulin Resistance, Thyroid‐Related Hormones, and Duration of Postpartum Amenorrhea in Lactating Women

Although the mechanisms regulating fertility during the postpartum period are not well understood, maternal nutritional status and suckling behaviors have been shown to be related to duration of postpartum amenorrhea (PPA). Some data also suggest that insulin resistance may play a role. The goal of this study was to test the hypothesis that women who experience relatively shorter periods of PPA are more resistant to insulin compared to those who have longer periods of PPA. We also wished to explore the possibility that thyroid function might be related to duration of PPA. To test these hypotheses, we documented baseline serum insulin, glucose, insulin‐like glucose factor‐I (IGF‐I), triiodothyronine (T3), thyroxine (T4), and thyroid‐stimulating hormone (TSH) as well as their response to an oral glucose tolerance test (OGTT) in healthy, lactating women (n = 17). OGTT were administered at 12, 16, 20, and 24 wk postpartum, and women were divided into earlier and later ovulation groups: ovulation 蠄 25 wk (EO, n = 10) and ovulation &gt; 25 wk (LO, n = 7). There was no interaction between ovulation group and time postpartum on any variable measured. However, there was a main effect (P &lt; 0.05) of ovulation group on serum insulin concentrations before and after OGTT, such that EO women had higher levels than did LO women. There was also an effect (P &lt; 0.05) of ovulation group on change in serum T3 due to OGTT, such that the EO group experienced less of a change than did the LO group. In summary, although reproductive capacity in the postpartum period may be affected by insulin and T3 concentrations, insulin resistance does not appear to play a role.

Factors affecting post-partum amenorrhea in Nepalese women

Introduction: Postpartum Amenorrhea (PPA) is important method of birth control and birth spacing especially in developing countries. Following a live birth, a woman generally experiences a 6-week period of amenorrhea related to the hormonal concomitants of pregnancy but not much work has been done in Nepal regarding the effects of various demographic factors and socioeconomic statuses of women on their postpartum amenorrhea.&#x0D; Methods: This study was based on the 2011 Nepal Demographic and Health Survey (NDHS) datasets. The duration of PPA was the response variable whereas key demographic and socio-economic variables of women and her children were explanatory variables. Since PPA period was not defined for some of women as they were still going through the PPA at the time of the survey, their data were censored. Therefore, survival analysis techniques: Life Tables and Semi-Parametric Hazard (Cox) Models were used.&#x0D; Results: All the demographic and socio-economic variables except the sex of child had statistically different median PPA durations. The bivariate cox models also revealed similar result in terms of relative risk associated with the reference categories. However, multivariate cox model revealed breast feeding, parity, birth interval, survival of the child, education of the mother and wealth quintile of the mother influenced the PPA after controlling the effect of other variables.&#x0D; Conclusions: This study revealed that longer the duration of breastfeeding, greater the delay in the return of menstrual cycle. Survival of child was the most important indicator for PPA among Nepalese women. The gender of the child and place of residence did not make any difference with respect to PPA. Mothers with birth interval of 3-4 years had lesser risk of return of monthly cycle.

Survival and Hazard Model Analysis of Breastfeeding Variables on Return to Postpartum Amenorrhea in Rural Mada Women of Central Nigeria.

An examination of breastfeeding and postpartum amenorrhea survey was carried out on 196 rural Mada women in central Nigeria. It was realized that, age, educational background and religious belief does not affect the duration of postpartum amenorrhea (PPA). The survival function of subjects decreases as the duration of breastfeeding without resuming menses increases, while, the hazard function increases as the duration of breastfeeding without return menses increases. Also, the duration of PPA varies from one woman to another. The study also shows that the association between breastfeeding and PPA does not necessarily indicate that duration of breastfeeding affect the duration of PPA, but could be that the two are control by some physiological effect of hormones.

Proximate determinants of Palestinian fertility: a decomposition analysis

Background The results of various studies have suggested a link between reduced fertility rate and improvements in women's health, particularly in the developing world. Despite the substantial reductions in Arab countries, the fertility rate in the occupied Palestinian territory (oPt) remains one of the highest in the world. Because of the increased education of Palestinian women, high rates of urbanisation, low rate of infant mortality, and improved access to contraception compared with other countries in the region with lower fertility rates, the persistently high fertility rate in the oPt has been described as a demographic puzzle. The proximate determinants of the high fertility rate in the oPt were analysed. These were based on Bongaarts framework and are the biological mechanisms, including marriage, contraception, post-partum amenorrhoea (as a result of breastfeeding duration), and induced abortion, that affect fertility. Methods Bongaarts framework was used to do a decomposition analysis of the proximate determinants of the trends in fertility rates in the oPt between 1996 and 2006. Data for the analysis were obtained from the 1996 health survey, 2000 Demographic Health Survey, and 2006 Palestinian Family Health Survey. Separate indices for the contributions of marriage, contraception, and post-partum infecundability were calculated (index for abortion was not calculated for abortion because data were not available). The index of proportion of married women is based on the weighted average age of the age-specific proportions of married women, weighted according to the age-specific fertility rates for women. The index of contraception is based on the proportion of women using contraception and the effectiveness of the type of contraception used. The index of post-partum infecundability is based on the duration of post-partum amenorrhoea and breastfeeding. Access to the data set was granted by the Palestinian Central Bureau of Statistics. Findings Between 1996 and 2006, contraceptive use accounted for the greatest fall in fertility; 16·8% in the West Bank and 14·7% in the Gaza Strip. In the West Bank, post-partum infecundability accounted for a reduction in fertility of 5·4% compared with 3·6% in the Gaza Strip, mainly because of increased duration of breastfeeding. Changes in the patterns of marriage—fewer marriages in the younger age groups 15–19 years and 20–24 years—led to a reduction in fertility of 6·7% in the Gaza Strip compared with 1·9% in the West Bank. Overall, most of the fall in fertility took place between 2000 and 2006 in the West Bank, whereas the reduction was fairly even between 1996 and 2006 in the Gaza Strip. Interpretation Although the fertility rate in the oPt remains high, it fell substantially between 1996 and 2006. The main cause of the overall reduction was an increase in contraceptive use by women in the West Bank and Gaza Strip. Additionally, the regional variations are consistent with, and important for understanding, the overall trend in the fertility rate. The results of this study draw attention to the important part played by contraception in the decline of fertility in the oPt. However, reasons for increased uptake of contraception are not clear, and need further investigation to understand the context of the increase and to guide policy for service delivery. Funding William and Flora Hewlett Foundation Fellowship.

Postpartum Amenorrhoea among Manipuri Women: A Survival Analysis

Among the three major components of a closed birth interval, waiting time to conception can somehow be managed with effective contraceptives while gestation is universally constant in its duration; the duration of postpartum amenorrhoea (PPA) varies in complex nature. The present study aimed to investigate the proximate factors influencing the duration of PPA. A community-based, cross-sectional study was conducted in four valley districts of Manipur, India, during 1 August-31 December 2009, to analyze the differentials and determinants of duration of PPA, applying the survival analysis technique. In total, 1,225 ever-married women were selected through two-stage cluster sampling. The median duration of PPA was 5.7 months. Among the 11 explanatory variables of interest, only three variables--place of residence (p<0.05), infant mortality from preceding pregnancy (p<0.01), and duration of breastfeeding (p<0.01)--had a significant effect on the duration of PPA. The findings may be used as baseline information for future researchers and maternal health policy-makers.

Maternal Supplementation Differentially Affects the Mother and Newborn

Although studying the effect of supplementation on maternal health or the outcome of pregnancy was not a primary goal of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study, many important findings in these areas were produced. As part of the study, a food supplementation program was implemented. Two villages received Atole, a gruel containing protein and energy, and 2 matched villages received a refreshing, low-energy drink containing no protein. Both drinks contained micronutrients. Some women did not choose to consume the supplements and those who did consumed widely varying amounts. More volume of Fresco was consumed than Atole. The energy in the supplements improved birthweight, with no apparent additional benefit from protein or micronutrients. Researchers identified several groups of women who benefited from supplementation more than others by having babies with higher birthweights, including those with poorer current nutritional status and those who consumed high amounts of the supplement continuously from one pregnancy to the next. Results from the study provided an early indication that supplementation might increase the duration of gestation and, thus, reduce preterm birth. On the other hand, maternal supplementation did not substantially alter the duration of postpartum amenorrhea once concurrent infant supplementation was taken into account. Finally, findings from this study provided evidence of a biological trade-off between maintenance of maternal nutritional status and increasing fetal size that was responsive to both current maternal nutritional status and supplement intake but not to the mother’s nutritional status earlier in life.

Lactation, maternal nutrition and fertility.

Due to the fact that the duration of postpartum infertility varies widely among lactating women, breastfeeding is considered to be an unreliable contraceptive method. At this time there is no simple or reliable procedure to detect when fertility returns. Consequently, lactating women are usually advised to use artificial forms of contraception. Yet, breastfeeding does have a considerable demographic impact. In the Philippines and Bangladesh, breastfeeding has been found to be more effective as a fertility control measure than oral contraceptives (OCs). In some countries the birth spacing effect of lactation is reinforced and safeguarded by the traditional custom of postpartum sexual abstinence. Maternal-based prolactin concentrations remain elevated for longer when infants are permitted to breastfeed on demand, and differences in the frequency and vigor of sucking are believed to be responsible for much of the variation in the duration of postpartum infertility. Although maternal nutritional status has been suggested as an influencing factor, no firm conclusion has been possible because of the presence of confounding variables which affect the duration of lactation or the frequency of suckling, such as differences in socioeconomic status or the provision of supplementary weaning foods. To exclude these variables, Prema et al. investigated nutrition-fertility interactions in a homogenous, low income group of 2250 Indian women who had never used any form of contraception and who lived in an area where there were no nutritional or health interventions. There were 2042 mothers in the study who breastfed their infants, and the duration of exclusive breastfeeding averaged 8.9 months; the total duration of lactation averaged 20.7 months. The mean duration of postpartum amenorrhea was 11.2 months and of interpregnancy interval was 24.2 months. For the 286mothers who did not breastfeed the mean duration of postpartum amenorrhea was only 4.6 months and the mean interpregnancy interval was 17.3 months. To assess the effect of maternal nutrition on fertility, the women were divided into 5 groups on the basis of body weight. The mean duration of exclusive breastfeeding, total duration of lactation, and duration of postpartum amenorrhea were all significantly shorter in women with body weight above 55 kg. When total duration of lactation was kept constant, there was a progressive fall in the duration of lactational amenorrhea with increasing body weight. If the conclusion that malnutrition reduces fertility is accurate, it is important to be aware that efforts to improve the diets of lactating women in the 3rd world may shorten birth intervals and exacerbate an already serious population growth problem.

Growth in colony living anubis baboon infants and its relationship with maternal activity budgets and reproductive status

Early growth is of interest because it is susceptible to maternal effects and linked to fitness components for a range of species. Here we present anthropometric measurements on 23 infant olive baboons born into a captive colony in order to describe growth over the first 2 years of life, to explore maternal influences on growth, and to assess the impact of growth profiles on maternal reproduction. Six main findings emerged: 1) Infant growth rates in our colony were higher than those reported for wild populations but comparable to those observed for food-enhanced animals. 2) The ratio of infant mass to maternal mass was positively associated with reproductive parameters, such as duration of post-partum amenorrhea and interbirth interval. 3) Mothers resumed cycling and reconceived when their infants attained a relatively consistent threshold mass. 4) Infant mass-for-age was associated with maternal rank and, independently, with maternal mass such that females of high dominance rank and heavy females had relatively large infants at their resumption of cycling. 5) Low-ranking and lighter females had longer investment periods but smaller infants. They continued investment in infant through prolonged lactation until their infants reached a mass similar to that of infants of high-ranking/heavy mothers, suggesting that the lengthening of investment is essentially compensatory for slow early growth. 6) There was no relationship between infant growth and maternal activity budgets. Maternal physical and social factors, not energetics, contributed to differences among infants in growth trajectories, and infant growth temporally influenced successive reproductive events.

Factors in the regulation of fertility in deprived populations

Background: Real differences in the duration of post-partum amenorrhoea for similar breastfeeding practices are observed in different populations.Aim: The present study investigated the role of energetics in the regulation of fertility among lactating women with high levels of physical activity and poor nutritional status.Subjects and methods: From 1996 to 1998, we carried out a longitudinal survey on the factors regulating fertility in lactating women. All women in our sample (n=150) had poor nutritional status and high levels of physical activity, and most of them were illiterate. Half of them were tea workers, and the other half were housewives of male tea workers. They lived in the same villages inside the tea plantation, and were highly comparable.Results: Survival analysis revealed a very significant longer median duration of post-partum amenorrhoea for tea workers (636 days) compared with non-workers (375 days) although the tea workers cannot breastfeed during the working day. These durations are much longer than those of the WHO multinational study, carried out with a similar protocol, where the medians ranged between 122 and 282 days.Conclusion: We suggest that our findings highlight the effect of energetics on the regulation of fertility in lactating women.