Hi everyone
I think this will be the limit of messages I can send to Lactnet today.
Permission to ask advice from colleagues. I'm working with a mother
who started off successfully exclusively breastfeeding her baby. The
baby lost only 6.5% of her birthweight, then gained well for the
first 4 weeks, (34g/day, a little above normal) and then the mother
received the Etonorgestrel implant. From 4-12 weeks the baby has
slipped down the WHO weight chart, gaining only 480g, or approx 8.5g
(about one-third ounce) per day. The mother describes the baby as
"windy" though I would attribute fussiness to hunger, and in fact
since starting formula supplements the baby has gained 90g/day - a
huge initial catch-up gain.
I've found in the past that maternal oral contraceptive use may
affect the baby's disposition and/or weight gain - not for all
mother-baby pairs, but for some. I also found research apparently
"proving" that it didn't make a difference but comparing the growth
of formula-fed and mixed-fed babies. I don't have much experience
with implants.
I found some info at
http://www.netdoctor.co.uk/sex-and-relationships/medicines/nexplanon.html#ixzz3GsBg1pTS
which says, "Etonogestrel does not affect the amount or quality of
breast milk produced, but may pass into breast milk in small amounts.
The health of breast-fed children whose mothers were using Nexplanon
has been studied up to three years of age. No effects on the growth
and development of the children were observed. The manufacturer
states that Nexplanon may be used by women who are breastfeeding;
however development and growth of the child should be carefully
followed as a precaution...."
And at <http://www.drugs.com/>www.drugs.com " A prospective,
nonrandomized trial compared 4 contraceptives in 10 women each to
assess their effect on milk production. One of the following were
begun on day 42 postpartum as chosen by the mother: combined ethinyl
estradiol 30 mcg plus levonorgestrel 150 mcg (Microvlar),
etonogestrel implant (Implanon), levonorgestrel intrauterine system
(Myrena), or a copper IUD (Optima). Milk intake was measured using
deuterium oxide given to the mother and measured in the infants'
saliva as well as numbers of wet diapers per day. Infants were also
weighed and measured to assess growth. No differences in milk intake
or infant growth were observed between the methods from days 42
through 63.[7] "
Also at www.drugs.com "Maternal Levels. Forty-two women had an
etonogestrel subcutaneous implant inserted implant inserted between
28 and 56 days postpartum. Breastmilk samples were obtained at 1, 2
and 4 months after insertion. The average breastmilk concentration of
etonogestrel was 178 ng/L at 1 month, 153 ng/L at 2 months, and 131
ng/L at 4 months after insertion. The authors calculated that the
infants would receive an average of 19.9 ng/kg daily at 1 month, 15.1
ng/kg daily at 2 months and 10.5 ng/kg daily at 4 months after
insertion. The decreasing doses were caused by both a reduced
quantity in milk and a lower breastmilk intake as time passed.[3] "
I'm wondering if the research saying that no effects on growth and
development was done on exclusively breastfed babies? Why would
babies of 4 months be taking less milk than babies at 1 and 2 months
after insertion unless they were being supplemented? Does anyone
else see a relationship between low weight gain and use of the
contraceptive implant? Does anyone have any advice, experience, or
more references for me?
Thanks so much if you can help.
Pamela Morrison IBCLC
Rustington, England
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