Dear all
I've recently come across information in a couple of document setting
out new findings on contraceptive choices for HIV-positive women, (at
<http://www.infoforhealth.org/pr/m20/NewFindings.pdf>http://www.infoforhealth.org/pr/m20/NewFindings.pdf
and http://www.infoforhealth.org/pr/l14/5.shtml#table3
It reads as follows, (refs are set out beneath):
"Hormonal methods that contain only a progestin are appropriate as
early as six weeks after childbirth. By that time breastfeeding is
well established (265) Progestin-only contraceptives include
certain oral contraceptives, injectables, vaginal rings, implants,
and the LNG-IUD. Before six weeks small amounts of the hormone would
be passed to the newborns, who cannot metabolize steroids at that age
(18) (25) (61). When the hormones are taken at six weeks or later,
the small amounts in breastmilk do not appear to harm an infant's
growth or affect the quantity and quality of breastmilk (227)."
Refs:
18. BASSOL, S., NAVA-HERNANDEZ, M.P., HERNANDEZ-MORALES, C.,
TRUJILLO-MACIAS, A.M., LOPEZ-LOZANO, M.R., and RECIO, R. Effects of
levonorgestrel implant upon TSH and LH levels in male infants during
lactation. International Journal of Gynecology and Obstetrics 76(3):
273-277. Mar. 2002.)
25. BLODE, H., FOIDART, J.M., and HEITHECKER, R. Transfer of
drospirenone to breastmilk after a single oral administration of 3 mg
drospirenone + 30 microg ethinylestradiol to healthy lactating women.
European Journal of Contraception and Reproductive Health Care 6(3):
167-171. Sep. 2001.
61. DIAZ, S. Contraceptive implants and lactation. Contraception
65(1): 39-46. Jan. 2002.
227. TRUITT, S.T., FRASER, A.B., GRIMES, D.A., GALLO, M.F., and
SCHULZ, K.F. Hormonal contraception during lactation. Systematic
review of randomized controlled trials. Contraception 68(4): 233-238. Oct.2003.
265. WORLD HEALTH ORGANIZATION (WHO). Medical eligibility criteria
for contraceptive use, 3rd edition. Geneva, WHO, 2004. 186 p. .
My experience is that hormonal contraceptives (even progestin only
contraceptives) _may_ negatively affect lactation success. When
mothers use them, difficulties may be perceptual (fussiness in the
baby) and/or real (babies experience low weight gain), and these
problems resolve when mothers subsequently stop using them. I'm
especially concerned that when exclusive breastfeeding may be the
feeding method of choice for babies under 6 months of HIV-positive
mothers in developing countries (for whom replacement feeding is
neither safe nor sustainable) that hormonal contraceptives may
negatively impact mothers' ability to breastfeed exclusively and/or
for their babies to thrive.
I know that many of the older studies showing that progestin-only
preparations were done on non-exclusively breastfed babies. And I
know that we've discussed oral contraceptives well on LACTNET, and
the problems that we, as LCs, have seen with them. The tone of the
above document is quite authoritative. Do these latest reviews
reflect new research conducted on babies who have been exclusively
breastfed, and for the full 6 months? I'd welcome others' comments
and thoughts, experiences or references.
Many thanks.
Pamela Morrison IBCLC
Co-coordinator WABA Breastfeeding and HIV Task Force
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