Friends,
The last comment about the study with 10 in the experimental group and ten in
the control group triggered me to look at my notes again. My apologies for
the need for this correction. This small study was actually from the article:
Koetsawang s, Nukulkarn P, Fotherby K et al: Transfer of contraeptive
steroids in women using long-acting gestagens. Contraception 1982
25:321-31.
This article was the one where a total of 20 women pumped for 12 weeks. The
authors stated that all women had enough milk for their babies. It was not
specified when the first injection was given. The focus was the amount of
progestin found in the milk.
The Dahlberg article: (1982 Internl j ob/gyn had larger groups. (210 in the
depo group, 121 in the experimental group). This author did not specify the
number of women in a subgroup of women who received depo at 48 hours pp. He
was looking at weight gain and infection rate. He only acknowledges that
most women received their first depo at "some time during the first 9 months
pp". He also speculated that since the 48 hr group had a 75% higher
infectious illness dr. visits in the first 1.5 yrs of life, that perhaps
their is some interference in antibody transfer if depo is given so early. No
study has duplicated this. I have written the author for more info. He does
not address supplementation but states that weght at 8 yrs of age were
comparable.
In addition, the article with the interview of Dr. Ann Friedmann is in the
journal
Comtemporary OB/GYN 8/2000 Vol 8 pgs 32-50. "Offering Effective B/f Advice".
Also, from my understanding based on the title of the article, the recent
mention of the study by Shaaban was actually re Norplant. Small amts of time
released progestin may be altogether different that the depo dose.
acog quotes this one article re use of depo at 24-48 hrs:
Tankeyoon M, Dusitsin N et al. Effects of hormonal contraceptives on milk
volume and infant growth. WHO Special Programme of research...
Contraception 1984 30:505-22.
This was an interesting article. They compared 4 groups: women who took a
combined pill(back then a higher dose of estrogen), a mini-pill, depo, and a
control group. It did state that the depo group (this was 59 women) showed a
slight increase in supply between week 16 and 20. No woman got depo prior to
6 weeks in this study. While no infants received formula, the "majority of
women used complementary foods by 12 wks. Partly b/c of this and b/c the
frequency of b/f was highest per day among the depo group at 6 wks 9.3/day vs
5.7fds/day, the authors could not conclude that the lack of difference in
weight gain was related to birth control used.
Lastly, as I referenced yestday, but read it today,
Guiloff, E et al Effects of contraception on lactation. Am J OB/GYN 1974
118:42-5.
This is the only article that substantiates that b/f duration is not affected
by giving depo 24-48 hrs pp. However, this being their endpoint, there is no
information on exclusive vs partial b/f. Women where their own controls in
reporting the complete cessation of milk production with a previous
pregnancy(when they did not use hormonal bcontrol pp). The Median Duration of
Lactation (MDL) for these 346 women was 5.3 months. Of these women 80 were
given depo every 6 months (not 3) with their initial dose at 24-48 hrs out.
Other subgroups received 6 other hormonal methods. The depo MDL was 9.3 mo,
the longest of all groups. The study was conducted in Chile in 1973.
That's should be the last of it folks, hope it broadens your understanding of
the data.
Warmly,
chris
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