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Effect of timing of postpartum depot medroxyprogesterone acetate administration on breastfeeding continuation, contraceptive usage, and postpartum depression: A randomized trial

Beatrice Chen, University of Pittsburgh, 2011

Project abstract

In the United States, depot medroxyprogesterone acetate (DMPA) is frequently administered prior to hospital discharge with the belief that women who delay initiation of DMPA may face higher risk of unintended pregnancy and that administration postpartum has little to no negative effect on breastfeeding. Administering DMPA to breastfeeding women has not been widely questioned because the limited existing studies do not show any adverse impact of DMPA on breastfeeding. However, these studies used inappropriate control groups and did not control for prior lactation experience.

We recently conducted a randomized controlled trial (RCT) which found that significantly fewer women who underwent immediate postplacental levonorgestrel-releasing IUD (LNG-IUD) placement continued to breastfeed at 6 months compared to those who underwent insertion at 6-8 weeks postpartum. Since systemic levels of progestins are much less with the LNG-IUD compared to DMPA, we became concerned about potential effects of administering DMPA immediately postpartum. We therefore propose to enroll 184 women who plan to breastfeed and use DMPA postpartum in a RCT to investigate whether the timing of postpartum administration of DMPA (prior to hospital discharge vs. 4-6 weeks postpartum) affects the duration or exclusivity of breastfeeding among women who plan to breastfeed their infants.

Secondary outcomes will include rates of use of highly effective contraception (defined as DMPA, IUD, implant, sterilization, or lactational amenorrhea) and postpartum depression. Outcomes will be assessed by phone at 2, 4, 6, 8, 12, 16, 20, 24, and 28 weeks postpartum.

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