RESUMO
The objective of this study was to evaluate the contraceptive efficacy and clinical performance of a Nestorone subdermal implant (NES) in the postpartum period. NES (n = 100) and Copper T intrauterine device (T-Cu; n = 100) acceptors initiated contraception at 8 weeks postpartum and were followed at monthly intervals during the first year and at 3-month intervals thereafter. Pregnancy rates, breastfeeding performance, infant growth, bleeding pattern, and side effects were assessed. Blood and milk NES concentration were measured. No pregnancy occurred in 2195 and 2145 woman-months of NES implant and T-Cu use, respectively. No effect of NES on lactation and infant growth and no serious adverse events were observed. Lactational amenorrhea was significantly longer in NES users (353 +/- 20 days) than in T-Cu users (201 +/- 11 days). More NES users (55.8%) experienced prolonged bleedings than did T-Cu users (36.2%). Concentrations of NES in breast milk ranged between 54-135 pmol/liter. The Nestorone implant is a highly effective contraceptive, safe for breastfed infants because the steroid is inactive by the oral route.
Assuntos
Anticoncepção , Anticoncepcionais Femininos/administração & dosagem , Lactação/efeitos dos fármacos , Norprogesteronas/administração & dosagem , Adolescente , Adulto , Amenorreia/fisiopatologia , Aleitamento Materno , Chile , Anticoncepcionais Femininos/metabolismo , Implantes de Medicamento , Feminino , Seguimentos , Humanos , Dispositivos Intrauterinos de Cobre/efeitos adversos , Leite Humano/efeitos dos fármacos , Leite Humano/metabolismo , Norprogesteronas/efeitos adversos , Norprogesteronas/metabolismo , Pacientes Desistentes do Tratamento , Período Pós-Parto/efeitos dos fármacos , Fatores de Tempo , Hemorragia Uterina/induzido quimicamente , DesmameRESUMO
The duration of breast-feeding and the growth of fully breast-fed infants during the first year of life were analyzed according to sex, birth weight, characteristics of the mother, and breast-feeding pattern. All infants (n = 1217) were healthy and fully breast-fed at 30 d postpartum and 63% and 24% were still fully breast-fed at 6 and 12 mo, respectively. The median ages at introduction of nondairy food and of milk supplements were 6.0 and 7.4 mo, respectively. The probability of remaining fully breast-fed for 12 mo was significantly higher in infants with higher birth weight and higher maternal weight, and in infants who breast-fed seven times a day or more in the first 6 mo. The comparison of the monthly weight and length of fully breast-fed infants with the World Health Organization/National Center for Health Statistics reference data showed the adequacy of breastfeeding to support infant growth. When mothers and infants are healthy, breast milk is sufficient to support adequate infant growth and health during the first months of life. The main variables that affect the duration of breast-feeding, nutrition and suckling frequency, are susceptible to interventions by health services. The results reinforce the need to care for maternal nutrition during pregnancy and to provide the support that women need to sustain a high suckling frequency.
Assuntos
Aleitamento Materno , Desenvolvimento Infantil/fisiologia , Saúde da População Urbana , Adolescente , Adulto , Análise de Variância , Peso ao Nascer/fisiologia , Chile , Feminino , Seguimentos , Alimentos Fortificados/normas , Humanos , Lactente , Recém-Nascido , Masculino , Fatores de Tempo , Organização Mundial da SaúdeRESUMO
The probability of experiencing the first postpartum bleeding, the first ovulation and the risk of pregnancy during exclusive breastfeeding was assessed in a selected group of urban Chilean women. Admission criteria included having had a normal pregnancy and a vaginal term delivery of a healthy infant and the desire to maintain breastfeeding for as long as possible. The risk of bleeding and the recovery of ovulation was assessed in 48 women selected for being amenorrheic and fully nursing at day 75 postpartum and their willingness to participate in the blood sampling protocol. The first bleeding and ovulation was experienced while fully nursing by 28% and 26% of these subjects, respectively, at day 180 postpartum. The probability of experiencing the first bleeding and the probability of pregnancy during full nursing were calculated for 236 women not contracepting who were enrolled during the first month postpartum. The cumulative probability of bleeding and of pregnancy was 52% and 9.4% at day 180 postpartum, respectively. The risk of pregnancy was less than 2% in the subset of amenorrheic cases. In this urban population selected for having the highest motivation and best breastfeeding performance, the association of breastfeeding with infertility was too weak to serve as an effective birth spacer, except for the period of lactational amenorrhea. When the first postpartum bleeding took place before the sixth postpartum month in fully nursing women, it had a good predictive value to indicate the onset of a higher risk period.
Assuntos
Amenorreia/sangue , Aleitamento Materno , Fertilidade , Ovulação , Período Pós-Parto/sangue , Análise Atuarial , Adulto , Chile , Feminino , Seguimentos , Humanos , Hormônio Luteinizante/sangue , Menstruação , Gravidez , Progesterona/sangue , Prolactina/sangue , Fatores de Risco , Fatores de Tempo , População UrbanaAssuntos
Crescimento/efeitos dos fármacos , Dispositivos Intrauterinos de Cobre , Lactação/efeitos dos fármacos , Norgestrel/farmacologia , Peso Corporal , Aleitamento Materno , Feminino , Humanos , Lactente , Recém-Nascido , Levanogestrel , Masculino , Leite Humano/análise , Norgestrel/análise , GravidezAssuntos
Anticoncepcionais Orais Hormonais/administração & dosagem , Anticoncepcionais Orais/administração & dosagem , Lactação , Progesterona/administração & dosagem , Adolescente , Adulto , Implantes de Medicamento , Feminino , Fertilidade , Humanos , Dispositivos Intrauterinos de Cobre , Leite Humano/análise , Gravidez , Progesterona/análise , Progesterona/sangueRESUMO
La progesterona presenta caracteristicas que la hacen potencialmente util para ser empleada como anticonceptivo en el periodo de lactancia. Para determinar su eficacia, se realizo un ensayo clinico con 6 pellets de progesterona que se insertaron en el tejido subcutaneo de mujeres en lactancia.Los niveles plasmaticos de progesterona se mantuvieron elevados por alrededor de 5 meses. Se observo un embarazo en 1614 meses-mujer, lo que es semejante a la tasa de embarazo de un grupo contemporaneo tratado con T cobre. En el grupo de mujeres lactantes sin anticoncepcion se observaron 19 embarazos en 677 meses-mujer. Los pellets tuvieron la misma eficacia al ser administrados al dia 30, 60 o 240 postparto.La duracao del efecto anticonceptivo fue de 5 meses y se observo una rapida recuperacion de la fertilidad, posteriormente.No se detectaron efectos negativos sobre la lactancia y el crecimiento de los ninos.El unico problema encontrado fue la expulsion de los pellets en ciertos casos
Assuntos
Gravidez , Adolescente , Adulto , Humanos , Feminino , Anticoncepcionais Orais Hormonais , Lactação , Progesterona , Dispositivos IntrauterinosRESUMO
PIP: This work describes a study conducted in a University of Chile hospital to determine the influence of a combined oral contraceptive (OC) containing 30 mcg of ethinyl estradiol and 150 mcg of norgestrel on lactation and infant growth. 103 women exclusively breastfeeding began using the OC on day 30-35 postpartum, 59 women exclusively breastfeeding whose infants gained at least 20 gm daily during the 3rd month of life began using the OC on day 90 postpartum, and 109 women exclusively breastfeeding received an injectable placebo on day 30 postpartum and an IUD or spermicides on day 90 if desired. A subgroup of 82 women from the 30-day control group who continued breastfeeding exclusively at day 90 postpartum and whose infants gained at least 20 gm daily during the 3rd month were a control group for the women beginning OCs on day 90. Follow-up visits were arranged every 10 days through the 3rd month and every 30 days subsequently through 1 year. At the beginning of the study, treatment and control groups were similar in age, parity, weight, maternal hemoglobin, and sex and weight of infants. 63 women were excluded from the study while still breastfeeding for a variety of reasons including loss to follow-up. The main reason for exclusion of OC users was termination of OC use or change of method. 11 pregnancies occurred in controls using spermicides or no contraception. Among women using OCs starting at day 30 postpartum, the percentage exclusively breastfeeding was significantly lower than among controls beginning in the 4th month, and a higher percentage of cases gave supplementary feedings on the advice of their physicians or their own decision. At 6 months, 61% of controls and 40% beginning OC use at 30 days were still breastfeeding exclusively. Fewer women beginning OC use at 90 days than controls were exclusively breastfeeding at 6 months, and a higher proportion were giving supplementary feedings on medical advice. The 2 treatment groups had smaller weight gains than their control groups in the 1st month of treatment. Total weight gain to the 6th month was significantly different for babies whose mothers began OC use at 30 days but not for those beginning use at 90 days. The average absolute weight of infants in the groups beginning treatment at 30 days was significantly lower at several ages but the differences were small. Growth of infants was good in most cases. Only 6 presented significant intercurrent illnesses. There were no deaths. No pregnancies occurred in women using OCs and tolerance was good. 1 woman discontinued use for metrorrhagia. It was concluded that the OC tested moderately inhibits lactation, especially when use is begun at the beginning of the 2nd postpartum month.^ieng