BACKGROUND: This study evaluated the effect of immediate postpartum depot medroxyprogesterone (DMPA) on breastfeeding cessation within 6 weeks postpartum. STUDY DESIGN: At low-income-serving obstetric and pediatric clinics, eligible mothers within 1 year postpartum were recruited to participate in a retrospective cohort study. The 183 participants completed a self-administered survey. Surveys were merged with birth certificate data and perinatal maternal/infant medical records. Kaplan-Meier distributions assessed the relationship between DMPA use and breastfeeding cessation. A multivariable Cox proportional hazards model estimated hazard ratios (HRs) and included five known risk factors (age, education, race, parity and parental cohabitation) and identified potential confounders. RESULTS: Consistent with the biologic model, the Kaplan-Meier results raised the possibility of a detrimental effect of DMPA on duration of any breastfeeding, but differences in these distributions did not achieve statistical significance (p=.24); after adjustment for potential confounders, this nonstatistically significant association remained (HR: 1.22; confidence interval: 0.75-1.98). CONCLUSION: Given the state of the evidence, it is unclear whether a causal effect does or does not exist. However, if there is a causal effect of DMPA on breastfeeding duration, it is minimal. Additional well-designed research is warranted.
BACKGROUND: This study evaluated the effect of immediate postpartum depotmedroxyprogesterone (DMPA) on breastfeeding cessation within 6 weeks postpartum. STUDY DESIGN: At low-income-serving obstetric and pediatric clinics, eligible mothers within 1 year postpartum were recruited to participate in a retrospective cohort study. The 183 participants completed a self-administered survey. Surveys were merged with birth certificate data and perinatal maternal/infant medical records. Kaplan-Meier distributions assessed the relationship between DMPA use and breastfeeding cessation. A multivariable Cox proportional hazards model estimated hazard ratios (HRs) and included five known risk factors (age, education, race, parity and parental cohabitation) and identified potential confounders. RESULTS: Consistent with the biologic model, the Kaplan-Meier results raised the possibility of a detrimental effect of DMPA on duration of any breastfeeding, but differences in these distributions did not achieve statistical significance (p=.24); after adjustment for potential confounders, this nonstatistically significant association remained (HR: 1.22; confidence interval: 0.75-1.98). CONCLUSION: Given the state of the evidence, it is unclear whether a causal effect does or does not exist. However, if there is a causal effect of DMPA on breastfeeding duration, it is minimal. Additional well-designed research is warranted.
Authors: Suzanne G Folger; Kathryn M Curtis; Naomi K Tepper; Mary E Gaffield; Polly A Marchbanks Journal: Contraception Date: 2010-03-31 Impact factor: 3.375
Authors: E Guiloff; A Ibarra-Polo; J Zañartu; C Toscanini; T W Mischler; C Gómez-Rogers Journal: Am J Obstet Gynecol Date: 1974-01-01 Impact factor: 8.661
Authors: Elizabeth A Brownell; I Diana Fernandez; Cynthia R Howard; Susan G Fisher; Sharon R Ternullo; Ryan J J Buckley; Ann M Dozier Journal: Breastfeed Med Date: 2011-11-15 Impact factor: 1.817
Authors: Susan E Andrade; Pamela E Scott; Robert L Davis; De-Kun Li; Darios Getahun; T Craig Cheetham; Marsha A Raebel; Sengwee Toh; Sascha Dublin; Pamala A Pawloski; Tarek A Hammad; Sarah J Beaton; David H Smith; Inna Dashevsky; Katherine Haffenreffer; William O Cooper Journal: Pharmacoepidemiol Drug Saf Date: 2012-07-03 Impact factor: 2.890
Authors: Ann M Dozier; Alice Nelson; Elizabeth A Brownell; Cynthia R Howard; Ruth A Lawrence Journal: J Womens Health (Larchmt) Date: 2014-01-20 Impact factor: 2.681