Abstract
Objectives
Little is known about provider attitudes regarding safety of selected hormonal contraceptives among breastfeeding women.
Methods
Using a nationwide survey, associations were analyzed between provider characteristics and perception of safety of combined oral contraceptives (COCs) in breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors and depot medroxyprogesterone acetate (DMPA) in breastfeeding women < 1 month postpartum and ≥ 1 month postpartum.
Results
Approximately 68% of public-sector providers considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among non-physicians versus physicians (adjusted odds ratios [aOR] range 0.34–0.51) and those with a focus on adolescent health/pediatrics versus reproductive health (aOR 0.68, 95% confidence interval [CI] 0.47–0.99). Most public-sector providers considered DMPA safe for breastfeeding women during any time postpartum, with lower odds among non-physicians versus physicians (aOR range 0.20–0.54) and those with primary clinical focus other than reproductive health (aOR range 0.26–0.65). The majority of office-based physicians considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among those who did not use, versus those who used, CDC’s contraceptive guidance (aOR 0.40, 95% CI 0.21–0.77). Most office-based physicians also considered DMPA safe for breastfeeding women during any time postpartum.
Conclusions for Practice
A high proportion of providers considered use of selected hormonal contraceptives safe for breastfeeding women, consistent with evidence-based guidelines. However, certain provider groups might benefit from education regarding the safety of these methods for breastfeeding women.
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References
American Academy of Pediatrics. (2012). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 129(3), 827–841.
American Medical Association. (2013). Physician masterfile. https://www.ama-assn.org/practice-management/masterfile/ama-physician-masterfile. Accessed February 11, 2018.
CDC. (2010). U.S. Medical eligibility criteria for contraceptive use. MMWR, 59(RR4), 1–84.
CDC. (2011). Update to CDC’s U.S. medical eligibility criteria for contraceptive use, 2010: Revised recommendation for the use of contraceptive methods during the postpartum period. MMWR, 60(26), 878–883.
Damle, L. F., Gohari, A. C., McEvoy, A. K., Desale, S. Y., & Gomez-Lobo, V. (2015). Early initiation of postpartum contraception: Does it decrease rapid repeat pregnancy in adolescents? Journal of Pediatric and Adolescent Gynecology, 28(1), 57–62. https://doi.org/10.1016/j.jpag.2014.04.005.
Dee, D. L., Pazol, K., Cox, S., Smith, R. A., Bower, K., Kapaya, M., Fasula, A., Harrison, A., Kroelinger, C. D., D’Angelo, D., Harrison, L., Koumans, E. H., Mayes, N., Barfield, W. B., & Warner, L. (2017). Trends in repeat births and use of postpartum contraception among teens—United States, 2004–2015. MMWR Morbidity and Mortality Weekly Report, 66(16), 422–426. https://doi.org/10.15585/mmwr.mm6616a3.
Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine, 374(9), 843–852. https://doi.org/10.1056/NEJMsa1506575.
Gipson, J. D., Koenig, M. A., & Hindin, M. J. (2008). The effects of unintended pregnancy on infant, child, and parental health: A review of the literature. Studies in Family Planning, 39(1), 18–38. https://doi.org/10.1111/j.1728-4465.2008.00148.x.
Jackson, E., Curtis, K. M., & Gaffield, M. E. (2011). Risk of venous thromboembolism during the postpartum period: A systematic review. Obstetrics and Gynecology, 117(3), 691–703. https://doi.org/10.1097/AOG.0b013e31820ce2db.
Manzoli, L., De Vito, C., Marzuillo, C., Boccia, A., & Villari, P. (2012). Oral contraceptives and venous thromboembolism: A systematic review and meta-analysis. Drug Safety, 35(3), 191–205. https://doi.org/10.2165/11598050-000000000-00000.
Petersen, J. F., Bergholt, T., Nielsen, A. K., Paidas, M. J., & Lokkegaard, E. C. (2014). Combined hormonal contraception and risk of venous thromboembolism within the first year following pregnancy. Danish nationwide historical cohort 1995-2009. Thrombosis and Haemostasis, 112(1), 73–78.
Phillips, S. J., Tepper, N. K., Kapp, N., Nanda, K., Temmerman, M., & Curtis, K. M. (2016). Progestogen-only contraceptive use among breastfeeding women: A systematic review. Contraception, 94(3), 226–252. https://doi.org/10.1016/j.contraception.2015.09.010.
Sedgh, G., Finer, L. B., Bankole, A., Eilers, M. A., & Singh, S. (2015). Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. Journal of Adolescent Health, 56(2), 223–230. https://doi.org/10.1016/j.jadohealth.2014.09.007.
Simmons, K. B., Zapata, L., & Curtis, K. M. (2018). Health care provider perceptions of the safety of IUDs for women with HIV. Perspectives on Sexual and Reproductive Health, 50(2), 67–73. https://doi.org/10.1363/psrh.12056.
Tepper, N. K., Boulet, S. L., Whiteman, M. K., Monsour, M., Marchbanks, P. A., Hooper, W. C., & Curtis, K. M. (2014). Postpartum venous thromboembolism: incidence and risk factors. Obstetrics and Gynecology, 123(5), 987–996. https://doi.org/10.1097/AOG.0000000000000230.
Tepper, N. K., Phillips, S. J., Kapp, N., Gaffield, M. E., & Curtis, K. M. (2016a). Combined hormonal contraceptive use among breastfeeding women: An updated systematic review. Contraception, 94(3), 262–274. https://doi.org/10.1016/j.contraception.2015.05.006.
Tepper, N. K., Whiteman, M. K., Marchbanks, P. A., James, A. H., & Curtis, K. M. (2016b). Progestin-only contraception and thromboembolism: A systematic review. Contraception, 94(6), 678–700. https://doi.org/10.1016/j.contraception.2016.04.014.
Zhu, B. P. (2005). Effect of interpregnancy interval on birth outcomes: Findings from three recent US studies. International Journal of Gynaecology and Obstetrics, 89(Suppl 1), 25–33. https://doi.org/10.1016/j.ijgo.2004.08.002.
Zolna, M. R., & Frost, J. J. (2016). Publicly funded family planning clinics in 2015: Patterns and trends in service delivery practices and protocols. Guttmacher Institute. https://www.guttmacher.org/report/publicly-funded-family-planning-clinic-survey-2015. Accessed 9 Dec 2018.
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Mayhew, A., Ermias, Y., Zapata, L.B. et al. Health Care Provider Attitudes Toward Safety of Selected Hormonal Contraceptives in Breastfeeding Women. Matern Child Health J 23, 1079–1086 (2019). https://doi.org/10.1007/s10995-019-02743-2
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DOI: https://doi.org/10.1007/s10995-019-02743-2