title: Lactational amenorrhea is associated with child age at the time of introduction of complementary food: a prospective cohort study in rural Senegal, West Africa.
abstract: BACKGROUND
  In Africa, lactational amenorrhea is the major reason for birth spacing.
  
  
  OBJECTIVE
  We studied whether the early introduction of complementary food to infants is associated with an increased risk of menstruation resumption in rural African women.
  
  
  METHODS
  Senegalese women (n = 855) were included at 2-3 mo postpartum and followed up at 4-5 and 6-7 mo in dispensaries. A subsample of 502 women were followed up at 9-10 mo and twice yearly at home thereafter. Risk factors for menstruation resumption were assessed with logistic regression, with control for maternal parity, occupation, education, postpartum body mass index, child sex and weight-for-age, and season.
  
  
  RESULTS
  The risk of menstruation resumption was 4.2% (95% CI: 2.8%, 5.6%) at 6-7 mo and 6.5% (4.0%, 8.9%) at 9-10 mo. Compared with the introduction of complementary food after 6-7 mo, introduction at 2-3, 4-5, or 6-7 mo was associated with a greater odds of menstruation resumption at 6-7 mo [odds ratios (ORs): 5.08 (1.01, 25.5), 6.00 (1.29, 27.4), and 4.45 (0.96, 20.6; NS), respectively]. Introduction of food at 4-5 or 6-7 mo compared with that after 6-7 mo was associated with significantly greater odds of menstruation resumption at 6-7 mo (5.13; 1.16, 22.6) but not at 9-10 mo (3.07; 0.65, 14.4; NS) or year 2.
  
  
  CONCLUSIONS
  Child age at introduction of complementary food was significantly associated with the odds of menstruation resumption at 6-7 mo postpartum.
authors.affiliation: Department of Epidemiology and Prevention, Institut de Recherche pour le Développement, Montpellier, France. kirsten.simondon@mpl.ird.fr
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Simondon
authors.forename: Valérie
authors.initials: V
authors.lastname: Delaunay
authors.forename: Aldiouma
authors.initials: A
authors.lastname: Diallo
authors.forename: Eric
authors.initials: E
authors.lastname: Elguero
authors.forename: François
authors.initials: F
authors.lastname: Simondon
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000209:etiology*; D001942:Breast Feeding; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007774:Lactation / Q000502:physiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D010053:Ovary / Q000502:physiology; D049590:Postpartum Period; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012424:Rural Population; D012675:Senegal; D013997:Time Factors