Combined oral contraceptive use among breastfeeding women: a systematic review.
BACKGROUND
Postpartum women need effective contraception, but using hormonal contraceptives may affect breastfeeding performance and infant health outcomes.


METHODS
We searched the MEDLINE and Cochrane databases for all articles published through May 2009 for primary research studies that investigated clinical outcomes among breastfeeding women who used hormonal contraception or their infants.


RESULTS
Three randomized controlled trials reported decreased mean duration of breastfeeding and higher rates of supplemental feeding among combined oral contraceptive (COC) users than among nonusers, while one multicountry trial found no differences in these parameters. Only one study demonstrated lower average weights during the first year of life for infants whose mothers used COCs while breastfeeding. None of the eight studies, four of which were observational, included in this review documented adverse infant health outcomes.


CONCLUSIONS
Limited evidence demonstrates an inconsistent effect of COC on breastfeeding duration and success. The evidence is inadequate to determine whether a mother's use of these drugs affects breastfeeding duration or the infant's health.
Kapp
Nathalie
N
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. kappn@who.int
Curtis
Kathryn M
KM
D001835:Body Weight; D001942:Breast Feeding; D002657:Child Development / Q000187:drug effects; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007774:Lactation / Q000187:drug effects; D016239:MEDLINE; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D003277:Contraceptives, Oral, Combined