Impact of injectable progestogen contraception in early puerperium on lactation and infant health.
BACKGROUND
Unmet need for family planning approaches 40% or higher and many women are at risk of unintended pregnancy. Progesterone contraception after birth is frequently recommended, but concern remain of inhibition of lactation or effects on infant health. In present study we aimed to evaluate impact of short term use of injectable depot medroxy progesterone acetate (DMPA) if given in early post partum period on infant health and breast feeding performance.


METHODS
A prospective case control study was conducted and 250 women immediately after delivery were recruited in the study. 150 women who were recruited as study group received Inj. DMPA 150 mg intra muscularly after initiation of lactation before discharge from hospital (Day 2-Day 10 of their delivery). 100 post partum women, not using hormonal contraception were taken as controls. All the subjects were followed to complete a full 6 months follow up. Duration and frequency of lactation, gain in weight, gain in height and any illness spells in the infant were noted at 6 weeks, 3 months and 6 months follow up. In the study group 100 subjects completed 6 months follow-up. The statistical analysis was carried out by using SPSS software version 7. The statistical technique used was z score(significance shown by z score> 1.96) and repeated measure analysis (two way Anova technique).


RESULTS
Hundred percent of primigravidas in the study group and 95% in the control group were satisfied with their lactation amount. The average gain in height was comparable in both study and control group {4.36±0.56 vs 4.33±0.54 (z score 0.38) at 6 weeks, 12.44±0.73 vs 12.40±0.71 (z score 0.39) at 3 months 17.30±0.91 vs 17.28±0.83 (z score 0.16) at 6 months}. Similarly average gain in weight was also not significantly different in two groups {0.89±0.11 vs 0.93±0.10 (z score 0.71) at 6 weeks, 1.77±0.17 vs 1.78±0.16 (z score 1.07) at 3 months and 3.53±0.30 vs 3.46±0.33 (z score 1.19) at 6 months}. The results were comparable with other studies.


CONCLUSIONS
Injectable DMPA use as a contraceptive in the immediate post partum period was found to be a safe and effective alternate method with no deleterious effect on mother's milk and infant's growth.
Associate Professor, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjang Hospital , New Delhi, India .
Seema
S
Singhal
Professor and Consultant, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjang Hospital , New Delhi, India .
Nivedita
N
Sarda
Post Graduate Student, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjang Hospital , New Delhi, India .
Shipra
S
Gupta
Senior Resident, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital , New Delhi, India .
Sakshi
S
Goel
Immediate puerperium; Infant health; Injectable DMPA; Lactation