title: Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact.
abstract: BACKGROUND
  Breast milk volume has never been evaluated when the etonogestrel (ENG) implant was inserted immediately postpartum. Thus, this study evaluated if the immediate postpartum insertion of the ENG implant alters breast milk volume.
  
  
  METHODS
  Twenty-four postpartum women and their newborns (NBs) were randomized into two groups: Implant group (ENG implant inserted within 48 h after delivery) and Control group (absence of contraceptive method). The primary outcome was the amount of breast milk intake by the NBs in the first 6 weeks after delivery. Five and ten grams of deuterium (D(2)O) were orally administered to the postpartum women on the day of randomization (day 0) and on the 29th study day, respectively. Saliva samples were collected from the mother-NB pairs prior to each D(2)O dose administration and after D(2)O ingestion (periodic collection). The amount of breast milk ingested by the NBs was estimated by the amount of deuterium (D(2)O) ingested by the NBs through breastfeeding, using mass spectrometry in the saliva samples.
  
  
  RESULTS
  Twenty-four postpartum women and their NB were randomized (12 per group). The median of breast milk intake by NBs following the two D(2)O doses were similar between groups {first D(2)O dose [Implant: 340 mL/day (240-420 mL/day) vs.
  
  
  METHODS
  330 mL/day (300-530 mL/day), p=.54]; second D(2)O dose [Implant: 845 mL/day (770-980 mL/day) vs.
  
  
  METHODS
  785 mL/day (680-980 mL/day), p=.63]}. The exclusive breastfeeding rate and NB weight were similar between groups in the first 6 weeks postpartum.
  
  
  CONCLUSIONS
  ENG implant insertion immediately postpartum does not alter the volume of breast milk intake by NBs.
  
  
  CONCLUSIONS
  Considering the benefits of immediate postpartum initiation of ENG implant on reducing unintended pregnancy and pregnancy recurrence, especially in vulnerable populations, our study adds safety data on breastfeeding effect of this practice.
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil. Electronic address: giordanacb@yahoo.com.br.
authors.forename: Giordana Campos
authors.initials: GC
authors.lastname: Braga
authors.affiliation: Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ferriolli
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
authors.forename: Silvana Maria
authors.initials: SM
authors.lastname: Quintana
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil; National Institute of Hormones and Women's Health, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
authors.forename: Rui Alberto
authors.initials: RA
authors.lastname: Ferriani
authors.affiliation: Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
authors.forename: Karina
authors.initials: K
authors.lastname: Pfrimer
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil; National Institute of Hormones and Women's Health, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
authors.forename: Carolina Sales
authors.initials: CS
authors.lastname: Vieira
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003267:Contraception / Q000009:adverse effects / Q000379:methods; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D017135:Desogestrel / Q000008:administration & dosage / Q000009:adverse effects*; D003903:Deuterium / Q000008:administration & dosage / Q000032:analysis; D004343:Drug Implants; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation; D008895:Milk, Human / Q000187:drug effects* / Q000378:metabolism; D049590:Postpartum Period; D011247:Pregnancy; D012463:Saliva / Q000737:chemistry
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; C044815:etonogestrel; D017135:Desogestrel; D003903:Deuterium
keywords: Breastfeeding; Contraception; Deuterium; Etonogestrel