title: The safety of intrauterine devices in breastfeeding women: a systematic review.
abstract: To investigate levonorgestrel (LNG)-releasing and copper-bearing (Cu) intrauterine device (IUD) safety among breastfeeding women and, for Cu-IUD use, breastfeeding performance and infant health.
  
  
  
  Systematic review.
  
  
  
  We searched PubMed, Embase, Cochrane Library and clinicaltrials.gov for articles through January 2016. We included studies of Cu-IUD or LNG-IUD users comparing IUD-specific (perforation, expulsion) and other contraceptive-related (infection, removal/cessation due to bleeding/pain and other adverse events) outcomes for breastfeeding vs. non-breastfeeding women. We also included studies of breastfeeding women comparing contraceptive-related outcome for IUD-users vs. other contraceptive-method users. Finally, we included studies comparing breastfeeding outcomes among Cu-IUD users to users of other nonhormonal contraceptives or no contraception.
  
  
  
  Of 548 articles identified, 23 (16 studies) met the inclusion criteria. Two studies suggested that the risk of IUD perforation was 6-10 times higher among breastfeeding vs. non-breastfeeding women. Seven studies suggested that risks for other adverse events were similar or lower among breastfeeding vs. non-breastfeeding women. Three studies among breastfeeding women found no increased risk of adverse events in IUD users vs. nonusers. Breastfeeding performance and infant growth were similar for Cu-IUD users and users of other nonhormonal methods or no contraception.
  
  
  
  Overall, risks for adverse events among IUD users, including expulsion, pain and removals, were similar or lower for breastfeeding women vs. non-breastfeeding women. Uterine perforation with IUDs, while rare, appeared more frequent among breastfeeding women. No evidence indicated that Cu-IUD use in breastfeeding women influences breastfeeding performance or infant growth.
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: wnw4@cdc.gov.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Berry-Bibee
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Naomi K
authors.initials: NK
authors.lastname: Tepper
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Tara C
authors.initials: TC
authors.lastname: Jatlaoui
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Maura K
authors.initials: MK
authors.lastname: Whiteman
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Curtis
mesh_terms: D001942:Breast Feeding; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage; D049590:Postpartum Period; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D014595:Uterine Perforation / Q000209:etiology*
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: IUD; Intrauterine device; breastfeeding; uterine perforation