Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study

Brito, Milena Bastos; Ferriani, Rui Alberto; Quintana, Silvana Maria; Yazlle, Marta Edna Holanda Diogenes; Silva de Sá, Marcos Felipe; Vieira, Carolina Sales

doi:10.1016/j.contraception.2009.05.124

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Volume 80, Issue 6 , Pages 519-526, December 2009

Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study

Milena Bastos Brito
- Department of Obstetrics and Gynecology, University of São Paulo, Ribeirão Preto, School of Medicine, Ribeirão Preto, SP, 14049-900, Brazil
Rui Alberto Ferriani
- Department of Obstetrics and Gynecology, University of São Paulo, Ribeirão Preto, School of Medicine, Ribeirão Preto, SP, 14049-900, Brazil
- National Institute of Hormones and Women's Health, Ribeirão Preto, SP, 14049-900, Brazil
Silvana Maria Quintana
- Department of Obstetrics and Gynecology, University of São Paulo, Ribeirão Preto, School of Medicine, Ribeirão Preto, SP, 14049-900, Brazil
Marta Edna Holanda Diogenes Yazlle
- Department of Obstetrics and Gynecology, University of São Paulo, Ribeirão Preto, School of Medicine, Ribeirão Preto, SP, 14049-900, Brazil
Marcos Felipe Silva de Sá
- Department of Obstetrics and Gynecology, University of São Paulo, Ribeirão Preto, School of Medicine, Ribeirão Preto, SP, 14049-900, Brazil
- National Institute of Hormones and Women's Health, Ribeirão Preto, SP, 14049-900, Brazil
Carolina Sales Vieira
- Department of Obstetrics and Gynecology, University of São Paulo, Ribeirão Preto, School of Medicine, Ribeirão Preto, SP, 14049-900, Brazil
- National Institute of Hormones and Women's Health, Ribeirão Preto, SP, 14049-900, Brazil
- Corresponding author. Carolina Sales Vieira, Avenida Bandeirantes, 3900, Campus Universitário, Monte Alegre, Ribeirão Preto, SP, CEP-14049-900, Brasil. Tel.: +55 16 36022804; fax: +55 16 36330946.

Received 12 February 2009; received in revised form 17 April 2009; accepted 21 May 2009. published online 13 July 2009.

Abstract

Background

The effects of etonogestrel (ETG)-releasing contraceptive implant during the immediate postpartum period on maternal safety are unknown.

Study design

Forty healthy women exclusively breastfeeding were randomized to receive either ETG-releasing implant 24–48 h after delivery (n=20) or depot medroxyprogesterone acetate (DMPA group; n=20) at the sixth week postpartum. We measured blood pressure, maternal and neonatal weight, body mass index (BMI; kg/m²), waist circumference (WC), complete blood count, C-reactive protein, interleukin-6, tumor necrosis factor (TNF-alpha), lipid profile, fasting serum glucose and maintenance of exclusive lactation up to the 12th week postpartum.

Results

Decreases in mean maternal weight, BMI (kg/m²) and WC were significantly greater in the ETG-releasing implant group than in the DMPA group during the first 6 weeks postpartum (-4.64±2.71 kg vs. -2.6±2.45 kg mean±SD, p=.017; -1.77±1.06 kg/m² vs. -0.97±0.95 kg/m², p=.026; -15.3±6.72 cm vs. -9.05±5.84 cm, p=.003, respectively). In addition, total cholesterol and HDL, were lower in DMPA users, and TNF-alpha and leukocytes were higher in DMPA users compared to in the implant group, between 6 and 12 weeks after delivery. The newborns of implant users showed a trend towards gaining more weight, as compared with the infants of the DMPA mothers during the first 6 weeks of life (implant group: +1460.50±621.34 g vs. DMPA group: +1035.0±562.43 g, p=.05). The remaining variables, including the duration of exclusive breastfeeding, were similar between the groups.

Conclusion

The insertion of ETG-releasing contraceptive implant during the immediate postpartum period was not associated with deleterious maternal clinical effects or with significant maternal metabolic alterations or decreased infant weight gain.

Keywords: Postpartum period, Breastfeeding, Contraceptive, Metabolism, Adverse effects, Etonogestrel