Research Article| Volume 50, ISSUE 1, P55-68, July 1994

Progestogen-only contraceptives during lactation: II. Infant development

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      Growth, development and health of infants whose mothers used progestogen-only contraceptives during lactation were examined in a prospective, non-randomized study that was carried out in seven centres in five countries (Egypt, Thailand, Kenya, Chile and Hungary). The results on development are reported here. Breastfeeding women requesting effective contraception were admitted to the study at six weeks postpartum. Infants of acceptors of progestogen-only methods (pill, DMPA, NET-EN or NORPLANT® implants) and non-hormonal methods (IUD, barrier methods or sterilization) formed the study groups. The follow-up was at monthly intervals until the end of the first postpartum year. At each visit, the infant examination included, among other things, a set of developmental tests covering the following areas: gross motor, vision and fine motor, hearing, language and concept development, and self help and social skills. Participating in the study were 2466 mother-infant pairs. The comparisons between the study groups were carried out within centres using life table methods and Cox-model analysis having the time to first passing the test as the criterion. There were altogether 247 comparisons between the study groups. Thirty-two (13%) of these comparisons showed statistically significant differences: 20 differences showed that the infants in the progestogen-only groups passed the tests at an earlier age and 12 at a later age than infants in the non-hormonal groups. Since no consistent trends were observed across the centres, we conclude that in this study the progestogen-only contraceptives used during lactation did not adversely affect infant development.


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        • World Health Organization
        The effect of female sex hormones on fetal development and infant health.
        in: Report of a WHO Scientific Group. VIIth edition. World Health Organization Technical Report Series 657. 1981 (Geneva, Switzerland:)
        • Strauss LT
        • Speckhard M
        • Rochat RW
        • Senanayake P
        Oral contraception during lactation: a global survey of physician practice.
        Int J Gynaecol Obstet. 1981; 19: 169-175
        • Pebley AR
        • Goldberg HI
        • Menken J
        Contraceptive use during lactation in developing countries.
        Stud Fam Plann. 1985; 16: 40-51
        • WHO Special Programme of Research, Development and Research Training in Human Reproduction
        • Task Force on Oral Contraceptives
        Effects of hormonal contraceptives on milk volume and infant growth.
        Contraception. 1984; 30: 505-522
        • WHO Special Programme of Research, Development and Research Training in Human Reproduction
        • Task Force on Oral Contraception
        Effects of hormonal contraceptives on breast milk composition and infant growth.
        Stud Fam Plann. 1988; 19: 361-369
        • Affandi B
        • Karmadibrata S
        • Prihartano J
        • Lubis F
        • Samil R
        Effect of NOR- PLANT® on mothers and infants in the postpartum period.
        Adv Contracept. 1986; 2: 371-380
        • Dahlberg K
        Some effects of depo-medroxyprogestorone acetate (DMPA): Observations in the nursing infant and in long-term user.
        Int J Gynaecol Obstet. 1982; 20: 43-48
        • Harlap S
        Exposure to contraceptive hormones through breast milk—are there long-term health and behavioral consequences?.
        Int J Gynaecol Obstet. 1987; : 47-55
        • Satayashit N
        • Tankeyoon M
        • Chaudhury RR
        The effect of medroxyprogester- one acetate, administered to the lactating rat, on the subsequent growth, maturation and reproductive function of the litter.
        J Reproduct Fertil. 1976; 46: 411-412
        • Birke LIA
        • Sadler D
        Progestin-induced changes in play behaviour of the prepubertal rat.
        Physiol Behav. 1983; 30: 341-347
        • Koetsawang S
        • Boonayaprakob V
        • Suvanichati S
        • Paipeekul S
        Long-term study of growth and development of children breast-fed by mothers receiving Depo-Provera (medroxy-progesterone acetate) during lactation.
        in: Zatuchni GI Goldsmith A Shelton JD Sciarra JJ Long-acting Contraceptive Delivery Systems. Harper and Row, Philadelphia1984: 378-387
        • Jimenez J
        • Ochoa M
        • Paz Soler M
        • Portales P
        Long-term follow-up of children breast-fed by mothers receiving depot-medroxyprogesterone acetate.
        Contraception. 1984; 30: 523-533
        • Jaffe B
        • Harlap S
        • Baras M
        • et al.
        Long-term effects of MPA on human progeny: intellectual development.
        Contraception. 1988; 37: 607-619
        • Jaffe B
        • Shye D
        • Harlap S
        • Baras M
        • Lieblich A
        Aggression, physical activity levels and sex role identity in teenagers exposed in utero to MPA.
        Contraception. 1989; 40: 351-363
        • Reinisch JM
        Prenatal exposure to synthetic progestins increases potential for aggression in humans.
        Science. 1981; 211: 1171-1173
        • Levine M.D.
        • Carey W.B.
        • Crocker A.C.
        • Gross R.T.
        Developmental-behavioral pediatrics.
        W.B. Saunders Company, Philadelphia1983
        • WHO, Task Force for Epidemiological Research on Reproductive Health, Special Programme of Research, Development and Research Training in Human
        • Reproduction
        Progestogen-only contraceptives during lactation: I. Infant growth.
        Contraception. 1994; 50: XX
        • World Health Organization Division of Family Health and Division of Mental Health
        Protocols for the development and field testing of techniques for monitoring physical growth and psychosocial development.
        WHO document WHO/MCH/MNH/86.1. 1986;
        • Frankenburg WK
        • Dodds J
        • Archer P
        • Shapiro H
        • Bresnick B
        The Denver II: A major revision and restandardization of the Denver Developmental Screening Test.
        Pediatrics. 1992; 89: 91-97
        • Illingworth R.S.
        Development of the infant and young child.
        VIIth edition. Churchill Livingstone, Edinburgh, London, New York1980