Immediate postpartum initiation of the etonogestrel contraceptive implant has been
proven to decrease rates of rapid, repeat pregnancies. Evidence supports that initiation
of the contraceptive implant 1–3 days postpartum in healthy women does not affect
breastfeeding success. However, little data exist for women at risk for low milk supply,
including women with obesity, polycystic ovarian syndrome, diabetes, premature delivery,
or prior history of low milk supply. Thus, our goal was to measure the impact of postpartum
implant insertion timing on breastfeeding success and duration in this high-risk population.
We conducted a three-armed randomized non-inferiority study of women who plan to breastfeed
and have known risk factors for low milk supply. Women were randomized to one of three
groups for the timing of implant placement: within 30 minutes of placental delivery,
24–72 hours postpartum, or six or more weeks postpartum. The primary outcome was time
to lactogenesis II. Secondary outcomes included duration and exclusivity of breastfeeding
and contraceptive implant satisfaction through six months postpartum.
We enrolled 153 participants. There were no significant differences in age, race,
ethnicity, insurance status, parity, gestational age at delivery and mode of delivery
between the three groups. There was no significant difference in time to lactogenesis
II with an average time of 62 hours (Kaplan-Meier, p=0.75). Duration and exclusivity
of breastfeeding, satisfaction with the implant, and reports of heavy or irregular
bleeding were similar among all groups.
Our study suggests that early etonogestrel implant insertion does not affect breastfeeding
success among women at risk for low milk supply.