Breastfeeding pattern and the duration of lactational amenorrhea in urban Chilean women

The influence of the breastfeeding pattern and several clinical variables upon the duration of postpartum amenorrhea was assessed in a group of healthy women selected for having had a normal pregnancy and delivery and being highly motivated for prolonged breastfeeding on demand. 676 women who were fully nursing at the second month postpartum entered the study. Supplements were administered to 11% and 48% of the infants by the end of the 3rd and 6th month, respectively. The first bleeding was experienced before the end of the sixth month postpartum by 57% of the cases. Supplementation had a strong negative influence while nursing frequency had a significant positive influence upon the length of amenorrhea. Notwithstanding, a frequency of 8+ suckling episodes per 24 h could not maintain amenorrhea in around half of the subjects. Age and parity had a moderate negative influence upon the risk of experiencing the first postpartum bleeding. Maternal weight and ponderal index, infant sex, birth weight and growth rate showed no significant influence upon the length of amenorrhea. In this urban population selected for having the highest motivation and best breastfeeding performance, the association of breastfeeding with amenorrhea was weak in comparison with what has been described for other populations. The risk of experiencing the first bleeding was reduced while fully breastfeeding with a high number of nursing episodes per day and night, particularly in older women with higher parity. But even in such situation 25% and 50% of the women had started to cycle by the end of the fifth and eight postpartum month.     

Contraceptive efficacy of lactational amenorrhea in urban Chilean women.

The contraceptive efficacy of breastfeeding was assessed in 236 healthy urban women who were followed at monthly intervals during the first postpartum year. Proportional hazard models were used to evaluate the influence of time postpartum, menstrual status and breastfeeding pattern upon the risk of pregnancy. Time and menstrual status had a highly significant effect on this risk. Those women who remained in amenorrhea had cumulative probabilities of pregnancy of 0.9% and 17% at 6 and 12 months postpartum, respectively. In those who recovered menstrual cycles, the risk rose to 36% and 55% at 6 and 12 months, respectively. Milk supplementation also increased significantly the risk when considered alone but not when time and/or menstrual status were included in the analysis. However, amenorrheic women who introduced bottle feeding, had a higher risk of pregnancy after 6 months postpartum than those who remained fully nursing. The analysis was unable to detect a significant influence of the nursing frequency. The results confirm that lactational amenorrhea is an effective contraceptive during the first six months postpartum. The first postpartum bleeding marks a great increase in the risk of pregnancy. Supplementation also increases the risk, particularly in amenorrheic women.     

Using complete breastfeeding and lactational amenorrhoea as birth spacing methods

The aim of this study was to evaluate the effectiveness of lactational amenorrhoea and to determine the relationship between extended breastfeeding and the return of fertility. Breastfeeding pattern, basal body temperature, cervical mucus, salivary ferning, vaginal blood discharge, frequency of sexual intercourse, and the presence of ovulation in the first cycle after the resumption of menses with ultrasonography were evaluated in 40 women. All subjects completed the study with only one case of incomplete breastfeeding. No pregnancies were observed. The mean number of feeding sessions and mean interval between sessions decreased significantly (p <0.01) during the first six months postpartum (7.5 +/- 1.3 after 60 days postpartum vs. 5.7 +/- 2.1 after 180 days, and 3.6 +/- 0.8 vs. 5.1 +/- 0.9, respectively). Eight women (20%) menstruated before weaning, but none had an adequate thermal shift, while 32 (80%) had their first vaginal bleeding after weaning with 12 (37.5%) registering an adequate thermal shift. Both basal body temperature and salivary ferning proved to be suggestive of ovarian activity, while mucus characteristics were not reliable in identifying fertile periods. Our study showed that breastfeeding associated with lactational amenorrhoea proved to be a good method of postpartum fertility control. Since the importance of supplementation is still debated, it is recommended that a "complete" breastfeeding program be used.     

The contraceptive benefit of breastfeeding

Breastfeeding has long been a means of fertility regulation in traditional communities but only recently have attempts been made to characterize and quantify this attribute. Breastfeeding encompasses behavioral, geographical, and cultural factors, which account for the differences in the prevalence and practice of breastfeeding in different communities. Ovarian activity is suppressed in the breastfeeding mother. Initially the suppression is complete and the woman is amenorrheic. This is followed by anovulatory menstrual cycles or ovulatory cycles that manifest luteal phase deficiency or normal ovulatory cycles. The duration of ovarian follicular suppression is variable and recent work suggests that lactation suppresses ovarian activity by disturbing the pulsatile pattern of luteinizing hormone (LH) secretion. During lactational amenorrhea, prolactin levels are high, LH levels are low to normal. Follicle stimulating hormone concentrations are normal by four weeks postpartum, and estrogen and progesterone levels are low. The degree of ovarian suppression is enhanced by increased frequency of suckling, longer duration of feeds, and more frequent night-time feeds. Introduction of supplementary feeds inhibits ovarian suppression. These and other factors account for variations in the length of lactational amenorrhea in an individual and between populations. The Bellagio Consensus Statement affirms that the risk of pregnancy in a fully breastfeeding, amenorrheic woman in the first six months of lactation is less than 2%. After the sixth month it is increasingly likely that ovulation will precede the first menstruation. The Bellagio Consensus has given scientific validity to birth-spacing in developing countries and the lactational amenorrhea method (LAM) as a means of contraception. If breastfeeding ceases to be full, menstruation resumes, or the baby is more than six months old, alternative methods of contraception should be used. Breastfeeding should feature more prominently in fertility regulation programs and counseling, especially in developing countries.     

A study of breastfeeding and the return of menses and pregnancy in Karachi, Pakistan

A longitudinal study of breastfeeding women was conducted to determine whether breastfeeding frequency is associated with the length of postpartum amenorrhea. The data are also conducive to testing the guidelines of the "Bellagio Consensus" (i.e., that there is no more than a 2% chance of pregnancy during breastfeeding in the first six months postpartum in the absence of vaginal bleeding and regular supplements). Twenty-eight breastfeeding women were followed-up weekly in Karachi, Pakistan. The frequency of breastfeeding was found to be a poor correlate of the duration of amenorrhea. Thirty-six percent of the women became pregnant during the study. However, all were having menses and/or giving regular supplements before the estimated date of conception, consistent with the Bellagio Consensus. In countries such as Pakistan, where contraceptive use is low, active promotion is needed to prevent the further decline of breastfeeding in order to retain its contraceptive as well as other maternal and child health benefits.     

The reliability of menses to indicate the return of ovulation in breastfeeding women in Manila, The Philippines

Demographic studies generally use menses to indicate the return of fertility during breastfeeding. In a prospective study of 40 breastfeeding women in Manila, the resumption of ovarian activity was monitored by urinary hormone assays, and menstrual status was determined by weekly interview. For the women who menstruated before six months postpartum, first menses was not a good indicator of ovulation because there was a high proportion of anovular menses (67 percent), and the lag between anovular first menses and subsequent ovulation was 15.7 (+/- 4.4) weeks. After six months postpartum the proportion of anovular first menses declined to 22 percent, and the lag between anovular first menses and ovulation was 7.3 (+/- 4.6) weeks. If all anovular and ovulatory menstrual episodes are considered, the mean interval between first observed menses and first ovulation was 8.4 weeks during the first six months postpartum and only 0.1 week after six months. Thus, in breastfeeding women, menses is an inaccurate proxy measure for the timing of fertility return before six months postpartum, but a good indicator of the resumption of ovulation after six months.     

A Bridge for postpartum women to Standard Days Method®: I. Developing the Bridge

BackgroundA new fertility-awareness-based Bridge was developed for postpartum women starting with their first postpartum menses and until they are eligible to use the Standard Days Method®. This article describes the development of the Bridge and theoretical efficacy.Study DesignAnalysis of a preexisting data set collected in 1986–1990 was performed. Seventy-three breastfeeding women in Australia, Britain and Canada were followed starting 42 days postpartum until they had at least two potentially fertile cycles. We used these data to calculate the theoretical probability of pregnancy from intercourse on different days of the cycle relative to ovulation for postpartum women following the instructions of the Bridge.ResultsThe fertility-awareness-based family-planning Bridge is theoretically effective for postpartum women until they reestablish cycle regularity and can start using the Standard Days Method.ConclusionThe Bridge can potentially be effective for postpartum women until they are eligible to use the Standard Days Method. Results from an efficacy study of the Bridge are described in a companion article.     

妇女产后月经恢复、避孕与再妊娠概率生命表法分析

本文讨论产后哺乳期闭经作为一种避孕方法纳入计划生育规划中的可行性。基于哺乳期自然避孕的机理,鼓励产后妇女尽可能地延长完全母乳喂养期限,充分发挥哺乳期闭经的避孕作用,既避免了可能的再妊娠,又有益于产妇和婴儿的健康。本研究采用现况调查方法,对山东省淄博市张店区南定镇和沣水乡的2 315例自1993年1月～1995年12月期间凡生育过至少一个活产婴儿的已婚育龄妇女进行了抽样调查。用生命表法分析了产后月经恢复、避孕和再妊娠等事件的发生概率。结果显示,产后三个月时,城乡妇女月经恢复累积概率分别为0.3042和0.3329;避孕累积概率分别为0.5909和0.8700;再妊娠累积概率分别为0.0009和0.0038。数据表明,妇女月经恢复之前,有相当数量的妇女较早使用了避孕方法,意味着哺乳期的避孕作用尚未引起人们的足够重视。因此,建议加强哺乳期闭经可作为一种避孕方法宣传、咨询和培训。     

孕产妇睡眠质量及产后睡眠的影响因素

目的 调查孕产妇睡眠质量,探析女性产后睡眠质量的影响因素,为制定干预措施提供依据.方法 调查时间为2018年4月-2019年7月,女性在孕期产检时完成第一次问卷调查,产后3～7 d完成第二次问卷调查.以匹兹堡睡眠问卷评估睡眠情况.同时收集一般情况、产科情况、孕产期抑郁及产妇母乳喂养信心.采用多元线性回归分析模型分析影响...     

Statement on breast feeding,fertility and contraception

An important part of the human reproductive process, breastfeeding also plays a key role in infant nutrition while protecting the infant from exposure to infection. Breastfeeding also plays a major role in the natural regulation of fertility, but breastfeeding patterns are changing along with urbanization and lifestyle changes. These changes are tending towards a shortening of the duration of breastfeeding, a reduction in the daily frequency of breastfeeding episodes, and an earlier introduction of food supplements. Consequently, the risk of pregnancy during lactation has increased. The literature suggests considerable variability in the length of breastfeeding and postpartum amenorrhea and in the duration of lactational infertility among different populations. Both the return of ovarian activity and fertility depends on the time elapsed since delivery. Variables that play a primary role in the length of amenorrhea and infertility include: the duration of breastfeeding the frequency and duration of suckling; the administration of supplements to the infant; the mother's nutritional status; and geographic, social, and cultural factors. Knowledge of local breastfeeding practices and the associated risks of pregnancy should be a prerequisite for those counseling nursing women. All women should be advised and encouraged to breastfeed fully, as far as is practicable. Women also need to be informed that it is difficult to predict exactly the duration of lactational infertility for each woman. The timing of the introduction of contraception depends on the risk factors and some programmatic aspects, such as the possibility that the woman may not return after delivery or after the 1st postpartum visit as well as the type of contraceptive chosen. Current information on the influence of contraceptive methods -- IUDs, oral contraceptives, injectable contraceptives, norplant, barrier methods, periodic abstinence, and sterilization -- upon breastfeeding are summarized.     

B超监测产后哺乳妇女排卵、子宫复旧和卵巢变化

目的:观察产后哺乳妇女首次排卵日,了解产后哺乳妇女卵巢变化及子宫体复旧情况,为产后哺乳妇女避孕节育措施的应用提供科学数据。方法:连续腹部B超探查101例产后哺乳妇女子宫体复旧、卵巢变化及排卵情况,辅以基础体温(BBT)测量及宫颈粘液评分。结果:53例(52.5％)B超监测到大于1.8cm卵泡,平均在产后154天(5.1个月),其中32例(60.4％;32/53)卵泡大于1.8cm后萎缩,结合BBT及宫颈粘液评分,提示排卵多为黄体功能不全。产后4个月内B超监测首次排卵为10.9％(11/101),4个月后排卵率为41.6％(42/101)。给婴儿添加辅食时间与月经复潮时间及首次排卵时间呈显著正相关(n=100,r=0.4764,P<0.01及n=53,r=0.5554,P<0.01)。产后61～90天(B组)子宫体明显比42～60天(A组)减小,91～120天(C组)及121～150天(D组)均明显比A组和B组减小(P<0.05～0.01),而151天以后各组(E组、F组及G组)间比较均无明显差异,但均明显小于A、B、C、D各组(P<0.01)。卵巢B超测量,产后151～210天(C组)及210天以上(G组)两组均明显比A组和B组增大。结论:添加辅食对产后月经复潮及排卵有较大影响。建议产后妇女在母乳喂养为主的情况下,自行选择避孕措施以产后60天为宜,落实具体实施情况应在产后4个月开始;延长母乳喂养时间是一种有效的避孕方法。产后哺乳妇?     

慢性HBV感染产妇产后抑郁症发生率调查与原因分析

目的:探讨慢性HBV感染产妇产后抑郁症发病情况及其影响因素。方法:采用孕期调查表、焦虑抑郁评定量表、爱丁堡产后抑郁量表和产后调查表分别于孕28～36周和产后4～6周对孕产妇进行调查。结果:慢性HBV感染产妇产后抑郁发生率为28.20%,其中顺产者产后抑郁症的发生率为26.11%(82/314),剖宫产及手术助产的产妇产后抑郁症的发生率为31.19%(68/218),两者差异无统计学意义(χ2=2.89,P>0.05)。这表明分娩方式与产妇产后抑郁发生无相关性。单因素分析结果表明,母婴阻断失败、母乳喂养中断、妊娠期焦虑、妊娠期抑郁、相关知识缺乏、经济收入低等6项为危险因素,家庭关系融洽、母婴阻断依从性良好2项为保护因素;多因素分析结果表明,母婴阻断失败、母乳喂养中断、妊娠期抑郁等3项为危险因素,家庭关系融洽、母婴阻断依从性良好2项为保护因素。结论:慢性HBV感染产妇产后抑郁症发生率高,母婴阻断效果及围产期心理社会因素与产后抑郁症发生密切相关。     

Contraceptive rings; self-administered treatment governed by bleeding

In an attempt to overcome bleeding problems and reduce the risk of ovulation during treatment, a new treatment schedule for contraceptive Silastic intravaginal rings (IVR) was studied in 16 women. The IVRs released about 300 μg of d-norgestrel (d-Ng) per day. They were used continuously and removed for five days only when bleeding occurred or after several days of spotting. A total treatment period of 2279 days was studied corresponding to 81 28-day cycles. After an initial peak, the height of which was correlated with the plasma sex hormone binding globulin capacity (SHBGc), the d-Ng concentrations in plasma decreased and stabilized at mean concentrations between 0.8 and 2.2 ng/ml. The mean d-Ng concentration correlated well with the body weight of the women. Follicular activity was depressed during treatment as judged by plasma estradiol concentrations and no ovulations occurred. Four women were amenorrheic for treatment periods between 101 and 197 days. In most of the other women the incidence of bleeding and spotting was less than would have been expected during a comparable period without treatment. Systemic side effects in the form of aggressiveness, weight gain, acne and headache were noted by some of the subjects. No local side effects were obsered and no pregnancy occurred.     

注射醋酸甲孕酮妇女月经改变的相关因素分析

目的:研究注射醋酸甲孕酮(DMPA)妇女月经改变的相关因素。方法:将390例受试者分为哺乳组和非哺乳组两组,对多种数据进行回归分析。结果:注射DMPA次数越多,体质指数越大,哺乳时间越长,发生问经的可能性越大,而经量多的妇女越容易发生不规则流血。注射期间持续阴道流血不闭经妇女和闭经妇女在初潮、经期、周期、经量、注射次数、是否哺乳六个指标上均有显著性差异。结论:本研究为注射前预测妇女月经改变提供了一定的咨询参考。     

黄石、荆门地区产妇母乳喂养自我效能影响因素分析

目的 探究黄石、荆门地区产后妇女母乳喂养自我效能的现状及影响因素,为改善母乳喂养率提供更多理论依据。方法 对2017年12月—2018年3月在湖北省黄石市、荆门市的三所医院住院分娩的产妇进行问卷调查,获得产妇社会人口特征、孕产相关资料、母乳喂养相关情况。采用多元线性回归分析母乳喂养自我效能的影响因素。结果 共1 023名产妇纳入分析,平均年龄(29.0±5.7)岁。已婚占98.3%,初产占54.0%,大专及以上学历占53.9%。研究对象的母乳喂养自我效能平均得分为(45.5±12.3)分。多元线性回归的结果显示:当前不存在乳腺问题(B=2.08,P=0.036)、有母乳喂养经历(B=3.62,P<0.001)、家人提供母乳喂养指导或经验(B=3.20,P=0.001)、丈夫支持母乳喂养(B=5.87,P=0.001)及产后30 min内有医护母乳喂养帮助(B=3.02,P=0.003)的产妇母乳喂养自我效能得分更高。结论 产后妇女的母乳喂养自我效能可能与其健康状况、母乳喂养经历、社会支持及母乳喂养卫生服务有关。应对产后妇女提供广泛的社会支持,加强母乳喂养卫生服务提供,以提高其母乳喂养的自我效能,促进母乳喂养。     

Breastfeeding duration and perinatal cigarette smoking in a population-based cohort

OBJECTIVES: We examined the association between breastfeeding duration and maternal smoking before, during, and after pregnancy. METHODS: Data from the 2000-2001 Oregon Pregnancy Risk Assessment Monitoring System were used. Early weaning was defined as not breastfeeding at 10 weeks postpartum. RESULTS: At 10 weeks after pregnancy, 25.7% of mothers who initiated breastfeeding no longer breastfed. After controlling for confounders, quitters (mothers who quit smoking during pregnancy and maintained quit status after pregnancy) and postpartum relapsers (mothers who quit smoking during pregnancy and resumed smoking after delivery) did not have significantly higher risk for early weaning than nonsmokers. However, persistent smokers (mothers who smoked before, during, and after pregnancy) were 2.18 times more likely not to breastfeed at 10 weeks (95% confidence interval=1.52, 2.97). Women who smoked 10 or more cigarettes per day postpartum (i.e., heavy postpartum relapsers and heavy persistent smokers) were 2.3-2.4 times more likely to wean their infants before 10 weeks than were nonsmokers. CONCLUSIONS: Maternal smoking is associated with early weaning. Stopping smoking during pregnancy and decreasing the number of cigarettes smoked postpartum may increase breastfeeding duration.     

New IPPF statement on breastfeeding,fertility and post-partum contraception

The International Planned Parenthood Federation International Medical Advisory Panel drew up the following statement in November, 1989. Breastfeeding is good for the infant. Antibodies passed to it from the mother protect it from infection. Patterns of breastfeeding are changing. Therefore, the risk of pregnancy is increased. Postpartum amenorrhea plays a major role in natural fertility regulation. Studies from around the world show a positive correlation between the length of breastfeeding and the length of lactational amenorrhea. Amenorrhea lasts longer in those who breastfeed more often at night and during the day. There is controversy over the effect of nutrition on postpartum infertility. Pregnancy and the puerperium are a good time for counseling on maternal nutrition, child spacing, breastfeeding, and contraceptive methods. Counseling nursing mothers about potential fertility during lactation should be based on local information. All women should be advised to fully breastfeed. Family planning programs should cooperate with maternity services in providing counseling and education for postpartum women who need contraception, for providing referral services, for producing educational resources, and in training health personnel. Postpartum contraception should be included in the training of traditional birth attendants. Women who do not breastfeed can select any contraceptive method. Mothers who nurse must not hurt success of lactation or the infant's health. Nonhormonal contraception should be the 1st choice for lactating women. IUDs do not harm infant growth or lactation. Postpartum insertions are appropriate, though care must be taken. Female sterilization can be conveniently done at this time. Barrier methods are reliable when used regularly. The failure rate should be lower when used after delivery. Progestagen-only contraception consists of progestagen-only pills, injectables, and Norplant. These do not affect quality and quantity of breast milk or length of lactation. They are suitable for those who do not wish nonhormonal methods. There are possible consequences, however, of the transfer of the steroid to breast milk. Hormonal methods should not be used earlier than 6 weeks postpartum. High and low dose oral contraceptives adversely affect the quality and quantity of breast milk. They also reduce duration of lactation. They should be withheld until 6 weeks after delivery, or until the infant is weaned--whichever comes first. The efficacy or periodic abstinence in nursing women requires further analysis.     

Drinking and smoking at 3 months postpartum by lactation history

Summary. A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied.) Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.     

Drinking and smoking at 3 months postpartum by lactation history

A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied). Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.