The safety of intrauterine devices in breastfeeding women: a systematic review.

Abstract

OBJECTIVES:

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.

STUDY DESIGN:

Systematic review.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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: Erin N Berry-Bibee, Naomi K Tepper, Tara C Jatlaoui, Maura K Whiteman, Denise J Jamieson, Kathryn M Curtis
• Journal: Contraception (Contraception) Vol. 94 Issue 6 Pg. 725-738 (12 2016) ISSN: 1879-0518 [Electronic] United States
• PMID: 27421765 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Contraceptive Agents, Female
• Levonorgestrel

Topics

• Breast Feeding
• Contraception (methods)
• Contraceptive Agents, Female (administration & dosage)
• Equipment Safety
• Female
• Humans
• Intrauterine Devices, Copper (adverse effects)
• Levonorgestrel (administration & dosage)
• Postpartum Period
• Randomized Controlled Trials as Topic
• Risk Assessment
• Uterine Perforation (etiology)