Singhal Seema, Sarda Nivedita, Gupta Shipra, Goel Sakshi
Associate Professor, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjang Hospital , New Delhi, India .
Professor and Consultant, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjang Hospital , New Delhi, India .
J Clin Diagn Res. 2014 Mar;8(3):69-72. doi: 10.7860/JCDR/2014/7775.4110. Epub 2014 Mar 15.
Unmet need for family planning approaches 40% or higher and many women are at risk of unintended pregnancy. Progesterone contraception after birth is frequently recommended, but concern remain of inhibition of lactation or effects on infant health. In present study we aimed to evaluate impact of short term use of injectable depot medroxy progesterone acetate (DMPA) if given in early post partum period on infant health and breast feeding performance.
A prospective case control study was conducted and 250 women immediately after delivery were recruited in the study. 150 women who were recruited as study group received Inj. DMPA 150 mg intra muscularly after initiation of lactation before discharge from hospital (Day 2-Day 10 of their delivery). 100 post partum women, not using hormonal contraception were taken as controls. All the subjects were followed to complete a full 6 months follow up. Duration and frequency of lactation, gain in weight, gain in height and any illness spells in the infant were noted at 6 weeks, 3 months and 6 months follow up. In the study group 100 subjects completed 6 months follow-up. The statistical analysis was carried out by using SPSS software version 7. The statistical technique used was z score(significance shown by z score> 1.96) and repeated measure analysis (two way Anova technique).
Hundred percent of primigravidas in the study group and 95% in the control group were satisfied with their lactation amount. The average gain in height was comparable in both study and control group {4.36±0.56 vs 4.33±0.54 (z score 0.38) at 6 weeks, 12.44±0.73 vs 12.40±0.71 (z score 0.39) at 3 months 17.30±0.91 vs 17.28±0.83 (z score 0.16) at 6 months}. Similarly average gain in weight was also not significantly different in two groups {0.89±0.11 vs 0.93±0.10 (z score 0.71) at 6 weeks, 1.77±0.17 vs 1.78±0.16 (z score 1.07) at 3 months and 3.53±0.30 vs 3.46±0.33 (z score 1.19) at 6 months}. The results were comparable with other studies.
Injectable DMPA use as a contraceptive in the immediate post partum period was found to be a safe and effective alternate method with no deleterious effect on mother's milk and infant's growth.
计划生育需求未满足率达40%或更高，许多女性面临意外怀孕风险。产后使用孕激素避孕常被推荐，但人们仍担心其会抑制泌乳或影响婴儿健康。在本研究中，我们旨在评估产后早期短期使用注射用醋酸甲羟孕酮（DMPA）对婴儿健康和母乳喂养情况的影响。
进行了一项前瞻性病例对照研究，研究招募了250名分娩后的女性。作为研究组的150名女性在开始泌乳后、出院前（分娩后第2天至第10天）接受了150毫克肌肉注射的DMPA。100名未使用激素避孕的产后女性作为对照组。所有受试者均接受了为期6个月的完整随访。在6周、3个月和6个月的随访中记录了婴儿的哺乳时长和频率、体重增加、身高增加以及任何疾病发作情况。研究组中有100名受试者完成了6个月的随访。使用SPSS软件版本7进行统计分析。所使用的统计技术为z分数（z分数>1.96表示有统计学意义）和重复测量分析（双向方差分析技术）。
研究组中100%的初产妇和对照组中95%的初产妇对其泌乳量感到满意。研究组和对照组的平均身高增长相当{6周时分别为4.36±0.56和4.33±0.54（z分数0.38），3个月时分别为12.44±0.73和12.40±0.71（z分数0.39），6个月时分别为17.30±0.91和17.28±0.83（z分数0.16）}。同样，两组的平均体重增加也无显著差异{6周时分别为0.89±0.11和0.93±0.10（z分数0.71），3个月时分别为1.77±0.17和1.78±0.16（z分数1.07），6个月时分别为3.53±0.30和3.46±0.33（z分数1.19）}。结果与其他研究相当。
产后立即使用注射用DMPA作为避孕方法被发现是一种安全有效的替代方法，对母乳和婴儿生长没有有害影响。
