This record contains information specific to the levonorgestrel intrauterine device (IUD). Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as levonorgestrel are considered the hormonal contraceptives of choice during lactation. Fair quality evidence indicates that levonorgestrel does not adversely affect the composition of milk, the growth and development of the infant or the milk supply. Expert opinion and a metanalysis hold that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum.[1-5] There are no reports of adverse effects in breastfed infants with maternal use of progestin-only contraceptives. Low quality evidence indicates that there may be no difference in breastfeeding rates at 6 months between immediate and delayed insertion of progestin-releasing IUDs.[6] Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.[7-9] The World Health Association recommends that progestin-only intrauterine devices (IUDs) can be inserted before 48 hours postpartum and after 4 weeks postpartum, but should not be inserted between 48 hours and 4 weeks postpartum.[1] Other guidelines and product labeling consider delayed postpartum insertion acceptable if immediate insertion is not feasible.[3] Four small, randomized studies on this point differed in their outcomes. Three found that early insertion did not adversely affect breastfeeding,[10-12] and the other found that immediate IUD insertion markedly reduced the breastfeeding rate at 6 months postpartum.[13] A meta-analysis found that uterine perforation with IUD insertion was 6 to 7% times in breastfeeding mothers, but that the risk of expulsion and adverse events was no greater in breastfeeding mothers.[14] More recent prospective studies found an increase in the risk of expulsion of intrauterine devices with breastfeeding,[11,15] while a large retrospective study found a 29% lower risk of expulsion in breastfeeding women.[16]
本记录包含左炔诺孕酮宫内节育器（IUD）的特定信息。虽然母乳喂养期间首选非激素方法，但左炔诺孕酮等仅含孕激素的避孕药被视为哺乳期激素避孕的首选。中等质量的证据表明，左炔诺孕酮不会对乳汁成分、婴儿生长发育或乳汁分泌产生不利影响。专家意见和一项荟萃分析认为，仅含孕激素的避孕产品的风险对于产后任何时间的哺乳母亲通常都是可以接受的。[1-5] 没有关于母亲使用仅含孕激素的避孕药对母乳喂养婴儿产生不良影响的报告。低质量的证据表明，立即和延迟插入释放孕激素的宫内节育器在6个月时的母乳喂养率可能没有差异。[6] 一些证据表明，仅含孕激素的避孕药可能有助于预防哺乳期骨密度流失，或至少不会使其恶化。[7-9] 世界卫生协会建议，仅含孕激素的宫内节育器（IUD）可在产后48小时前和产后4周后插入，但不应在产后48小时至4周之间插入。[1] 其他指南和产品标签认为，如果无法立即插入，产后延迟插入是可以接受的。[3] 关于这一点的四项小型随机研究结果各不相同。三项研究发现早期插入不会对母乳喂养产生不利影响，[10-12] 另一项研究发现立即插入宫内节育器会显著降低产后6个月的母乳喂养率。[13] 一项荟萃分析发现，母乳喂养母亲中宫内节育器排出的风险并不更高。[14] 最近的前瞻性研究发现，母乳喂养会增加宫内节育器排出的风险，[11,15] 而一项大型回顾性研究发现，母乳喂养女性中宫内节育器排出的风险降低了29%。[16] 美国妇产科医师学会建议，应告知女性，产后立即插入的宫内节育器排出率可能高于稍后插入。[3]
