Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA.
Matern Child Health J. 2019 Aug;23(8):1079-1086. doi: 10.1007/s10995-019-02743-2.
Little is known about provider attitudes regarding safety of selected hormonal contraceptives among breastfeeding women.
Using a nationwide survey, associations were analyzed between provider characteristics and perception of safety of combined oral contraceptives (COCs) in breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors and depot medroxyprogesterone acetate (DMPA) in breastfeeding women < 1 month postpartum and ≥ 1 month postpartum.
Approximately 68% of public-sector providers considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among non-physicians versus physicians (adjusted odds ratios [aOR] range 0.34-0.51) and those with a focus on adolescent health/pediatrics versus reproductive health (aOR 0.68, 95% confidence interval [CI] 0.47-0.99). Most public-sector providers considered DMPA safe for breastfeeding women during any time postpartum, with lower odds among non-physicians versus physicians (aOR range 0.20-0.54) and those with primary clinical focus other than reproductive health (aOR range 0.26-0.65). The majority of office-based physicians considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among those who did not use, versus those who used, CDC's contraceptive guidance (aOR 0.40, 95% CI 0.21-0.77). Most office-based physicians also considered DMPA safe for breastfeeding women during any time postpartum.
A high proportion of providers considered use of selected hormonal contraceptives safe for breastfeeding women, consistent with evidence-based guidelines. However, certain provider groups might benefit from education regarding the safety of these methods for breastfeeding women.
对于选择在哺乳期使用的激素避孕药具的安全性，提供者的态度鲜为人知。
通过一项全国性调查，分析提供者特征与以下情况之间的关联：产后 1 个月以上且无其他静脉血栓形成危险因素的母乳喂养妇女使用复方口服避孕药（COC），产后 1 个月以内和产后 1 个月以上的母乳喂养妇女使用 depot 甲羟孕酮（DMPA）。
大约 68%的公共部门提供者认为 COC 对产后 1 个月以上且无其他静脉血栓形成危险因素的母乳喂养妇女是安全的，与医生相比，非医生的可能性较低（调整后的优势比 [aOR] 范围为 0.34-0.51），以及关注青少年健康/儿科学与生殖健康的提供者的可能性较低（aOR 0.68，95%置信区间 [CI] 0.47-0.99）。大多数公共部门的提供者认为 DMPA 在任何产后时期对母乳喂养的妇女都是安全的，与医生相比，非医生的可能性较低（aOR 范围 0.20-0.54），以及主要临床重点不是生殖健康的提供者的可能性较低（aOR 范围 0.26-0.65）。大多数以办公室为基础的医生认为 COC 在产后 1 个月以上且无其他静脉血栓形成危险因素的母乳喂养妇女中是安全的，与不使用 CDC 避孕指南的医生相比，使用该指南的医生的可能性较低（aOR 0.40，95%CI 0.21-0.77）。大多数以办公室为基础的医生也认为 DMPA 在任何产后时期对母乳喂养的妇女都是安全的。
很大一部分提供者认为某些激素避孕药具在哺乳期使用是安全的，这与基于证据的指南一致。然而，某些提供者群体可能需要接受有关这些方法对母乳喂养妇女安全性的教育。
