To investigate levonorgestrel (LNG)-releasing an
d copper-bearing (Cu) intrauterine
device (IUD) safety among breastfee
ding women an
d, for Cu-IUD use, breastfee
ding performance an
d infant health.
d="absSec_2">Study design
d="sp0040">Systematic review.
d="absSec_3">Methods
d="sp0045">We searched PubMed, Embase, Cochrane Library and d="ir0005" class="interref" data-locatorType="url" data-locatorKey="http://clinicaltrials.gov">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.
d="absSec_4">Results
d="sp0050">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.
d="absSec_5">Conclusion
d="sp0055">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.
