CDC Issues Revised Guidelines for Postpartum Contraceptive Use

From Medscape Education Clinical Briefs

News Author: Laurie Barclay, MD
CME Author: Charles P. Vega, MD

07/12/2011;

Study Highlights

• The CDC convened a group of 13 ad hoc reviewers to evaluate current recommendations for postpartum contraception from the WHO.
• Ovulation can occur as early as 25 days postpartum among non–breast-feeding women, although fertile ovulation will not usually occur until at least 42 days after delivery.
• Short interpregnancy interval is associated with a higher risk for low birth weight and preterm birth.
• Competing with these issues is that the risk for VTE is elevated by 22-fold to 84-fold in women during the first 42 days of the postpartum period vs control participants. This risk is particularly high in the 3 weeks after delivery.
• Women with other risk factors for VTE, such as advanced maternal age, smoking, or cesarean delivery, carry an even higher risk for postpartum VTE.
• Nonetheless, there is no direct evidence examining the risk for VTE among postpartum women using combined hormonal contraceptives.
• The current recommendations strongly discourage the use of combined oral contraceptives during the first 21 days after delivery. The risk for pregnancy is low during this period, but the risk for VTE is significantly elevated.
• Combined hormonal contraceptives may be initiated between 21 and 42 days postpartum among women without other risk factors for VTE. However, among women with a risk factor, including age 35 years or older, previous VTE, immobility, transfusion after delivery, obesity, smoking, or postpartum hemorrhage, the use of combined hormonal contraceptives should be avoided until at least 42 days postpartum.
• After 42 days postpartum, there are no restrictions on the use of combined hormonal contraceptives based on postpartum status.
• Clinicians should also bear in mind that combined hormone contraceptives can interfere with successful breast-feeding.

Clinical Implications

• Progestin-only hormonal contraceptives and the IUD may be initiated immediately after delivery, whereas women should not initiate contraception with a diaphragm or cervical cap until 6 weeks postpartum.
• The current recommendations strongly discourage the initiation of combined hormonal contraceptives in the first 21 days postpartum among all women. Women without any risk factor for VTE may initiate combined hormonal contraceptives between 21 and 42 days postpartum, but women with a risk factor for VTE should wait until more than 42 days postpartum.