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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
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Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 2

Category: Clinical Obstetrics

Poster Session 2

(444) Combined Hormonal Contraceptives During Lactation: A Network Meta-Analysis of Breastfeeding, Maternal, and Infant Outcomes

Wednesday, February 11, 2026
3:30 PM - 5:00 PM  
Objective:
To assess the safety and efficacy of various contraceptive methods used during breastfeeding, with a focus on estrogen-based options, using a network meta-analysis approach.

Study Design:
Eligible studies included randomized controlled trials and observational studies (cohort and case-control) that compared different contraceptive methods in postpartum breastfeeding women. Contraceptives were classified into three categories: (1). Progestin-only (2). Combined estrogen and progestin (3). Non-hormonal methods (e.g., copper IUD, sterilization, condoms, spermicides. Primary maternal outcomes included breast milk volume, breastfeeding discontinuation, and unplanned pregnancies. Infant outcomes included weight and height. A network meta-analysis was performed to compare interventions.

Results:
Of 5,728 screened records, 38 studies were included (5 RCTs, 33 observational), comprising a total of 13,122 women. No statistically significant reduction in breast milk volume was observed when comparing combined oral contraceptives (COC) to progestin-only ([SMD] 13.41ml, 95% CI −29.5 to 56.33; p = 0.54) or to non-hormonal methods ([SMD] 24.5ml, 95% CI −18.95 to 67.95; p = 0.27). Similarly, no significant difference was found in breastfeeding discontinuation rates: COC vs. progestin-only: OR 1.37 (95% CI 0.67–2.81; p = 0.4) and COC vs. non-hormonal: OR 1.13 (95% CI 0.57–2.24; p = 0.7). Among 8,712 women, 149 unplanned pregnancies were reported. Mechanical barrier methods were associated with a higher pregnancy risk compared to progestin-only methods (OR 1.92, 95% CI 1.06–3.48; p = 0.0308). Infant growth parameters (weight and height) showed no significant differences across groups.

Conclusion:
Estrogen-containing contraceptives do not appear to adversely affect milk volume, breastfeeding continuation, or infant growth compared to other methods. These findings support the consideration of a broader range of contraceptive options during lactation, based on individual preference and clinical context. Nonetheless, larger and well-designed studies are needed to confirm these results and inform practice guidelines.