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Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning.

OBJECTIVE: Our purpose was to ascertain the effects of timing of conception on the risk of spontaneous abortion. STUDY DESIGN: To assess these effects, women who conceived while using natural family planning were identified in five centers worldwide between 1987 and 1993. Timing of conception was determined from 868 natural family planning charts that recorded day of intercourse and indices of ovulation (cervical mucus peak obtained according to the ovulation method and/or basal body temperature). Conceptions on days - 1 or 0 with respect to the natural family planning estimated day of ovulation were considered to be "optimally timed," and all other conceptions were considered as "non-optimally timed." The rate of spontaneous abortions per 100 pregnancies was examined in relation to timing of conception, ages, reproductive history, and other covariates with bivariate and multivariate statistical methods. RESULTS: There were 88 spontaneous abortions among 868 pregnancies (10.1%). The spontaneous abortion rate was similar for 361 optimally timed conceptions (9.1%) and 507 non-optimally timed conceptions (10.9%). However, among 171 women who had experienced a spontaneous abortion in a prior pregnancy, the rate of spontaneous abortion in the index pregnancy was significantly higher with non-optimally timed conceptions (22.6%) as compared with optimally timed conceptions (7.3%). This association was not observed among 697 women with no history of pregnancy loss. The adjusted relative risk of spontaneous abortion among women with non-optimally timed conceptions and a history of pregnancy loss was 2.35 (95% confidence intervals 1.42 to 3.89). The excess risk of spontaneous abortion was observed with both preovulatory and postovulatory conceptions. CONCLUSIONS: Overall, there is no excess risk of spontaneous abortion among the pregnancies conceived during natural family planning use. However, among women with a history of pregnancy loss, there is an increased risk of spontaneous abortion associated with preovulatory or postovulatory delayed conceptions.

Abortion, Spontaneous↗

Premature weaning in east Bhutan: only if mother is pregnant again.

The relationship between breast-feeding and subsequent pregnancy in East Bhutan is examined, against the background of local attitudes to family planning. Ninety-eight mothers who had given birth 30-36 months earlier were interviewed. Semisolid supplementary feeding was introduced at a median age of 3 months. Median total duration of breast-feeding was 28 months, and day and night breast-feeding on demand was continued throughout. Median duration of postpartum amenorrhoea was 12 months, and was associated with the timing of the introduction of supplementary foods. There was a significant association between the occurrence of a subsequent pregnancy and early termination of breast-feeding. The relationships between breast-feeding pattern and pregnancy interval are complex, and their relative influence changes with time. During the first year postpartum, infertility during lactational amenorrhoea is important. During the second year there is a strong negative effect on lactation from the next pregnancy. The only important reason for ceasing to breast-feed within 2 years seems to be a new pregnancy.

Amenorrhea↗

[The risk of conception during lactation].

The contraceptive effect of lactation is undisputed. Nursing increases the prolactin level in the serum. This hyperprolactinaemia suppresses all levels of the hypothalamus-hypophysis-ovary axis. The risk of ovulation can be greatly reduced by a proper nursing routine, frequency of nursing being credited with a greater anovulatory effect than duration of nursing. In addition, full nursing increases contraceptive safety. To prevent a drop in the serum prolactin level, nursing should also be done at night-time. Amenorrhoea during the lactation period is one of the most important prerequisites for an adequate contraception. The risk of ovulation increases dramatically, if vaginal bleeding occurs. However, the first cycles in the lactation period are often anovular and characterized by corpus luteum insufficiency. Lactation-induced amenorrhoea, nursing frequency of at least 6 x/day, nursing duration of at least 60 minutes/day, additional feedings of maximum 1 x/day and nocturnal nursing are the requirements for sufficient nursing-induced contraception. Even if these requirements are fulfilled, the risk of ovulation increases with the length of time post partum. Effective contraceptive protection is attained only up to the 9th p.p. week. If high post partum contraceptive safety is required, a mini-pill or micro-pill must be recommended. Lactation can only be recommended as a moderate contraceptive measure even in this case, an additional method (chemico-mechanical) should be initiated 3 months post partum.

Adult↗

Individual and community characteristics influencing breastfeeding duration in Vietnam.

This analysis of selected community and maternal characteristics influencing duration of breastfeeding in Vietnam utilized data from the 1988 Demographic and Health Survey and 1990 Accessibility of Contraceptives Survey available for the 4434 children born to 2769 women having their last birth between 1983-88. Explanatory variables included as covariates in the hazards model were mother's education, age of the mother at the time of the child's birth, birth order, and gender of the child, urban versus rural residence, infant mortality risk in the child's province, locality (mountains and highlands compared to delta and coastal), and region of the country (north, south). Indicators of development in the child's village included availability of electricity and public transportation. Breastfeeding duration was longer among the more highly educated women and among those women living in provinces with higher infant mortality. However, there were no significant differences in the duration of breastfeeding with variations among certain development characteristics of the village. Although there were regional differences in the duration of breastfeeding for the rural population, there were no regional differences for the overall population. There were no significant variations in the duration of breastfeeding by age of the mother, birth order or gender of the child. Although there were significant variations in duration of breastfeeding by some maternal and community characteristics, between 80-90 per cent of all women breastfeed for at least the first year of the child's life.

Adolescent↗