Understanding the Lactational Amenorrhea Method of Contraception for Mothers of Preterm and Term Infants

了解早产儿和足月儿母亲哺乳期闭经的避孕方法

• 批准号: 9385677
• 负责人: Melissa Joy Chen
• 金额: $ 16.84万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9385677
• 关键词: Adherence; Affect; Amenorrhea; Applications Grants; Birth Intervals; Breast; Breast Feeding; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical Research; Clinical Trials; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Data; Decision Making; Detection; Development; Discipline of obstetrics; Effectiveness; Eligibility Determination; Exclusive Breastfeeding; Failure; Family Planning; Feeding Patterns; Feeds; Fellowship; Fertility; Future; Goals; Gynecology; Home environment; Human Milk; Infant; Infertility; International; Interview; K-Series Research Career Programs; Lactation; Luteinizing Hormone; Maternal Health; Maternal and Child Health; Measures; Medical; Melissa; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Milk; Mothers; Observational Study; Outcome; Ovarian Ablation; Ovulation; Ovulation Detection; Participant; Pilot Projects; Play; Postpartum Abstinence; Postpartum Period; Postpartum Women; Pregnancy; Pregnancy Interval; Premature Birth; Premature Infant; Progesterone; Pump; Qualitative Research; Questionnaires; Recruitment Activity; Recurrence; Reporting; Research; Research Methodology; Research Personnel; Risk; Risk Factors; Role; Sample Size; Sampling; Serum; Sex Behavior; Sexuality; Structure; Technology; Testing; Time; Training; Update; Woman; breast pump; career; career development; contraceptive efficacy; disorder prevention; experience; feeding; hormonal contraception; improved; lactational amenorrhea; milk expression; patient oriented; postpartum contraception; premature; professor; prospective; research and development; secondary outcome; skills; trial design; urinary

7. Project Summary/Abstract Melissa Chen, MD, MPH is an Assistant Professor in the Department of Obstetrics and Gynecology at UC Davis who completed fellowship training in family planning in June 2016. She is seeking this Career Development Award to establish herself as an independent investigator in postpartum contraception with a specific focus on lactation as a contraceptive method. This K23 award enables Dr. Chen to achieve her career goal through the following objectives: (1) to broaden her understanding of clinical research through coursework, (2) to diversify her research skills with experience in conducting different types of patient-oriented contraception studies, and (3) to facilitate her professional development into an academic researcher. Dr. Chen has assembled a team of mentors and advisors to guide her through her research and career development. Her primary mentor is Dr. Mitchell Creinin, an expert in contraceptive clinical trials, and her co-mentor is Dr. Eleanor Bimla Schwarz, who has expertise in lactation on maternal health and qualitative research methods. Research: Postpartum contraception plays a role in determining interpregnancy intervals, but lactation experts express concerns that early initiation of hormonal contraception may adversely affect breastfeeding. The lactational amenorrhea method (LAM) is an effective initial method of contraception; however, the extent to which women who are pumping can rely on LAM is unknown. This issue is particularly relevant to mothers of preterm infants who are at risk of recurrent preterm birth and who often delay hormonal contraception while pumping breast milk. The proposed research will improve counseling about LAM as a contraceptive method by: (1) understanding differences in ovarian suppression between mothers who are breastfeeding (i.e. feed at the breast) and those who are pumping breastmilk and (2) exploring whether these differences exist between mothers who deliver preterm compared to those who deliver at term. This goal will be accomplished with 3 aims. The first aim is to compare amenorrhea rates, duration of lactation, and resumption of sexual activity among postpartum women who are breastfeeding versus expressing milk after term and preterm delivery through a prospective observational study following women through 6 months postpartum. The second aim is to conduct a pilot study assessing the feasibility and acceptability of using home urinary luteinizing hormone test kits to detect ovulation in exclusively breastfeeding women. Serum progesterone levels will be drawn to confirm ovulation, and the average time to ovulation as determined with this technology will be assessed. The third aim is to understand decision-making regarding contraception and infant feeding practices in mothers of preterm infants using a qualitative approach with semi-structured interviews. Findings from these proposed studies will form the basis for a potential R01 grant application for a multicenter contraceptive clinical trial on the efficacy of LAM in mothers of term and preterm infants who are pumping breastmilk.

7.项目总结/摘要 Melissa Chen，医学博士，公共卫生硕士，加州大学妇产科助理教授 戴维斯于2016年6月完成了计划生育奖学金培训。她正在寻找这个职业。 发展奖，以确立自己作为一个独立的调查员在产后避孕与 特别注重将哺乳作为一种避孕方法。这个K23奖项使陈博士能够实现她的职业生涯 通过以下目标实现目标：（1）通过以下方式拓宽她对临床研究的理解 课程，（2）多样化她的研究技能，在进行不同类型的以病人为导向的经验， 避孕研究，以及（3）促进她成为一名学术研究人员的专业发展。陈医生 她组建了一个导师和顾问团队，指导她完成研究和职业发展。 她的主要导师是米切尔克雷宁博士，在避孕临床试验的专家，她的共同导师是博士。 埃莉诺比姆拉施瓦茨，谁在产妇健康和定性研究方法的哺乳专业知识。 研究：产后避孕在确定解释间隔方面发挥作用，但哺乳专家 表示关切的是，早期开始使用激素避孕可能对母乳喂养产生不利影响。的 哺乳期闭经方法（LAM）是一种有效的初始避孕方法;然而， 哪些正在抽水的妇女可以依靠LAM是未知的。这一问题与下列儿童的母亲特别相关： 有反复早产风险的早产儿，经常推迟激素避孕， 抽母乳拟议的研究将改善关于LAM作为避孕方法的咨询 通过：（1）了解母乳喂养的母亲（即， （2）探索这些差异是否存在于 与足月分娩的母亲相比，这一目标将在3 目标。第一个目的是比较闭经率、哺乳期持续时间和性活动的恢复 在足月分娩和早产后母乳喂养与挤奶的产后妇女中 通过一项前瞻性观察性研究，跟踪妇女产后6个月。第二个目标是 进行一项试点研究，评估使用家庭尿促黄体激素的可行性和可接受性 用于检测纯母乳喂养妇女排卵的检测试剂盒。将抽取血清孕酮水平， 确认排卵，并将评估使用该技术确定的排卵平均时间。的 第三个目标是了解怀孕妇女在避孕和婴儿喂养方面的决策， 早产儿使用半结构化访谈的定性方法。这些建议的结果 这些研究将成为潜在的R 01拨款申请的基础，用于多中心避孕临床试验， LAM对正在吸奶的足月儿和早产儿母亲的疗效。