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

7.项目摘要/摘要 梅丽莎·陈，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。她正在寻求这份事业 发展奖将使她成为产后避孕的独立调查者 特别关注哺乳作为一种避孕方法。这一K23奖项使陈医生能够实现她的事业 目标通过以下目标：(1)通过以下途径拓宽她对临床研究的理解 课程工作，(2)通过指导不同类型的以病人为导向的研究经验，使她的研究技能多样化 避孕研究，以及(3)促进她的专业发展成为一名学术研究人员。陈医生 组建了一支由导师和顾问组成的团队，指导她完成研究和职业发展。 她的主要导师是避孕药临床试验专家米切尔·克莱宁博士，她的共同导师是米切尔·克莱宁博士。 埃莉诺·比姆拉·施瓦茨，她在哺乳期产妇健康和定性研究方法方面拥有专业知识。 研究：产后避孕在确定分娩间隔方面起着作用，但哺乳专家 对及早开始荷尔蒙避孕可能对母乳喂养产生不利影响表示关切。这个 哺乳期闭经方法(LAM)是一种有效的初步避孕方法，但在一定程度上 目前尚不清楚哪些正在抽水的女性可以依靠LAM。这一问题与儿童的母亲尤其相关 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作为一种避孕方法的咨询 通过：(1)了解母乳喂养的母亲之间卵巢抑制的差异(即 以及(2)研究这些差异是否存在于 早产的母亲与足月分娩的母亲相比。这个目标将在3个月内实现 目标。第一个目标是比较闭经率、哺乳时间和恢复性行为。 产后母乳喂养的妇女与足月和早产后哺乳的妇女比较 通过对产妇产后6个月的前瞻性观察研究。第二个目标是 进行一项初步研究，评估使用家庭尿促黄体激素的可行性和可接受性。 检测纯母乳喂养妇女排卵的试剂盒。血清孕酮水平将被吸引到 确认排卵，用这项技术确定的排卵的平均时间将被评估。这个 第三个目标是了解婴儿母亲在避孕和婴儿喂养方面的决策。 采用半结构化访谈的定性方法对早产儿进行研究。这些建议的调查结果 研究将成为潜在的R01拨款申请的基础，以进行一项多中心避孕临床试验 LAM在足月儿和早产儿母亲吸母乳中的疗效。

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.