Immediate versus delayed postpartum contraceptive implant on lactogenesis and breastfeeding: a systematic review and meta-analysis

To evaluate the impact of immediate postpartum contraceptive implant insertion on lactogenesis, breastfeeding outcomes, maternal satisfaction, implant continuation, and pregnancy rates within six months after delivery. This systematic review and meta-analysis followed the <i>Cochrane Handbook for Systematic Reviews of Interventions</i> and PRISMA guidelines. Randomised controlled trials comparing immediate (≤24 h after delivery) versus delayed (≥2 weeks postpartum) insertion of etonogestrel or levonorgestrel contraceptive implants were identified through PubMed, Embase, Cochrane Central, and ClinicalTrials.gov up to October 2025. Random-effects models were used to pool results, and heterogeneity was assessed by the I² statistic. The protocol was registered in PROSPERO (CRD42025117074). Eight randomised controlled trials including 881 postpartum women were analysed. Immediate insertion did not delay lactogenesis or reduce exclusive or any breastfeeding rates at six months. However, immediate insertion was associated with higher rates of exclusive breastfeeding at 3 months (RR = 1.25; 95% CI 1.02 to 1.52; <i>p</i> = 0.032) and any breastfeeding at 3 months (RR = 1.16; 95% CI −1.04 to 1.30; <i>p</i> = 0.007). Implant continuation at last follow-up was also higher with immediate insertion (RR= 1.44; 95% CI 1.19 to 1.75; <i>p</i> &lt; 0.001). No differences were found for overall satisfaction or pregnancy within 6 months postpartum. Certainty of evidence was moderate to high for primary outcomes. The results of our meta-analysis suggest that immediate postpartum contraceptive implant insertion is safe, does not interfere with lactogenesis, and maintains breastfeeding performance. Compared with delayed insertion, it increases implant continuation rates and offers a convenient, effective, and acceptable postpartum contraceptive option, particularly relevant for settings with limited postpartum follow-up access. Immediate postpartum insertion of contraceptive implants is safe, does not delay lactation, and improves early breastfeeding and continuation rates, offering an effective, convenient contraceptive option for women after delivery.

本研究旨在评估产后即刻放置避孕植入剂对分娩后6个月内的泌乳启动、母乳喂养结局、产妇满意度、植入剂续用率及妊娠率的影响。本系统评价与荟萃分析遵循《Cochrane干预性系统评价手册》（Cochrane Handbook for Systematic Reviews of Interventions）及PRISMA指南进行。本研究通过PubMed、Embase、Cochrane Central及ClinicalTrials.gov数据库，检索截至2025年10月的相关随机对照试验，对比产后即刻（分娩后≤24小时）与延迟（产后≥2周）放置依托孕烯（etonogestrel）或左炔诺孕酮（levonorgestrel）避孕植入剂的研究。采用随机效应模型合并研究结果，并通过I²统计量评估研究间异质性。本研究方案已在PROSPERO平台注册（注册号：CRD42025117074）。最终纳入8项随机对照试验，共涉及881名产后女性。产后即刻放置避孕植入剂并未延迟泌乳启动，也未降低分娩后6个月时的纯母乳喂养或任意母乳喂养率。但产后即刻放置组在分娩后3个月时的纯母乳喂养率（RR=1.25，95%置信区间[CI]：1.02~1.52，p=0.032）及任意母乳喂养率（RR=1.16，95%置信区间[CI]：-1.04~1.30，p=0.007）均显著更高。末次随访时的植入剂续用率在即刻放置组中同样更高（RR=1.44，95%置信区间[CI]：1.19~1.75，p<0.001）。两组产妇的总体满意度及产后6个月内妊娠率无显著差异。主要结局指标的证据质量为中等至高等水平。本荟萃分析结果显示，产后即刻放置避孕植入剂具有安全性，不会干扰泌乳启动，且可维持母乳喂养效果。与延迟放置相比，产后即刻放置可提升植入剂续用率，是一种便捷、有效且易于接受的产后避孕方案，尤其适用于产后随访资源有限的地区。产后即刻放置避孕植入剂安全可靠，不会延迟泌乳启动，且可改善早期母乳喂养情况及续用率，为产后女性提供了一种有效且便捷的避孕选择。