Immediate versus delayed postpartum contraceptive implant on lactogenesis and breastfeeding: a systematic review and meta-analysis
Bibliographic record
Abstract
Objective 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.Study design This systematic review and meta-analysis followed the Cochrane Handbook for Systematic Reviews of Interventions 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).Results 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; p = 0.032) and any breastfeeding at 3 months (RR = 1.16; 95% CI −1.04 to 1.30; p = 0.007). Implant continuation at last follow-up was also higher with immediate insertion (RR= 1.44; 95% CI 1.19 to 1.75; p < 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.Conclusion 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.027 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.025 | 0.044 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".