Postupci za potiskivanje stvaranja mlijeka (laktacije)
Abstract
Background
Various pharmacologic and non‐pharmacologic interventions have been used to suppress lactation after childbirth and relieve associated symptoms. Despite the large volume of literature on the subject, there is currently no universal guideline on the most appropriate approach for suppressing lactation in postpartum women.
Objectives
To evaluate the effectiveness and safety of interventions used for suppression of lactation in postpartum women (who have not breastfed or expressed breastmilk) to determine which approach has the greatest comparative benefits with least risk.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2012).
Selection criteria
Randomised trials evaluating the effectiveness of treatments used for suppression of postpartum lactation.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data.
Main results
We included 62 trials (6428 women). Twenty‐two trials did not contribute data to the meta‐analyses. The trials were generally small and of limited quality. Three trials (107 women) indicated that bromocriptine significantly reduced the proportion of women lactating compared with no treatment at or within seven days postpartum (three trials, 107 women; risk ratio (RR) 0.36, 95% confidence interval (CI) 0.24 to 0.54). Seven trials involving oestrogen preparations (diethylstilbestrol, quinestrol, chlorotrianisene, hexestrol) suggested that they significantly reduced the proportion of lactating women compared with no treatment at or within seven days postpartum (RR 0.40, 95% CI 0.29 to 0.56). We found no trials comparing non‐pharmacologic methods with no treatment. Trials comparing bromocriptine with other pharmacologic agents such as methergoline, prostaglandins, pyridoxine, carbegoline, diethylstilbestrol and cyclofenil suggested similarity in their effectiveness. Side effects were poorly reported in the trials and no case of thromboembolism was recorded in the four trials that reported it as an outcome.
Authors' conclusions
There is weak evidence that some pharmacologic treatments (most of which are currently unavailable to the public) are better than no treatment for suppressing lactation symptoms in the first postpartum week. No evidence currently exists to indicate whether non‐pharmacologic approaches are more effective than no treatment. Presently, there is insufficient evidence to address the side effects of methods employed for suppressing lactation. When women desire treatment, bromocriptine may be considered where it is registered for lactation suppression in those without predisposition to its major side effects of public concerns. Many trials did not contribute data that could be included in analyses. Large randomised trials are needed to compare the effectiveness of pharmacologic (especially bromocriptine) and non‐pharmacologic methods with no treatment. Such trials should consider the acceptability of the intervention and lactation symptoms of concern to women and be large enough to detect clinically important differences in major side effects between comparison groups.
PICO
Plain language summary
Postupci za potiskivanje stvaranja mlijeka (laktacije)
Žene nisu uvijek u mogućnosti dojiti nakon poroda. Mogući razlozi su smrt djeteta ili usvajanje djeteta, bolest majke, ili neki drugi razlozi vezani za dobrobit majke ili djeteta. HIV‐pozitivne majke, pogotovo one koje nisu na antiretrovirusnoj terapiji u trudnoći, izbjegavaju dojenje da ne bi prenijele virus na svoje dijete. Neke majke ne doje zbog osobnih ili društvenih razloga. Bez sisanja, stvaranje mlijeka (laktacija) samo po sebi, postupno prestaje. U međuvremenu, žene mogu doživjeti zastoj mlijeka u dojkama, curenje mlijeka, nelagodu pa čak i bol. Liječnici mogu prepisati lijekove za potiskivanje laktacije i smanjenja ovih simptoma. Metode bez lijekova uključuju: zamatanje dojki ili nošenje čvrstog grudnjaka, primjena infracrvene lampe, ograničenja unosa tekućine i hrane, vanjska primjena cvijeta jasmina i hladnih obloga. Lijekovi uključuju preparate estrogena i bromokriptin, koji smanjuju razinu prolaktina. Međutim uz njihovu upotrebu se veže povećani rizik od stvaranja ugrušaka, moždanog udara i srčanog udara.
Dokazi o djelotvornosti terapija za potiskivanje laktacije su ograničeni. Pretraživanjem literature pronašli smo 62 kontrolirana pokusa koja su randomizirala 6428 žena u intervencijsku skupinu, skupinu bez terapije i skupinu s drugom terapijom. Dvadeset i dva istraživanja nisu pridonijela podatke zajedničkoj statističkoj analizi (metaanalizi). Općenito govoreći, istraživanja su ograničene kvalitete i rađena su na zdravim ženama koje nisu htjele dojiti iz osobnih razloga u industrijaliziranim zemljama prije 1980. godine. Polovina istraživanja odnosila su se na upotrebu bromokriptina. Dva istraživanja (107 žena) su pronašla da je davanje bromokriptina bilo učinkovito u potiskivanju laktacije tijekom prvog tjedna po porodu u usporedbi s nedavanjem bilo kakve terapije. Kod jedanaest istraživanja u kojima su korišteni preparati estrogena (diethylstilbestrol, quinestrol, chlorotrianisene, hexestrol) također je uočeno potiskivanje stvaranja mlijeka. Kombinacija testosterona i estrogena je također dovela do potiskivanja laktacije u tri istraživanja (436 žena). Drugi farmakološki pripravci (clomiphene, tamoxifen, prostaglandini, pyridoxine, oxytocin, L‐dopa and homeopatski preparati) su ispitivani u malim, pojedinačnim istraživanjima. Općenito, nuspojave su slabo opisane, ali u onim studijima u kojima su spominjani, tromboembolija nije uočena kao nuspojava liječenja. Većina ispitivanih lijekova nije više dostupna ili registrirana za supresiju laktacije. Niti jedno istraživanje nije usporedilo ne‐farmakološku terapiju s odsustvom bilo kakve terapije niti je uzeta u obzir razina zadovoljstva majke ispitivanom terapijom.
