The effect of early vs. delayed postpartum insertion of the LNG-IUS on breastfeeding continuation: a systematic review and meta-analysis of randomised controlled trials

Abstract Objective: The aim of the study was to compare early vs. delayed postpartum insertion of the 52 mg levonorgestrel intrauterine system (LNG-IUS). Methods: The databases of PubMed, Scopus, Web of Science and CENTRAL were searched to February 2019. The search comprised randomised controlled trials (RCTs) comparing early vs. delayed postpartum insertion of the LNG-IUS. Data were extracted and combined in a meta-analysis. Pooled results were expressed as the relative risk (RR) with 95% confidence interval (CI). The main outcome measures were breastfeeding continuation, LNG-IUS expulsion, uterine perforation, LNG-IUS use, satisfaction and number of pregnancies. Results: Twelve RCTs were included, comprising 1006 women in total. Our analysis indicated no significant difference between early and delayed insertion of the LNG-IUS in terms of any breastfeeding continuation (RR 0.99; 95% CI 0.84, 1.16; p = 0.88). After removal of heterogeneity, there was a statistically significant superiority in LNG-IUS use at the endpoint in the early insertion group compared with the delayed insertion group (RR 1.27; 95% CI 1.07, 1.51; p = 0.006). LNG-IUS expulsion was significantly less in the delayed insertion group in comparison with the early insertion group (RR 5.32; 95% CI 2.68, 10.53; p = 0.00001). No significant differences were found between the groups in satisfaction, number of pregnancies and risk of uterine perforation. Conclusion: Early postpartum insertion of the LNG-IUS has no negative effects on breastfeeding continuation. Early postpartum insertion may be used as an alternative to delayed postpartum insertion.