Appendix G: Lactational Amenorrhea Method

Overview

The Bellagio Consensus provided the scientific basis for defining the conditions under which breastfeeding can be used safely and effectively for birth-spacing purposes; programmatic guidelines were developed at a meeting of family planning experts for its use as a method of contraception, and the method was then named the lactational amenorrhea method (LAM).^[1–3] These guidelines include the following three criteria, all of which must be met to ensure adequate protection from pregnancy: 1) amenorrhea, 2) fully or nearly fully breastfeeding (intervals between feedings not exceeding 4 hours during the day or 6 hours at night), and 3) <6 months postpartum.^[4–6]

The U.S. Dietary Guidelines for Americans recommend that infants be exclusively breastfed for about the first 6 months, with continued breastfeeding while introducing appropriate complementary foods for 1 year or longer.^[7] The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about the first 6 months, with continued breastfeeding along with introducing appropriate complementary foods for up to age 2 years or longer.^[8]

No medical conditions exist for which use of LAM for contraception is restricted. However, breastfeeding might not be recommended for persons or infants with certain conditions.

LAM does not protect against sexually transmitted infections (STIs), including HIV infection, and patients using LAM should be counseled that consistent and correct use of external (male) latex condoms reduces the risk for STIs, including HIV infection.^[9] Use of internal (female) condoms can provide protection from transmission of STIs, although data are limited.^[9] Patients also should be counseled that pre-exposure prophylaxis, when taken as prescribed, is highly effective for preventing HIV infection.^[10]

HIV Infection
HIV transmission can occur during breastfeeding. For breastfeeding persons on antiretroviral therapy with a sustained undetectable HIV viral load during pregnancy, the risk for transmission through breastfeeding is <1%, but not zero. Patients with HIV infection should receive evidence-based, person-centered counseling to support shared decision-making about infant feeding. For comprehensive information, refer to Infant Feeding for Individuals with HIV in the United States. These recommendations are included within the U.S. Department of Health and Human Services's Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States.^[11]

Other Medical Conditions
CDC and AAP also recommend against both breastfeeding and feeding expressed milk for persons with untreated brucellosis, positivity for human T-cell lymphotropic virus types I or II, herpes simplex lesions on a breast, Ebola virus disease, or mpox. In addition, infants with classic galactosemia should not breastfeed.^{[8],[12],[13]}

Medication Used During Breastfeeding
Although many medications do pass into breast milk, most have little or no effect on milk supply or on infant well-being. Few medications are contraindicated while breastfeeding. More information about specific medications and radioactive compounds is provided by AAP,^[14] LactMed, Mother to Baby, and InfantRisk Center.

References