Exogenous administration of POCs could theoretically inhibit
Exogenous administration of POCs could theoretically inhibit breastfeeding ; however, the evidence in this review does not generally support a negative impact on breastfeeding outcomes. Studies examining the glutathione s-transferase of POCs among postpartum women overall demonstrated no adverse effects on measures of breastfeeding success, such as duration of breastfeeding or time to supplementation, although a few reported differences in both positive and negative directions at individual time points. The preponderance of the evidence points toward no deleterious impact of POCs on breastfeeding success, although further study is warranted to examine the impact of immediate postpartum placement of the LNG-IUD.
Theoretical concerns also have been raised regarding the impact of exposure to progestogens on neonates, particularly in the first 6weeks of life . Studies identified in this review showed no consistent adverse effects of exposure to progestogens through breast milk on infant health outcomes such as growth, development and health through the first few years of life. We identified no data to inform a conclusion on longer-term effects and any such effects remain unknown.
The PVR was not addressed in this review. A recent review concluded that PVR use among breastfeeding women did not affect breastfeeding performance or infant growth during the first year postpartum .
Our ability to draw firm conclusions is limited as most studies are observational, have lacked clear definitions of breastfeeding patterns and failed to control for potential confounders . Many did not provide information key to determining their quality and did not perform tests of significance. Some were not informative to our cutoff point of 6weeks as participants initiated both before 6weeks and after. Initiation before 6weeks ranged from immediately postpartum to nearly 42days.
In 2014, the WHO Expert Working Group reviewed this evidence to evaluate medical eligibility criteria for the use of POCs among breastfeeding women. All of the abovementioned studies were reviewed with the exception of one, which was identified after the meeting and found no deleterious effects of POCs . The findings of this systematic review were incorporated into the recent update of the MEC .
Conclusion The following are the supplementary data related to this article.
Acknowledgements The authors would like to acknowledge the contributions of Mary Lyn Gaffield, Roger Chou and the Guidelines Development Group for the Medical Eligibility for Contraceptive Use. This review was supported by the WHO, the US Centers for Disease Control and Prevention and FHI 360.
Introduction Innate immunity is of primary importance in combating infections in fish and plays an instructive role in the acquired immunity. Activation of the innate defense mechanisms is characterized by stimulation of phagocytes, production of cytokines, and activation of the complement system and various cell receptors leading to stimulation of T- and B-cells and antigen presenting cells (Lo et al., 1999). Similar to other vertebrates, fish display a network of signaling molecules, cytokines and chemokines that control and coordinate the innate and acquired immune response. Especially macrophages are critical regulatory cells in the immune response but many of their cellular functions are acquired during the process of macrophage differentiation to a fully activated state. Classically activated macrophages are known to produce a set of proinflammatory cytokines consisting of interleukin 1 β (IL-1β), tumor necrosis factor α (TNF α), and interferon γ (IFN γ), whereas alternative macrophage activation displays a type II immune response with antiinflammatory properties integrating regulatory cytokines, such as TGF β and IL-10 (Mantovani et al., 2003, Joerink et al., 2006). Upon infection recognition of non-self structures by toll-like receptors mediates macrophage activation leading to an increased production of reactive oxygen species (ROS) and reactive nitrogen species (RNS). The synthesis of anti-microbial NO by macrophages and granulocytes is mediated by induction of the inducible nitric oxide synthase (iNOS) which converts l-arginine to l-citrulline. Since NO plays a central role in the immune system, investigations on regulatory mechanisms of NO release by leukocytes is an important contribution to understand the regulation of defense mechanisms against pathogens. In our studies we used the ubiquitous bacterium Aeromonas hydrophila as a natural stimulant of the innate immune responses. A. hydrophila can cause high mortality in aquaculture (Sioutas et al., 1991, Camus et al., 1998), and the virulence of bacteria like A. hydrophila is mainly due to components of the outer membrane including lipopolysaccharides (LPS) and extracellular products (Maji et al., 2006).