User:Smaho22/sandbox

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Practice Editing Here (Nov 23rd in-class Wiki session work)

 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).
 * Combined oral contraceptive pill

Assignment # 3
2)     Currently the article does not state how long after birth before it is safe to use COCPs again by women who are breastfeeding and taking into account concerns about lactation. It also does not mention what the recommended time is for women who are not breastfeeding. It is necessary to specify the amount of time postpartum that COCPs can generally be used again by both women who are breastfeeding and women who are not when no risks factors for VTE are present. The recommendations for both of these time frames are taken from the WHO and CDC guidelines. For each point, the most conservative recommendation was selected: https://www.who.int/publications/i/item/9789241549158  https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/appendixd.html
 * Note: You will be emailing your assignment # 3 directly to your tutor, however, please paste a version here that excludes your personal information. This will allow us to support your efforts on Wikipedia prior to editing "live" in the article.
 * Proposed changes: Currently in Contraindications section: “Postpartum women who are breastfeeding are also advised not to start COCPs until 4 weeks after birth due to increased risk of blood clots”. The following are two proposed additional sentences to follow this point: 1)     “While studies have demonstrated conflicting results about the effects of COCPs on lactation duration and milk volume, there exist concerns about the transient risk of COCPs on breast milk production when breastfeeding is being established early postpartum. "  2)     “Due to the stated risks and additional concerns on lactation, women who are breastfeeding are not advised to start COCPs until at least six weeks postpartum, while women who are not breastfeeding and have no other risks factors for blood clots may start COCPs after 21 days postpartum.  ”
 * Rationale for proposed changes: 1)     While the existing article includes information regarding contraindications for the use of COCPs by women breastfeeding postpartum due to an increased risk of blood clots, more elaboration is required. In addition to the risk of blood clots, concerns exist about the effects of COCPs on lactation, especially early postpartum when milk flow and feeding is being established. The information used is from the selected review which found that while studies had conflicting results about the effects of COCPs on lactation duration and milk volume, two of the studies assessed showed negative effects on lactation as well as noting the general concerns that exist when establishing breastfeeding early postpartum and referencing the WHO and CDC recommendations:  Lopez, L.M., Grey, T. W., Stuebe, A.M., Chen, M., Truitt, S.T., Gallo, M.F. (2015). Combined hormonal versus non-hormonal versus progestin‐only contraception in lactation. Cochrane Database of Systematic Reviews, 3, CD003988. https://doi.org/10.1002/14651858.CD003988.pub2
 * Areas of Ambiguity: Two areas of ambiguity exist for the proposed changes. First, studies have demonstrated conflicting results about the effects of COCPs on milk production during lactation. Early studies found a negative effect of COCPs on breast milk volume while more recent trials did not report any significant differences. However, because there are concerns surrounding the transient risks of COCPs on establishing breastfeeding early postpartum, I believe it is necessary to state this contraindication. Second, there are slight differences between the CDC and WHO guidelines for COCP use postpartum. In women who are breastfeeding, the WHO guidelines state that COCPs are considered category 4 for women breastfeeding up to six weeks postpartum, category 3 for six weeks to six months postpartum, and category 2 for over six months postpartum. However, the CDC guidelines state that COCPs are category 4 until 21 days postpartum, category 3 until 4 weeks, and category 2 after 4 weeks. The CDC guidelines states that the use of COCPs by women who are not breastfeeding postpartum and have no other risks factors for VTE is considered a category 4 for 21 days postpartum and category 2 afterwards, while the WHO guidelines consider COCPs category 3 for the first 21 days. Generally, WHO guidelines are more conservative and often used in developing countries while CDC guidelines are typically used in more developed countries, such as Canada. I selected the most conservative recommendations from the guidelines for both breastfeeding and non-breastfeeding women.
 * Critique of Source: A validity issue that exists with the secondary source is that only four trials examining the effects of COCPs on lactation were included, all with assessed risks of bias. Two of these studies were conducted over 50 years ago with reporting limitations and largely unclear assessments on risks of selection, participation, and attrition bias. Additionally, the two more recent studies had generally low risks of selection and participation bias, but one of them had incomplete outcome data which resulted in a high risk of attrition bias assessed by the authors. This was acknowledged by the authors and contributed to them concluding conflicting results about the effects of COCPs on lactation duration and milk volume. Despite this conclusion, the study still raised the concern about the possibility of risks when establishing milk flow and referenced both the WHO and CDC guidelines for practical recommendations of this research.

What to post on the Wikipedia article talk page?

 * This will also be covered on Nov 23rd in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2020/Talk Page Template