Breast-milk jaundice and the pill.

SIR,-Drs. Y. K. Wong and B. S. B. Wood (13 November, p. 403) purported to show a relationship between maternal oral contraception ("the pill") and subsequent jaundice in breast-fed infants-confusingly referred to as "breast-milk jaundice" (a term best reserved for instances where there is evidence that the breast milk does indeed contain a factor inhibiting conjugation of bilirubin).' They gave no time relationships between cessation of pill-taking and conception; the implication was that previous pill-taking, however distant in time and of as short a duration as one month, was related to the subsequent neonatal jaundice. The authors have not set out their data for the mothers of non-jaundiced infants. Other centres were invited to record their data and we would like to do so. Records for the four years 1968-71 inclusive were used to obtain the names of all neonates clinically considered to be jaundiced during the first 10 days of life; each such infant had had a serum bilirubin deternination routinely performed and the results were available to us. A serum bilirubin in excess of 10 mg/100 ml was chosen for inclusion; infants of low birth weight (<2 kg), sick infants, and those with a positive direct Coombs test were excluded. One hund-red and twenty fulfilled these criteria. Questionnaires were then sent to the mothers concerned, asking about prior oral contraception, and in particular its duration and the time lapse between cessation and conception. Eighty-two replies were received. An identical questionnaire was completed by 82 mothers of comparable but nonjaundiced infants born sequentially during early 1972. The results are shown in Tables I and II.