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Staudt A, Kiechl SJ, Gande N, Hochmayr C, Bernar B, Stock K, Geiger R, Egger A, Griesmacher A, Knoflach M, Kiechl-Kohlendorfer U. Influence of Oral Contraceptives on Lipid Profile and Trajectories in Healthy Adolescents-Data From the EVA-Tyrol Study. J Adolesc Health 2024; 75:479-486. [PMID: 39001754 DOI: 10.1016/j.jadohealth.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Oral contraception is one of the most popular contraceptive methods both in adults and adolescents. However, the effects of oral contraception on lipids in adolescents are not well studied. METHODS Lipid profiles were measured and contraceptive use was assessed in 14- to 19-year-old female participants of the prospective population-based Early Vascular Ageing-Tyrol Study between 2015 and 2018, twice on average 22 months apart. RESULTS For this analysis, data from 828 young women with a median age of 17.0 years were available. Of them, 317 (38%) used oral contraceptives (OCs). OC users had a slightly higher systolic and diastolic blood pressure and larger changes over time and were more likely to use cigarettes than nonusers. Total cholesterol (179.6 vs. 162.4 mg/dL), low-density lipoprotein-cholesterol (106.4 vs. 94.6 mg/dL), and triglycerides (104.0 vs. 67.0 mg/dL) were significantly higher in OC users after multivariable adjustment in linear regression models. No difference in high-density lipoprotein-cholesterol between the two groups was found. In 558 females, follow-up data were available. Those who initiated OC use had on average 15.4 mg/dL higher low-density lipoprotein-cholesterol and 36.2 mg/dL higher triglyceride level changes between baseline and follow-up than never users. Duration of OC use did not show a significant association with lipid levels and changes. DISCUSSION We showed an independent association between OC use and blood lipids as well as lipid trajectories over time in a large cohort of healthy adolescents. These changes are especially relevant to consider in adolescents with other risk factors for dyslipidemia or other cardiovascular risk factors.
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Affiliation(s)
- Anna Staudt
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sophia J Kiechl
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Nina Gande
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Hochmayr
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria
| | - Benoît Bernar
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria; Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Stock
- Department of Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Egger
- Central Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria; Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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de Araújo PX, Moreira P, de Almeida DC, de Souza AA, do Carmo Franco M. Oral contraceptives in adolescents: a retrospective population-based study on blood pressure and metabolic dysregulation. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03671-z. [PMID: 38554180 DOI: 10.1007/s00228-024-03671-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE This study aimed to explore the relationship between oral contraceptive use and blood pressure values and in a national cohort of women adolescents and to investigate the level of coexistence of the high blood pressure levels, dyslipidemia or insulin resistance. METHODS This is a retrospective cohort study that evaluated data form 14,299 adolescents aged 14 to 17 years. Crude and race-and age-adjusted analyses were performed using Poisson regression to estimate the prevalence ratios. Data clustering analysis was performed using machine learning approaches supported by an unsupervised neural network of self-organizing maps. RESULTS We found that 14.5% (n = 2076) of the women adolescents use oral contraceptives. Moreover, an increased prevalence of high blood pressure, dyslipidemia, and insulin resistance (all P < 0.001) was observed among adolescents who use oral contraceptives as compared to those who do not. Our analysis also showed that 2.3% of adolescents using oral contraceptives had both high blood pressure levels and dyslipidemia, whereas 3.2% had high blood pressure levels combined with insulin resistance (all P < 0.001). The algorithmic investigative approach demonstrated that total cholesterol, LDLc, HDLc, insulin, and HOMA-IR were the most predicted variables to assist classificatory association in the context of oral contraceptive use among women adolescents with high blood pressure. CONCLUSIONS These findings suggest that oral contraceptives were associated with an increased prevalence of high blood pressure, dyslipidemia, and insulin resistance among women adolescents. Although the indication of this therapy is adequate to avoid unintended pregnancies, their use must be based on rigorous individual evaluation and under constant control of the cardiometabolic risk factors.
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Affiliation(s)
| | - Priscila Moreira
- Program of Translational Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Alexandra Aparecida de Souza
- Laboratory of Applied Computing-LABCOM3, Federal Institute of Education, Science and Technology of São Paulo, São Paulo, Brazil
| | - Maria do Carmo Franco
- Physiology Department, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
- LiTiVasC - Laboratory of Translational Research in Vascular and Molecular Physiology, School of Medicine, Federal University of São Paulo. Rua Botucatu, 862 - 5° floor - , São Paulo, SP, 04023-062, Brazil.
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Flores-Rodriguez A, Diaz Gonzalez-Colmenero F, Garcia-Leal M, Saenz-Flores M, Burciaga-Jimenez E, Zuñiga-Hernandez JA, Alvarez-Villalobos NA, Rodríguez-Guajardo R, Morales-Martinez FA, Sordia-Hernandez LH, Rodriguez-Gutierrez R. Harms of third- and fourth-generation combined oral contraceptives in premenopausal women: A systematic review and meta-analysis. J Investig Med 2023; 71:871-888. [PMID: 37415461 DOI: 10.1177/10815589231184227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
We assessed the available evidence regarding adverse effects on surrogate and patient-important health outcomes of third- and fourth-generation combined oral contraceptives among premenopausal women. We performed a systematic review and meta-analysis including randomized controlled trials and observational studies comparing third- and fourth-generation combined oral contraceptives with other generation contraceptives or placebo. Studies that enrolled women aged 15 to 50 years, with at least three cycles of intervention and 6 months of follow-up were included. A total of 33 studies comprising 629,783 women were included. Low-density lipoprotein cholesterol levels were significantly lower in fourth-generation oral contraceptives (mean differences (MD): -0.24 mmol/L; [95% CI -0.39 to -0.08]), while total cholesterol was significantly increased in levonorgestrel users when compared to third-generation oral contraceptives (MD: 0.27 mmol/L; [95% CI 0.04 to 0.50]). A decreased arterial thrombosis incidence was shown in fourth-generation oral contraceptive users, as compared to levonorgestrel (incidence rate ratio (IRR): 0.41; [95% CI 0.19 to 0.86]). No difference was found in the occurrence of deep venous thrombosis between fourth-generation oral contraceptives and levonorgestrel users (IRR: 0.91; [95% CI 0.66 to 1.27]; p = 0.60; I2 = 0%). Regarding the remaining outcomes, data were heterogeneous and showed no clear difference. In premenopausal women, the use of third- and fourth-generation oral contraceptives is associated with an improved lipid profile and lower risk of arterial thrombosis. Data were inconclusive regarding the rest of outcomes assessed. This review was registered in PROSPERO with CRD42020211133.
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Affiliation(s)
- Andrea Flores-Rodriguez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Fernando Diaz Gonzalez-Colmenero
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
- Research Unit, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mariana Garcia-Leal
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Melissa Saenz-Flores
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Erick Burciaga-Jimenez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge A Zuñiga-Hernandez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Neri A Alvarez-Villalobos
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
- Research Unit, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, México
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Rene Rodríguez-Guajardo
- Gynecology and Obstetrics Department, University Hospital "Dr. JosJosé E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Felipe A Morales-Martinez
- Gynecology and Obstetrics Department, University Hospital "Dr. JosJosé E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Luis H Sordia-Hernandez
- Gynecology and Obstetrics Department, University Hospital "Dr. JosJosé E. González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rene Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
- Research Unit, University Hospital "Dr. José E. González," Universidad Autónoma de Nuevo León, Monterrey, México
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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Herzig M, Bertsche A, Hilbert C, Kiess W, Bertsche T, Neininger MP. Pharmacoepidemiological Analysis of Oral Contraceptive Use in Adolescents in a German Longitudinal Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020393. [PMID: 36832522 PMCID: PMC9955156 DOI: 10.3390/children10020393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
To assess the use of oral contraceptives (OC) in adolescents, using data from a longitudinal, population-based pediatric cohort study (LIFE Child). We also investigated associations between OC use and socioeconomic status (SES), and associations between OC use and potential adverse drug reactions such as effects on blood pressure. We included 609 female participants of the LIFE Child cohort, aged ≥13 to <21 years, who visited the study center between 2012 and 2019. Data collection compromised drug use in the past 14 days, SES, and anthropometric data such as blood pressure. An analysis of covariance was used to detect potential associations between participants' blood pressure and OC. Multivariate binary logistic regression was used to obtain odds ratios (aOR) adjusted for age and 95% confidence intervals (95% CI). The prevalence of OC use was 25.8%. OC intake was less common in participants with a high SES (aOR 0.30, 95% CI 0.15, 0.62). The mean age at OC initiation did not change between 2012 and 2019. We observed an increased use of second-generation OC (2013: 17.9%, 2019: 48.5%; p = 0.013) and a decreased use of fourth-generation OC (2013: 71.8%, 2019: 45.5%; p = 0.027). We found a higher systolic (mean: 111.74 mmHg, p < 0.001) and diastolic (69.15 mmHg, p = 0.004) blood pressure in OC users compared to non-users (systolic: 108.60 mmHg; diastolic: 67.24 mmHg). Every fourth adolescent took an OC. The share of second-generation OC increased during the study period. OC intake was associated with low SES. OC users had a slightly higher blood pressure than non-users.
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Affiliation(s)
- Markus Herzig
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Drug Safety Center, Leipzig University and University Hospital, Brüderstraße 32, 04103 Leipzig, Germany
| | - Astrid Bertsche
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- Division of Neuropediatrics, University Hospital for Children and Adolescents, Fleischmannstr. 8, 17475 Greifswald, Germany
| | - Cornelia Hilbert
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- LIFE Leipzig Research Centre for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- LIFE Leipzig Research Centre for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Drug Safety Center, Leipzig University and University Hospital, Brüderstraße 32, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-9711800; Fax: +49-341-9711813
| | - Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Drug Safety Center, Leipzig University and University Hospital, Brüderstraße 32, 04103 Leipzig, Germany
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Fabunmi OA, Dludla PV, Ngcobo SR, Nkambule BB. Investigating the risks of cardiovascular disease among premenopausal women using oral contraceptive: a protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e071118. [PMID: 36657759 PMCID: PMC9853212 DOI: 10.1136/bmjopen-2022-071118] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The use of oral contraceptives (OCs) is linked to an increased risk of cardiovascular diseases (CVDs) in women of reproductive age. CVD remain one of the top causes of death worldwide, with at least three-quarters of deaths occurring in low-income and middle-income nations. The impact of various types of combined oral contraceptive (COC) on several modifiable risk factors associated with CVDs in premenopausal women is inconsistent regardless of genetic mutations. The aim of this systematic review will be to provide a comprehensive synthesis of the available evidence on the impact of COC usage on modifiable risk factors associated with CVDs and assess ethnic and geographic disparities in the reported prevalence of CVD. METHODS AND ANALYSIS This systematic review protocol was prepared in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols 2015 statement. An extensive search on the Embase, MEDLINE and Cochrane Library will be conducted from inception until. Two reviewers will independently screen for eligible studies using a predefined criterion. The risk of bias and quality of included studies will be assessed using the modified Downs and Black's checklist. Whereas the overall quality of included studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation assessment tool. ETHICS AND DISSEMINATION This is a review of existing studies and will not require ethical approval. The findings will be disseminated through peer-reviewed publication. The use of OC and the risk of CVDs including arterial and venous thrombosis remain a major concern among women of reproductive age. Thus, given the impact of COCs on the risk variables linked with CVDs, this review may provide an insight and assistance during COC use. PROSPERO REGISTRATION NUMBER CRD42020216169.
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Affiliation(s)
- Oyesanmi A Fabunmi
- Human Physiology, School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Human Physiology, College of Medicine, Ekiti State University, Ado Ekiti, Nigeria
| | - Phiwayinkosi V Dludla
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa
| | - Siphamandla R Ngcobo
- Human Physiology, School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bongani B Nkambule
- Human Physiology, School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Kofole Z, Haile D, Solomon Y. Fasting blood glucose, blood pressure and body mass index among combined oral contraceptive users in Chencha town Southern Ethiopia, 2019. Front Glob Womens Health 2023; 4:992750. [PMID: 37187593 PMCID: PMC10175825 DOI: 10.3389/fgwh.2023.992750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
Background The use of contraceptives has become prevalent among women in Ethiopia. Oral contraceptive use has been suggested to trigger changes in glucose metabolism, energy expenditure, blood pressure, and body weight, among various populations and ethnic groups. Objective To elucidate the pattern of fasting blood glucose, blood pressure, and body mass index among combined oral contraceptive pills users compared to controls. Methods An institution-based cross-sectional study design was employed. A total of 110 healthy women using combined oral contraceptive pills were recruited as cases. Another 110 healthy age and sex-matched women not using any hormonal contraceptives were recruited as controls. A study was conducted between October 2018 and January 2019. Data obtained was entered and analyzed using IBM SPSS version 23 software packages. One-way ANOVA was used to identify the variation of variables in relation to the duration of use of the drug. The P-value of < 0.05 at the 95% confidence level was statistically significant. Results Fasting blood glucose level among oral contraceptive users (88.55 ± 7.89 mg/dl) was higher than fasting blood glucose level among oral contraceptive non-users (86.00 ± 9.85 mg/dl) with a p-value of 0.025. The mean arterial pressure of oral contraceptive users (88.2 ± 8.48 mmHg) was relatively higher than their counterparts (86.0 ± 6.74 mmHg), with a p-value of 0.04. Comparatively the body weight and body mass index among oral contraceptive users were 2.5% and 3.9% higher than non-users with a p-value of 0.03 and 0.003, respectively(5). Utilization of oral contraceptive pills for prolonged period of time seemed to be a significant predictive factor for higher mean arterial pressure and body mass index with p < 0.001and p < 0.05 respectively. Conclusions Use of combined oral contraceptives was associated with higher fasting blood glucose (+2.9%), mean arterial pressure (+2.5%), and body mass index (3.9%) compared to controls.
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Affiliation(s)
- Zelalem Kofole
- Department of Biomedical Sciences, School of Medicine, College of Health Science, Arba Minch University, Arba Minch, Ethiopia
- Correspondence: Zelalem Kofole Yerukneh Solomon
| | - Diresbachew Haile
- Department of Physiology, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopian
| | - Yerukneh Solomon
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
- Correspondence: Zelalem Kofole Yerukneh Solomon
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Barros BDS, Kuschnir MCC, Kuschnir FC, Jordão ÉADOC. ERICA: cardiovascular risks associated with oral contraceptive use among Brazilian adolescents. J Pediatr (Rio J) 2022; 98:53-59. [PMID: 34000229 PMCID: PMC9432124 DOI: 10.1016/j.jped.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the association between oral contraceptive use and cardiovascular risks, including metabolic syndrome and their components in Brazilian adolescents. METHOD This study used data from the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study with individuals aged 12-17 years. Sociodemographic variables and OC use were assessed by a self-administered questionnaire. International Diabetes Federation criteria were used to define metabolic syndrome. Descriptive statistics were reported as prevalence and their respective confidence interval of 95% of oral contraceptives according to variables. Logistic regression was performed. Crude and adjusted odds ratios were calculated. RESULTS This subsample was composed of 22,682 female adolescents, of which 12.65% reported using oral contraceptives and their use was associated with hypertension and hypertriglyceridemia. These associations remained statistically significant after adjusting for age, school region, race, and tobacco use with an increase of 2.68 (1.66 - 4.32) and 3.45 (2.56 - 4.65) times, respectively. CONCLUSION The present study was the first to examine the association between the use of oral contraceptives and cardiovascular risk factors among the largest number of female Brazilian adolescents. This method was significantly associated with hypertension, hypertriglyceridemia. Teenagers using oral contraceptives should be monitored for side effects, including blood pressure measurements and advised to avoid smoking.
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Affiliation(s)
- Bruna de Siqueira Barros
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciência Médicas, Núcleo de Estudos da Saúde do Adolescente, Programa de Pós-Graduação em Ciências Médicas, Rio de Janeiro, RJ, Brazil.
| | - Maria Cristina Caetano Kuschnir
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciência Médicas, Núcleo de Estudos da Saúde do Adolescente, Programa de Pós-Graduação em Ciências Médicas, Rio de Janeiro, RJ, Brazil
| | - Fábio Chigres Kuschnir
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Ciências Médicas, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
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Factors associated with overweight and obesity in adults using structural equation model: mediation effect of physical activity and dietary pattern. Eat Weight Disord 2020; 25:1561-1571. [PMID: 31650388 DOI: 10.1007/s40519-019-00793-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 10/04/2019] [Indexed: 02/08/2023] Open
Abstract
PURPOSE This study aimed to determine the indirect effect of risk factors associated with overweight and obesity through physical activity (PA) and dietary pattern (DP), using structural equation model in the adults' population. METHODS This cross-sectional study was conducted on 10,000 adults from baseline data of Ravansar Non Communicable Disease cohort study, in the west region of Iran in 2018. Structural equation modeling was used to assess the causal effects of associated factors on obesity and overweight as the outcome. RESULTS In general, the population at higher economic level was significantly more dependent on the healthy DP. The direct effect of socioeconomic status (SES) on overweight and obesity was - 0.070, the indirect effect was 0.127, and the total effect was 0.057. When stratified by gender, in women, SES had a weak direct effect (β = 0.024) and indirectly, through the variables of PA and DP, had a significant effect (β = 0.088) on the outcome. The same situation has been observed in men. That is a weak direct effect of SES (β = 0.070) and a significantly indirect effect, through three variables such as PA, DP, and smoking status, on the outcome. CONCLUSION Factors associated with overweight and obesity not only by direct effect, but also can indirectly and through mediators (such as DP and PA as two important mediation variables) cause this outcome. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.
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Gynecologic Considerations for Adolescents and Young Women With Cardiac Conditions: ACOG Committee Opinion, Number 813. Obstet Gynecol 2020; 136:e90-e99. [PMID: 33093425 DOI: 10.1097/aog.0000000000004133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.
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Moubasher AEA, Abdel Basset HA, Khalil AAM, Youssef EMK. Levonorgestrel vs combined oral contraceptive pills in treatment of female acne and hirsutism. Dermatol Ther 2020; 33:e13700. [PMID: 32713062 DOI: 10.1111/dth.13700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/25/2020] [Accepted: 05/16/2020] [Indexed: 12/01/2022]
Abstract
Combined oral contraception was used in many studies for treatment of acne and hirsutism. However, levonorgestrel (LNG) alone has not been evaluated before. Our objective is to evaluate the efficacy of oral contraceptive (OC) pills containing LNG and ethinyl estradiol (EE) compared with LNG only for the treatment of acne and hirsutism in a randomized, controlled prospective clinical trial. Eighty females (20 with acne, 20 with hirsutism, and 40 healthy females) received LNG + EE or LNG only for 6 months. Assessment of acne by global acne grading system (GAGS) and hirsutism by modified Ferriman-Gallwey scale (MFGS) grading system and serum free testosterone was measured before and 6 months after treatment. Serum free testosterone was significantly higher before treatment in acne and hirsutism patients compared to control group (P < .000). In acne patients, after 6 months of treatment with LNG/EE, serum free testosterone, and (GAGS), were significantly decreased compared to LNG only (P < .000). In hirsutism group, after 6 months of treatment with LNG/EE, serum free testosterone and (MFGS), were nonsignificantly decreased compared to LNG only. OCs containing either LNG/EE or LNG seem to be effective and safe treatment for acne and hirsutism.
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Affiliation(s)
- Alaa E A Moubasher
- Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abdel Basset
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Eman M K Youssef
- Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Perol S, Hugon-Rodin J, Plu-Bureau G. [Hypertension and contraception]. Presse Med 2019; 48:1269-1283. [PMID: 31757732 DOI: 10.1016/j.lpm.2019.07.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 01/23/2023] Open
Abstract
Hypertension is a major risk factor for cardiovascular diseases. Because of the high frequency of hormonal contraceptives use, assessing their side effects is an important public health issue. In this perspective, we conducted a review of the risk of hypertension associated with the use of hormonal contraceptives, either combined estrogen-progestin or only progestin. The use of combined hormonal contraceptives, regardless of its type and route of administration, is associated with a slight increase in blood pressure, both systolic and diastolic blood pressures. The frequency of onset of hypertension in women who use combined hormonal contraception is between 0.6% and 8.5%. Progestin-only contraception seems safe with respect to the risk of hypertension. It is therefore important to remember that the use of combined hormonal contraception is contra-indicated in hypertensive women, even well controlled. Finally, we propose a prescription assistance algorithm according to the recommendations of an expert panel. It should be remembered that taking blood pressure at each contraceptive consultation (initial and follow-up) is essential.
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Affiliation(s)
- Sandrine Perol
- Hôpital Cochin Port-Royal, unité de gynécologie médicale, 75014 Paris, France
| | - Justine Hugon-Rodin
- Hôpital Cochin Port-Royal, unité de gynécologie médicale, 75014 Paris, France
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Abarbanell G, Tepper NK, Farr SL. Safety of contraceptive use among women with congenital heart disease: A systematic review. CONGENIT HEART DIS 2019; 14:331-340. [PMID: 30681774 PMCID: PMC6719294 DOI: 10.1111/chd.12752] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Women with congenital heart disease (CHD) are at increased risk of pregnancy complications and need information on safe, effective contraceptive methods to avoid unintended pregnancy. This systematic review examines evidence regarding safety of contraceptive use among women with CHD. METHODS The PubMed database was searched for any peer-reviewed articles published through April 2018 that included safety outcomes associated with reversible contraceptive methods among women with CHD. RESULTS Five articles met inclusion criteria: three studies comparing contraceptive users to nonusers and two noncomparative studies. Sample sizes ranged from 65 to 505 women with CHD. Two studies found a higher percent of thromboembolic complications among women with Fontan palliation or transposition of the great arteries using oral contraceptives. One study, among women with Fontan palliation, found no increased risk of thromboembolic complications between contraceptive users (not separated by type) and nonusers. Two studies found no endocarditis among intrauterine device users. CONCLUSIONS There is a paucity of data regarding the safety of contraceptive methods among women with CHD. Limited evidence suggests an increased incidence of thromboembolic complications with use of oral contraceptives. Further studies are needed to evaluate contraceptive safety and quantify risk in this growing population. There is also limited data regarding the safety of contraceptive methods among women with CHD. Further information is needed to assist practitioners counseling women with CHD on safety of contraceptive methods.
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Affiliation(s)
- Ginnie Abarbanell
- Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine/St. Louis Children’s Hospital, St. Louis, Missouri
| | - Naomi K. Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherry L. Farr
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ribeiro CCM, Shimo AKK, Lopes MHBDM, Lamas JLT. Effects of different hormonal contraceptives in women's blood pressure values. Rev Bras Enferm 2019; 71:1453-1459. [PMID: 29972547 DOI: 10.1590/0034-7167-2017-0317] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/01/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify evidence in the literature of the relationship between the use of different hormonal contraceptive methods and alterations in women's blood pressure values. METHOD This is an integrative literature review, consisting of ten scientific articles published in PubMed and BVS, between 2012 and 2016, selected by keywords, available fully and free of charge, in English, Portuguese, or Spanish. RESULTS The articles showed that exogenous estrogen helps in the activation of the renin-angiotensin-aldosterone system causing hypertensive effects even in small doses; and that combined use with drospirenone reduces these effects. Routes of administration without passage through the liver and use of isolated progestin showed promising results in reducing the effects on blood pressure. CONCLUSION There is evidence in the literature of pressure alterations associated with different hormonal contraceptives and that personal history of morbidities are to be considered in an attempt to reduce the effects on the cardiovascular system.
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FSRH Guideline (January 2019) Combined Hormonal Contraception (Revision due by January 2024). BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:1-93. [PMID: 30665985 DOI: 10.1136/bmjsrh-2018-chc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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15
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Abstract
Oral contraceptive pills (OCPs) continue to be the most commonly used form of prescription contraceptives used by adolescents in the United States. With proper use, oral contraceptives provide safe and effective birth control. Broad categories of OCPs include progestin-only pills (POPs) and combined oral contraceptive pills (COCs). Certain types of progestins have more potent antiandrogenic properties and are more effective in treating acne, hirsutism, and polycystic ovary syndrome. This article reviews types of OCPs, discusses risks and benefits of OCPs, and provides guidance for how to choose the most beneficial and appropriate OCP for individual adolescent patients.
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Lin KJ, Schneeweiss S. Considerations for the analysis of longitudinal electronic health records linked to claims data to study the effectiveness and safety of drugs. Clin Pharmacol Ther 2016; 100:147-59. [DOI: 10.1002/cpt.359] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Affiliation(s)
- KJ Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
- Department of Medicine, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts USA
- Department of Epidemiology; Harvard School of Public Health; Boston Massachusetts USA
| | - S Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
- Department of Epidemiology; Harvard School of Public Health; Boston Massachusetts USA
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Kelly RK, Thomson R, Smith KJ, Dwyer T, Venn A, Magnussen CG. Factors Affecting Tracking of Blood Pressure from Childhood to Adulthood: The Childhood Determinants of Adult Health Study. J Pediatr 2015; 167:1422-8.e2. [PMID: 26342719 DOI: 10.1016/j.jpeds.2015.07.055] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/26/2015] [Accepted: 07/28/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the modifiable factors that alter the trajectory of blood pressure (BP) from childhood to adulthood. STUDY DESIGN This study investigated the BP of 798 participants (53% female) from the Childhood Determinants of Adult Health Study who had BP measured when aged 9, 12, or 15 years, and at follow-up 20 years later. BP was classified as normal or elevated (prehypertensive or hypertensive) in childhood and adulthood. BP trajectory groups (persistently normal, resolution, incident elevated, persistently elevated) were established according to these classifications. Potentially modifiable factors measured at both examinations included body mass index, fruit and vegetable intake, physical activity, cardiorespiratory fitness, alcohol consumption, smoking, and socioeconomic status. RESULTS Spearman correlation coefficients for BP tracking from childhood to adulthood were 0.31 (P < .001) for systolic BP and 0.16 (P < .001) for diastolic BP. Children with elevated BP had a 35% increased risk of elevated BP in adulthood compared with those with normal BP (relative risk 1.35, 95% CI 1.18-1.55, P < .001). Relative to those with persistently elevated BP, participants in the resolution group significantly decreased their body mass index z-score, decreased their alcohol consumption z-score, and increased their vegetable consumption z-score between childhood and adulthood. The proportion of participants with upwardly mobile socioeconomic status was significantly higher in the resolution group (41.2%) compared with the persistently elevated group (27.5%). CONCLUSIONS Resolution of elevated BP in the transition from childhood to adulthood appeared to be partially determined by modifiable factors associated with a healthy lifestyle.
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Affiliation(s)
- Rebecca K Kelly
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Russell Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Kylie J Smith
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; The George Institute for Global Health/Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
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