1
|
Rasul MG, Fahim SM, Alam MA, Das S, Mostafa I, Mahfuz M, Ahmed T. Prevalence and factors associated with undernutrition and overnutrition among ever-married adolescent girls in Bangladesh: an analysis of national surveys from 2004 to 2017. J Biosoc Sci 2024; 56:292-313. [PMID: 37712505 DOI: 10.1017/s0021932023000160] [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: 09/16/2023]
Abstract
Nutritional impairment during adolescence may result in adverse physical and reproductive health outcomes. We investigated the prevalence and determined the factors associated with underweight and overweight/obesity among ever-married adolescent girls in Bangladesh. We used Bangladesh Demographic and Health Surveys data conducted in 2004, 2007, 2011, 2014, and 2017. A total of 7040 ever-married adolescent girls aged 15-19 years were included in this analysis. Prevalence of underweight (body mass index [BMI]<18.5 kg/m2) significantly decreased from 39.53% (95% CI = 36.71, 42.43) to 23.62% (95% CI = 21.35, 26.05) during 2004-2017 (p < 0.001). However, prevalence of overweight/obesity (BMI ≥ 23 kg/m2) significantly increased from 5.9% (95% CI = 4.67, 7.43) to 22.71% (95% CI = 20.39, 25.20) during the same period (p < 0.001). The girls with higher age (OR = 0.94, 95% CI = 0.90, 0.99, p = 0.023), higher level of education (OR = 0.60, 95% CI = 0.43, 0.83, p = 0.002), and richest wealth quintile (OR = 0.78, 95% CI = 0.62, 0.98, p = 0.035) had significantly lower risk of being underweight. Adolescent girls having more than one child (OR = 1.41, 95% CI = 1.15, 1.73, p = 0.001) were more likely to be underweight. Elderly adolescents with better economic status were more at risk of being overweight/obese (OR = 2.57, 95% CI = 1.86, 3.55, p < 0.001). Girls married to skilled/unskilled workers (OR = 0.58, 95% CI = 0.44, 0.77, p < 0.001) and persons involved in small businesses (OR = 0.66, 95% CI = 0.49, 0.89, p = 0.007) had lower risk of having a high BMI. Using contraceptive (OR = 0.8, 95% CI = 0.69, 0.94, p = 0.006) was negatively associated with overweight/obese. Although prevalence of undernutrition among ever-married adolescent girls is declining, the proportion of being overweight/obese is increasing in Bangladesh warranting effective strategies to improve adolescent nutrition.
Collapse
Affiliation(s)
- Md Golam Rasul
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shah Mohammad Fahim
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Ashraful Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Subhasish Das
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ishita Mostafa
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Global Health Department, University of Washington, Seattle, Washington, USA
- Department of Public Health Nutrition, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
2
|
McNamee K, Edelman A, Li RHW, Kaur S, Bateson D. Best Practice Contraception Care for Women with Obesity: A Review of Current Evidence. Semin Reprod Med 2022; 40:246-257. [PMID: 36746158 DOI: 10.1055/s-0042-1760214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of obesity among females of reproductive age is increasing globally. Access to the complete range of appropriate contraceptive options is essential for upholding the reproductive rights of this population group. People with obesity can experience stigma and discrimination when seeking healthcare, and despite limited evidence for provider bias in the context of contraception, awareness for its potential at an individual provider and health systems level is essential. While use of some hormonal contraceptives may be restricted due to increased health risks in people with obesity, some methods provide noncontraceptive benefits including a reduced risk of endometrial cancer and a reduction in heavy menstrual bleeding which are more prevalent among individuals with obesity. In addition to examining systems-based approaches which facilitate the provision of inclusive contraceptive care, including long-acting reversible contraceptives which require procedural considerations, this article reviews current evidence on method-specific advantages and disadvantages for people with obesity to guide practice and policy.
Collapse
Affiliation(s)
| | - Alison Edelman
- Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Raymond Hang Wun Li
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong
| | - Simranvir Kaur
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
| | - Deborah Bateson
- Faculty of Medicine and Health, Daffodil Centre, University of Sydney, Sydney, Australia
| |
Collapse
|
3
|
Frederico G, Dos Santos PNS, Ferreira JM, Bahamondes L, Fernandes A. Female Body Mass Index and the election of a Long-Acting Reversible Contraception for the first time. Int J Gynaecol Obstet 2021; 158:748-753. [PMID: 34939199 DOI: 10.1002/ijgo.14081] [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: 08/24/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We evaluated Brazilian women with different body mass index (BMI, kg/m2 ) values who were switching from a short-acting reversible contraceptive (SARC) to a long-acting reversible contraceptive (LARC) method in relationship to the reasons reported for switching and the LARC method chosen. METHOD We analyzed retrospective data from 1,508 women aged 18-49 years who chose a LARC for the first time. The variables were sociodemographic, BMI, SARC in use, the reason given for switching, the chosen LARC [copper intrauterine device (Cu-IUD), levonorgestrel (52mg) intrauterine system or etonorgestrel implant], and expectations of the LARC. We used the Chi-square, Mann-Whitney and Kruskal-Wallis tests to compare BMI groups. The significance level adopted was 5%. RESULTS The obesity group, 320 women (21.2%), reported weight gain (P <0.000) and fear of pregnancy (P = 0.004) as the most frequent reasons for switching, while the normal weight group, 637 women (42.2%), reported more loss of libido (P <0.000) and other personal complaints (P = 0.002). The IUD was chosen by 851 women (56.6%) and significantly by the largest number of obese women. CONCLUSION Women in different BMI categories report different reasons for switching from SARC methods and elect different LARC methods for contraception.
Collapse
Affiliation(s)
- Giulia Frederico
- Family Planning Clinic, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Priscilla N Silva Dos Santos
- Family Planning Clinic, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Jéssica M Ferreira
- Family Planning Clinic, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Luis Bahamondes
- Family Planning Clinic, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Arlete Fernandes
- Family Planning Clinic, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| |
Collapse
|
4
|
La anticoncepción en la mujer obesa. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2019. [DOI: 10.1016/j.gine.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
5
|
FSRH Guideline (April 2019) Overweight, Obesity and Contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:1-69. [PMID: 31053605 DOI: 10.1136/bmjsrh-2019-ooc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
6
|
Abstract
Importance In the United States, 27% of reproductive-aged women are overweight, and 35% are obese. Until recently, contraceptive research excluded women greater than 130% of their ideal body weight. Gaps in data limit evidence-based decision making for effective contraceptive counseling and management in this rapidly growing population. Objectives The aims of this summary are to review the benefits, adverse effects, and risk factors associated with contraceptive methods in obese women, with special attention to effectiveness, and provide contraceptive management and counseling recommendations for best clinical practice. Evidence Acquisition We performed a thorough search of PubMed for current literature, including original research articles, review articles, and guidelines on contraceptive counseling and management in obese women in the United States. We reviewed the body of evidence with special attention to studies published since recent Cochrane and systematic reviews on this topic. Conclusions Contraceptive use is safer than pregnancy, especially for obese women who have increased pregnancy risks. Baseline health is compromised by obesity, but contraceptive risks remain low. Long-acting, reversible contraceptive methods offer superior effectiveness, minimal risk, and numerous noncontraceptive benefits across body mass index groups. No substantial evidence supports ineffectiveness of any method in obese women except oral emergency contraception and the patch. Pharmacokinetic changes of obesity associated with other oral methods do not seem to result in clinically significant declines in effectiveness. Future contraceptive efficacy studies should include obese women to better discuss their contraceptive needs. Relevance This review is beneficial for all providers caring for reproductive-aged women wanting to avoid unintended pregnancy.
Collapse
|
7
|
Mosher WD, Lantos H, Burke AE. Obesity and contraceptive use among women 20-44years of age in the United States: results from the 2011-15 National Survey of Family Growth (NSFG). Contraception 2017; 97:392-398. [PMID: 29221939 DOI: 10.1016/j.contraception.2017.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/02/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Obesity has increased dramatically in the United States in recent decades. Our objective was to explore associations of contraceptive choices of US women, aged 20-44years, with body mass index (BMI) and relevant covariates. STUDY DESIGN Data are based on interviews with a national sample of 11,300 women in the 2011-2015 National Survey of Family Growth. We analyzed women ages 20-44 at risk of unintended pregnancy. The primary dependent variable was BMI category. Covariates analyzed included age, parity, race/ethnicity, marital status, self-reported health and education. Data were analyzed via cross-tabulation and logistic regression. We determined unadjusted and adjusted odds ratios for three categories of contraceptive method: female sterilization, intrauterine device (IUD) and hormonal contraception. RESULTS Obese women have higher odds of female sterilization (BMI 30.0-34.9 kg/m2: adjusted odds ratio (aOR)=1.96, 95% confidence interval (CI) 1.45-2.66; BMI 35.0 kg/m2 and higher: aOR=1.56, 95% CI 1.13-2.14) compared to women with normal BMI. Odds of IUD use are significantly higher among women with BMI >35 kg/m2 (aOR=1.64, 95% CI 1.20-2.25). Odds of hormonal contraceptive use are correspondingly reduced (aOR=0.78, 95% CI 0.62-0.98) for women in the highest BMI category. CONCLUSIONS Contraceptive use varies by BMI category even after adjusting for usual correlates of use. Differences in contraceptive use by BMI category have implications for contraceptive counseling and provision. IMPLICATIONS Findings that obese women are more likely to rely on female sterilization raise questions about how weight concerns and obesity affect contraceptive decision making. Future research could explore associations between obesity and contraceptive use in adolescent women.
Collapse
Affiliation(s)
- William D Mosher
- Department of Population, Family, & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Johns Hopkins University, Baltimore, MD. 21205
| | - Hannah Lantos
- Department of Population, Family, & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Johns Hopkins University, Baltimore, MD. 21205; Child Trends, 7315 Wisconsin Ave Suite 1200W, Bethesda, MD 20814
| | - Anne E Burke
- Department of Population, Family, & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Johns Hopkins University, Baltimore, MD. 21205; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine.
| |
Collapse
|
8
|
Pregnancy Intention and Contraceptive Use among Women by Class of Obesity: Results from the 2006-2010 and 2011-2013 National Survey of Family Growth. Womens Health Issues 2017; 28:51-58. [PMID: 29146297 DOI: 10.1016/j.whi.2017.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/13/2017] [Accepted: 09/20/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Conflicting research findings on the association of obesity and pregnancy intention may be due to their collective definition of obesity at a body mass index of 30 kg/m2 or greater. However, obese women with a BMI of 40 kg/m2 or greater may be both behaviorally and clinically different from obese women with a lower BMI. This study reexamines this relationship, stratifying by class of obesity; the study also explores variations in contraceptive use by class of obesity given their potential contribution to the incidence of unintended or unwanted pregnancy. METHODS This study combined data from the 2006 through 2010 and 2011 through 2013 US National Survey of Family Growth. Pregnancy intention (intended, mistimed, unwanted) and current contraceptive use (no method, barrier, pill/patch/ring/injection, long-acting reversible contraceptive, sterilization) were compared across body mass index categories: normal (18.5-24.9 kg/m kg/m2), overweight (25.0-29.9), obese class 1 (30.0-34.9 kg/m2), class 2 (35.0-39.9 kg/m2), and class 3 (≥40 kg/m2, severe obesity). Weighted multinomial logistic regressions were refined to determine independent associations of body mass index class and pregnancy intention, as well as contraceptive method, controlling for demographic, socioeconomic, and reproductive factors. RESULTS Body mass index data were available for 9,848 nonpregnant, sexually active women who reported not wanting to become pregnant. Women with class 3 obesity had significantly greater odds of mistimed (adjusted odd ratio [aOR], 1.67; 95% confidence interval [CI], 1.02-2.75) or unwanted (aOR, 1.96; 95% CI, 1.15-3.32) pregnancy compared with normal weight women. Women with class 2 or 3 obesity were more likely to not be using contraception (aOR, 1.53-1.62; 95% CI, 1.04-2.29). Although women with class 2 obesity were more likely to be using long-acting reversible contraceptive methods and sterilization over short-acting hormonal methods (aOR, 1.67; 95% CI, 1.08-2.57; aOR, 2.05; 95% CI,1.44-2.91), this association was not observed among women with class 3 obesity. CONCLUSIONS Women with class 3 obesity are at greater risk of unintended pregnancy and are less likely to be using contraception than normal weight women. Whether these findings are related to patient and/or provider barriers that are not as visible among women with class 1 and class 2 obesity warrants further investigation.
Collapse
|
9
|
Rocha ALL, Campos RR, Miranda MMS, Raspante LBP, Carneiro MM, Vieira CS, Reis FM. Safety of hormonal contraception for obese women. Expert Opin Drug Saf 2017; 16:1387-1393. [PMID: 28988524 DOI: 10.1080/14740338.2018.1389893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Obese women have special safety requirements for contraceptive choice, but the evidence supporting such decision is dispersed and sometimes conflicting. Despite being effective, well tolerated and safe for most women, hormonal contraceptives are underused by obese women due to fear of contraceptive failure, weight gain and venous thrombosis. Areas covered: We performed a comprehensive literature search to identify studies about hormonal contraception in overweight and obese women, including safety concerns. We considered the safety of hormonal contraceptives for otherwise healthy obese women and for those with comorbidities such as hypertension, diabetes, vascular disease, or a history of deep venous thrombosis. Expert opinion: Over time there is no convincing evidence that obesity increases the risk of contraceptive failure. Hormonal contraceptive users may have a modest weight gain that is comparable to that of non-users. Current evidence supports the safe use of combined hormonal contraceptives by obese women after detailed clinical screening to exclude comorbidities that may contraindicate the use of estrogens. Progestin-only methods are generally safe, and long-acting reversible contraceptives hold the best combination of efficacy, safety and convenience for this group, although individualization is advisable.
Collapse
Affiliation(s)
- Ana Luiza L Rocha
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Rayana R Campos
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Marina M S Miranda
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Laio B P Raspante
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Márcia M Carneiro
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Carolina S Vieira
- b Department of Gynecology and Obstetrics, Medical School of Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , Brazil.,c Population Council , New York , NY , USA
| | - Fernando M Reis
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| |
Collapse
|
10
|
Bhuva K, Kraschnewski JL, Lehman EB, Chuang CH. Does body mass index or weight perception affect contraceptive use? Contraception 2016; 95:59-64. [PMID: 27621045 DOI: 10.1016/j.contraception.2016.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 07/06/2016] [Accepted: 09/04/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Overweight and obese women may avoid contraceptive methods they believe are associated with weight gain. The objective of this study was to examine the role of weight and weight perception on contraceptive use. STUDY DESIGN Using cross-sectional data from the MyNewOptions study, we analyzed contraceptive use among 987 privately insured, sexually active women aged 18-40 years. Contraception was categorized into three groups: (1) long-acting reversible contraceptives (LARCs), (2) non-LARC prescription methods and (3) nonprescription methods/no method. Multinomial logistic regression was used to model the effect of body mass index category and weight perception on contraceptive use while controlling for pregnancy intentions, sexual behavior and sociodemographic characteristics. RESULTS Eighty-three (8.4%) women were using LARCs, 490 (49.6%) women were using non-LARC prescription methods and 414 (42.0%) were using nonprescription methods or no method. In the adjusted multinomial model, overweight [adjusted odds ratio (aOR) 3.84, 95% confidence interval (CI) 1.85-7.98) and obese women (aOR 2.82, 95% CI 1.18-6.72) were significantly more likely to use LARCs compared to normal-weight women. There were greater adjusted odds of overweight and obese women using nonprescription methods/no method compared with non-LARC prescription methods, but this finding did not reach statistical significance. Weight perception was not associated with contraceptive use. CONCLUSION In this study sample, overweight and obese women were more likely to use LARCs than normal-weight women. It will be important to further understand how weight influences women and providers' views on contraception in order to better assist women with individualized, patient-centered contraceptive decision making. IMPLICATIONS Overweight and obese women may be reluctant to use contraceptive methods they believe are associated with weight gain (i.e., pills, shot), but how that affects contraceptive use is unclear. Compared with normal-weight women, overweight and obese women in this study were more likely to use LARCs than non-LARC prescription methods.
Collapse
Affiliation(s)
- Kalpesh Bhuva
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA 17033, USA
| | - Jennifer L Kraschnewski
- Division of General Internal Medicine, Department of Medicine, Penn State College of Medicine, Hershey, PA 17033, USA; Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA 17033, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA 17033, USA
| | - Cynthia H Chuang
- Division of General Internal Medicine, Department of Medicine, Penn State College of Medicine, Hershey, PA 17033, USA; Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey, PA 17033, USA.
| |
Collapse
|
11
|
Simmons KB, Edelman AB. Hormonal contraception and obesity. Fertil Steril 2016; 106:1282-1288. [PMID: 27565257 DOI: 10.1016/j.fertnstert.2016.07.1094] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 12/18/2022]
Abstract
The rising rate of overweight and obesity is a public health crisis in the United States and increasingly around the globe. Rates of contraceptive use are similar among women of all weights, but because contraceptive development studies historically excluded women over 130% of ideal body weight, patients and providers have a gap in understanding of contraceptive efficacy for obese and overweight women. Because of a range of drug metabolism alterations in obesity, there is biologic plausibility for changes in hormonal contraception effectiveness in obese women. However, these pharmacokinetic changes are not linearly related to body mass index or weight, and it is unknown what degree of obesity begins to affect pharmacokinetic or pharmacodynamics processes. Overall, most studies of higher quality do not demonstrate a difference in oral contraceptive pill effectiveness in obese compared with non-obese women. However, data are scant for women in the highest categories of obesity, and differences by progestin type are incompletely understood. Effectiveness of most non-oral contraceptives does not seem to be compromised in obesity. Exceptions to this include the combined hormonal patch and oral levonorgestrel emergency contraception, which may have lower rates of effectiveness in obese women. The purpose of this review is to summarize evidence on contraceptive use in women with obesity, including differences in steroid hormone metabolism, contraceptive effectiveness, and safety, compared with women of normal weight or body mass index using the same methods.
Collapse
Affiliation(s)
- Katharine B Simmons
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Alison B Edelman
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
| |
Collapse
|
12
|
Shepherd R, Raker CA, Savella GM, Du N, Matteson KA, Allen RH. The effect of obesity on intraoperative complication rates with hysteroscopic compared to laparoscopic sterilization: a retrospective cohort study. Contracept Reprod Med 2016; 1:1. [PMID: 29201391 PMCID: PMC5675056 DOI: 10.1186/s40834-016-0008-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 01/06/2016] [Indexed: 12/02/2022] Open
Abstract
Background Surgical sterilization is a common method of contraception. There have been few studies evaluating the effect of obesity on procedural complications with either laparoscopic or hysteroscopic methods of sterilization. The purpose of this study was to compare the incidence of intraoperative complications of hysteroscopic tubal occlusion with laparoscopic tubal ligation among obese and nonobese women. Methods This retrospective cohort study compared women undergoing interval laparoscopic or hysteroscopic sterilization in the operating room between September 2009 and December 2011 at a single hospital. Serious complications included: unintended surgery, uterine perforation, anaphylaxis, blood transfusion, infection requiring antibiotics, hospital admission, fluid overload, myocardial infarction, and venous thromboembolism. Post-operative events included: nausea/vomiting, doctor evaluation or additional pain medication required in the recovery room, and emergency department visit within 2 weeks of surgery. The association between sterilization type and incidence of complications was examined overall, separately by BMI group, and also among patients who received general anesthesia. Results A total of 433 laparoscopic and 277 hysteroscopic procedures were reviewed. The BMI distribution of the sample was 35 % normal weight, 31 % overweight, and 34 % obese which is comparable to the general US female population. No life-threatening events were identified. Serious complications were similar with 20 (4.6 %) in the laparoscopic group and 11 (4.0 %) in the hysteroscopic group (p = 0.9). The most common serious complications were bleeding from the tube, cervical laceration, and uterine perforation. Although not statistically significant, women with a BMI of 30 or greater had only 1 (1 %) serious complication in the hysteroscopic group compared to 7 (5.2 %) in the laparoscopic group. Postoperative events were increased in the laparoscopic group (16.2 %) compared to the hysteroscopic group (6.9 %), especially among overweight and obese women (p <0.01). Failure to complete the intended bilateral occlusion occurred for 14 women in the hysteroscopic group compared to just one woman in the laparoscopic group (p <0.001). Conclusion Both laparoscopic and hysteroscopic tubal sterilization are safe with few serious complications based on these data. No cases of laparotomy, blood transfusion, or life-threatening events were identified. There was no difference in serious complication rate by sterilization method. Overweight and obese women were no more likely to experience a serious complication with either method than women with a BMI <25. There were fewer postoperative events (p <0.01) with hysteroscopic sterilization, but far fewer failed laparoscopic procedures (p <0.001). These study findings can be used to enhance sterilization counseling.
Collapse
Affiliation(s)
- Rachel Shepherd
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley St, Providence, RI 02905 USA
| | - Christina A Raker
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley St, Providence, RI 02905 USA
| | - Gina M Savella
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley St, Providence, RI 02905 USA
| | - Nan Du
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley St, Providence, RI 02905 USA
| | - Kristen A Matteson
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley St, Providence, RI 02905 USA
| | - Rebecca H Allen
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley St, Providence, RI 02905 USA
| |
Collapse
|
13
|
Safety and Efficacy of Contraceptive Methods for Obese and Overweight Women. Obstet Gynecol Clin North Am 2015; 42:647-57. [DOI: 10.1016/j.ogc.2015.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
14
|
McKeating A, O’Higgins A, Turner C, McMahon L, Sheehan SR, Turner MJ. The relationship between unplanned pregnancy and maternal body mass index 2009–2012. EUR J CONTRACEP REPR 2015; 20:409-18. [DOI: 10.3109/13625187.2015.1023893] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
15
|
Simmons KB, Edelman AB. Contraception and sexual health in obese women. Best Pract Res Clin Obstet Gynaecol 2014; 29:466-78. [PMID: 25498914 DOI: 10.1016/j.bpobgyn.2014.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/13/2014] [Indexed: 01/29/2023]
Abstract
As the proportion of women with obesity increases worldwide, understanding the influence of body weight on sexual behavior, fertility, and contraceptive effectiveness is critical for health-care professionals and patients. Although many have theorized that obese women are different from normal-weight women regarding sexual health and behavior, current evidence for the most part disproves this. The exception is in adolescents where body image may play a role in riskier behavior, placing them at a greater risk of an unintended pregnancy. Given that most modern contraceptives were not originally evaluated in obese women, understanding how weight affects contraceptive pharmacokinetics and efficacy should be a focus of ongoing research. Evidence is reassuring that most modern contraceptive methods are safe and effective in obese women. This paper reviews what is known about sexual and contraceptive behavior, as well as the effectiveness and pharmacokinetics of modern contraceptives, for overweight and obese women.
Collapse
Affiliation(s)
- Katharine B Simmons
- Oregon Health & Science University, Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR 97239, USA.
| | - Alison B Edelman
- Oregon Health & Science University, Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Road, Mailcode UHN 50, Portland, OR 97239, USA
| |
Collapse
|
16
|
Callegari LS, Nelson KM, Arterburn DE, Prager SW, Schiff MA, Schwarz EB. Factors associated with lack of effective contraception among obese women in the United States. Contraception 2014; 90:265-71. [DOI: 10.1016/j.contraception.2014.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 12/30/2022]
|
17
|
Ingraham N, Roberts SCM, Weitz TA. Prior Family Planning Experiences of Obese Women Seeking Abortion Care. Womens Health Issues 2014; 24:e125-30. [DOI: 10.1016/j.whi.2013.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 12/01/2022]
|
18
|
Lopez LM, Edelman A, Chen M, Otterness C, Trussell J, Helmerhorst FM. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev 2013; 7:CD008815. [PMID: 23821307 PMCID: PMC3855691 DOI: 10.1002/14651858.cd008815.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Progestin-only contraceptives (POCs) are appropriate for many women who cannot or should not take estrogen. Many POCs are long-acting, cost-effective methods of preventing pregnancy. However, concern about weight gain can deter the initiation of contraceptives and cause early discontinuation among users. OBJECTIVES The primary objective was to evaluate the association between progestin-only contraceptive use and changes in body weight. SEARCH METHODS Through May 2013, we searched MEDLINE, CENTRAL, POPLINE, LILACS, ClinicalTrials.gov, and ICTRP. The 2010 search also included EMBASE. For the initial review, we contacted investigators to identify other trials. SELECTION CRITERIA All comparative studies were eligible that examined a POC versus another contraceptive method or no contraceptive. The primary outcome was mean change in body weight or mean change in body composition. We also considered the dichotomous outcome of loss or gain of a specified amount of weight. DATA COLLECTION AND ANALYSIS Two authors extracted the data. We computed the mean difference (MD) with 95% confidence interval (CI) for continuous variables. For dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated. MAIN RESULTS We found 16 studies; one examined progestin-only pills, one studied the levonorgestrel-releasing intrauterine system (LNG-IUS), four examined an implant, and 10 focused on depot medroxyprogesterone acetate (DMPA). Outcomes examined were changes in body weight only (14 studies), changes in both body weight and body composition (1 study), and changes in body composition only (1 study). We did not conduct meta-analysis due to the various contraceptive methods and weight change measures.Comparison groups did not differ significantly for weight change in 12 studies. However, three studies showed weight change differences for POC users compared to women not using a hormonal method. In one study, weight gain (kg) was greater for the DMPA group than the group using a non-hormonal IUD in years one through three [(MD 2.28; 95% CI 1.79 to 2.77), (MD 2.71, 95% CI 2.12 to 3.30), and (MD 3.17; 95% CI 2.51 to 3.83), respectively]. The differences were notable within the normal weight and overweight subgroups. Two implant studies also showed differences in weight change. The implant group (six-capsule) had greater weight gain (kg) compared to the group using a non-hormonal IUD in both studies [(MD 0.47 (95% CI 0.29 to 0.65); (MD 1.10; 95% CI 0.36 to 1.84)]. In one of those studies, the implant group also had greater weight gain than a group using a barrier method or no contraceptive (MD 0.74; 95% CI 0.52 to 0.96).The two studies that assessed body composition change showed differences between POC users and women not using a hormonal method. Adolescents using DMPA had a greater increase in body fat (%) compared to a group not using a hormonal method (MD 11.00; 95% CI 2.64 to 19.36). The DMPA group also had a greater decrease in lean body mass (%) (MD -4.00; 95% CI -6.93 to -1.07). The other study reported differences between an LNG-IUS group and a non-hormonal IUD group in percent change in body fat mass (2.5% versus -1.3%, respectively; reported P value = 0.029) and percent change in lean body mass (-1.4% versus 1.0%, respectively; reported P value = 0.027). AUTHORS' CONCLUSIONS The overall quality of evidence was moderate to low, given that the studies were evenly divided across the evidence quality groups (high, moderate, low, or very low quality). We found limited evidence of weight gain when using POCs. Mean gain was less than 2 kg for most studies up to 12 months. Weight change for the POC group generally did not differ significantly from that of the comparison group using another contraceptive. Two studies that assessed body composition showed that POC users had greater increases in body fat and decreases in lean body mass compared to users of non-hormonal methods. Appropriate counseling about typical weight gain may help reduce discontinuation of contraceptives due to perceptions of weight gain.
Collapse
Affiliation(s)
- Laureen M Lopez
- Clinical Sciences, FHI 360, Research Triangle Park, North Carolina, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Reifsnider E, Mendias N, Davila Y, Babendure JB. Contraception and the obese woman. J Am Assoc Nurse Pract 2013; 25:223-33. [PMID: 24170564 PMCID: PMC4862368 DOI: 10.1111/1745-7599.12011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 12/10/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Obesity has reached epidemic rates among U.S. women of reproductive age, many of whom want to use contraception. However, some forms of contraception can have adverse effects on an obese woman's health. This article explores risks of contraception available in the United States and provides clinical recommendations for use by obese women. DATA SOURCES Information was compiled by reviewing the scientific literature on contraception and female obesity using CINAHL, MEDLINE, PubMed search engines. CONCLUSIONS The evidence is largely supportive of combined oral contraceptive (COC) use in carefully screened obese women without known risks factors for cardiovascular disease. The efficacy of COCs may be slightly reduced in obese women because of increased body mass. Other types of hormonal contraceptives have varying safety and efficacy reports when used by obese women. Intrauterine devices do not have reduced efficacy nor increased risks for obese women but insertion may be more difficult. Obesity has no effect on efficacy of barrier methods of contraception. IMPLICATIONS Clinicians should conduct a careful history and physical exam with selected supporting laboratory tests when considering prescription of hormonal contraceptives for obese women. Obese women require health counseling to carefully follow directions for contraceptive use to avoid unintended pregnancy.
Collapse
Affiliation(s)
- Elizabeth Reifsnider
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Nonie Mendias
- School of Nursing, University of Texas Medical Branch, Galveston, Texas
| | - Yolanda Davila
- School of Nursing, University of Texas Medical Branch, Galveston, Texas
| | | |
Collapse
|
20
|
Garbers S, Chiasson MA. Class III Obesity and Unwanted Pregnancy Among Women with Live Births in New York City, 2004–2007. Matern Child Health J 2012; 17:1459-67. [DOI: 10.1007/s10995-012-1150-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Progestin-only contraceptive pill use among women in the United States. Contraception 2012; 86:653-8. [PMID: 22682722 DOI: 10.1016/j.contraception.2012.05.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 04/25/2012] [Accepted: 05/03/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Progestin-only contraceptive pills (POPs) offer a safe and effective contraceptive option, particularly for women at increased risk of venous thromboembolism. However, the prevalence of POP use among women in the United States is unknown. STUDY DESIGN We analyzed population-based data from 12,279 women aged 15-44 years in the National Survey of Family Growth. Data were collected continuously from 2006 to 2010 by in-person, computerized household interviews. Analyses describe POP use across sociodemographic and reproductive characteristics and thromboembolic risk profiles. RESULTS Overall, 0.4% of all reproductive-aged women in the United States currently use POPs. POP use was higher among parous, postpartum and breastfeeding women than their counterparts (all p values<.001). Women at higher risk of thromboembolism (older, obese, diabetic or smoking women) had similar proportions of POP use as women without those risks. CONCLUSION POPs are rarely used by US women. While data on chronic disease were limited, our results suggest that relatively few women with increased risk of thromboembolism are considering POPs when choosing an oral contraceptive.
Collapse
|
22
|
Contraceptive choices of overweight and obese women in a publically funded hospital: possible clinical implications. Contraception 2012; 86:122-6. [PMID: 22459235 DOI: 10.1016/j.contraception.2011.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 12/06/2011] [Accepted: 12/06/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite the growing obesity epidemic in the United States, family planning for overweight and obese women has been understudied. The aim of this study was to describe the contraception methods selected by normal weight, overweight and obese women. STUDY DESIGN We retrospectively reviewed 7262 charts of women who underwent first trimester surgical termination of pregnancy at the John H. Stroger, Jr. Hospital of Cook County between January 1, 2008, and January 1, 2010. We analyzed the relationship between body mass index (BMI) and choice of contraceptive method, after adjusting for age, race, smoking and level of education. RESULTS When compared to patients with BMI <25 kg/m², overweight (BMI 25-29.9 kg/m²) and obese patients (BMI ≥30 kg/m²) were more likely to select the intrauterine device (OR 1.3, 95% CI 1.28-1.32 for overweight; OR 1.6, 95% CI 1.59-1.61 for obese), contraceptive ring (OR 1.4, 95% CI 1.28-1.52 for overweight; OR 1.6, 95% CI 1.57-1.63 for obese) and tubal ligation (OR 1.5 95% CI 1.44-1.62 for overweight; OR 2.9, 95% CI 2.79-3.01 for obese). They were less likely to choose injectable contraception (OR 0.7, 95% CI 0.59-0.81 for overweight; OR 0.52, 95% CI 0.48-0.56 for obese). There was no relationship between BMI and choice of condoms, oral contraceptive pills and implantable methods. CONCLUSION In our population, the contraceptive choices of overweight and obese women differed from those of normal weight women. These differences in contraceptive selection are important to recognize in light of the potential effect of BMI on the safety and efficacy of different contraceptive methods. Further research is needed to evaluate the contraceptive preferences, risks and benefits for overweight and obese women.
Collapse
|
23
|
Cochrane RA, Gebbie AE, Loudon JC. Contraception in obese older women. Maturitas 2012; 71:240-7. [PMID: 22240491 DOI: 10.1016/j.maturitas.2011.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 11/26/2022]
Abstract
Obesity is increasing in most western countries and rises significantly with age. Obese women are as sexually active as women of normal weight, and new sexual relationships in the older reproductive years are becoming more commonplace and still require effective contraception. Continuation of pregnancy in a woman over 40 carries health risks which are exacerbated by the presence of obesity. A high proportion of pregnancies in women over 40 are unplanned and end in therapeutic abortion. The prevalence of obesity and the high rates of contraceptive use amongst older women mean that any increase in associated risk is likely to be of public health concern. There are very few data on the specific risks of contraceptive use in obese older women. As fertility declines with age, all methods become increasingly effective. No single method is contraindicated by age alone but particular caution is required where the use of estrogen containing preparations is considered as the risks associated with estrogen are all also independently associated with increasing age and body mass index. Non-estrogen containing methods are available, whether hormonal, barrier or surgical, which are effective, acceptable and safer in the obese older woman. Some methods of contraception may indeed have particular non-contraceptive benefits for this population.
Collapse
Affiliation(s)
- Rosemary A Cochrane
- NHS Lothian Sexual and Reproductive Health Service, Chalmers Centre for Sexual Health, Edinburgh, UK.
| | | | | |
Collapse
|
24
|
Abstract
BACKGROUND Progestin-only contraceptives (POCs) are appropriate for many women who cannot or should not take estrogen. Many POCs are long-acting, cost-effective methods of preventing pregnancy. However, concern about weight gain can deter the initiation of contraceptives and cause early discontinuation among users. OBJECTIVES The primary objective was to evaluate the association between progestin-only contraceptive use and changes in body weight. SEARCH STRATEGY We searched MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, ClinicalTrials.gov, and ICTRP, and contacted investigators to identify other trials. SELECTION CRITERIA All comparative studies were eligible that examined a POC versus another method or no contraceptive. The primary outcome was mean change in body weight or body composition. DATA COLLECTION AND ANALYSIS Two authors extracted the data. We computed the mean difference with 95% confidence interval (CI) for continuous variables and odds ratio with 95% CI for dichotomous variables. MAIN RESULTS We did not conduct meta-analysis due to the various contraceptive methods and weight change measures. Fifteen studies examined progestin-only pills (N=1), Norplant (N=4), and depot medroxyprogesterone acetate (DMPA) (N=10). Comparison groups were similar for weight change in 11 studies. Four studies showed differences in weight or body composition change for POCs compared to no hormonal method. Adolescents using DMPA had a greater increase in body fat (%) versus a group using no hormonal method (mean difference 11.00; 95% CI 2.64 to 19.36). The DMPA group also had a greater decrease in lean body mass (%) (mean difference -4.00; 95% CI -6.93 to -1.07). In another study, weight gain (kg) was greater for the DMPA group than an IUD group (mean difference 2.28, 2.71, 3.17, respectively). The differences were notable within the normal weight and overweight subgroups. One study showed the Norplant (six-capsule) group had greater weight gain (kg) than a non-hormonal IUD group (mean difference 0.47 (95% CI 0.29 to 0.65) and a group using non-hormonal or no method (mean difference 0.74; 95% CI 0.52 to 0.96). Another study also showed a Norplant group also had greater weight gain (kg) than an IUD group (mean difference 1.10; 95% CI 0.36 to 1.84). AUTHORS' CONCLUSIONS We found little evidence of weight gain when using POCs. Mean gain was less than 2 kg for most studies up to 12 months, and usually similar for the comparison group using another contraceptive. Appropriate counseling about typical weight gain may help reduce discontinuation of contraceptives due to perceptions of weight gain.
Collapse
Affiliation(s)
- Laureen M Lopez
- Clinical Sciences, FHI, P.O. Box 13950, Research Triangle Park, North Carolina, USA, 27709
| | | | | | | | | |
Collapse
|