1
|
Puliani R, Bhatt Y, Gupta S, R N A, B D T, Jayanna K. A Scoping Review of Barriers and Facilitators for Preconception Care: Lessons for Global Health Policies and Programs. Asia Pac J Public Health 2024; 36:531-541. [PMID: 38736330 DOI: 10.1177/10105395241252867] [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: 05/14/2024]
Abstract
Preconception care (PCC) encompasses a set of actions taken before pregnancy to support the health and well-being of women before conception to improve maternal and child health (MCH) outcomes. The utilization of PCC services is influenced by multifaceted factors that can either enable or impede women's capacity to access and utilize them effectively. This scoping review examined the barriers and facilitators influencing the utilization of PCC services among women of reproductive age (15-49 years) at both individual and community levels. Through an extensive review of published articles from 2004 to 2021, including peer-reviewed sources, barriers and facilitators were identified. At the individual level, barriers included limited knowledge about PCC, neglect of self-health, and financial constraints. Community-level barriers encompassed insufficient supply of supplements, restricted access to health care, high health care costs, and setbacks due to delayed delivery of MCH services. Conversely, individuals reported that credible sources of information, such as friends, family, and community health volunteers, facilitated their engagement with PCC services. At the community level, facilitators included government-regulated supply chains for supplements and the involvement of community workers in health monitoring. Understanding and addressing these factors can help improve the utilization of PCC services among women of reproductive age (WRA) and improve MCH outcomes.
Collapse
Affiliation(s)
- Reedhika Puliani
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Yogita Bhatt
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Soumya Gupta
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Dehradun, India
| | - Agnita R N
- Karnataka Health Promotion Trust, Bengaluru, India
| | - Tejaswini B D
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Krishnamurthy Jayanna
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| |
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
|
Boyce TM, Neiterman E. Women in larger bodies' experiences with contraception: a scoping review. Reprod Health 2021; 18:89. [PMID: 33926501 PMCID: PMC8082612 DOI: 10.1186/s12978-021-01139-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/12/2021] [Indexed: 01/29/2023] Open
Abstract
Background As the prevalence of obesity increases and the age of onset decreases, more women of reproductive age will be living in larger bodies. Research on weight-related efficacy and safety has informed clinical guidelines for routine and emergency contraceptive use by women with a higher body mass index; however, patient perspectives are needed to understand women in larger bodies’ experiences with contraception and contraceptive care. This scoping review summarizes the literature on women in larger bodies’ experiences with contraception with the goal of gaining a better understanding of the nature of these experiences and identifying gaps in the existing research. Methods Following Arksey and O’Malley’s framework, a scoping review of the literature was conducted. Four databases (PubMed, PsycINFO, SCOPUS, and CINAHL) were searched for peer-reviewed, empirical articles published in English between 2010 and 2020, with a focus on North America, Europe, Australia, and New Zealand. Data were summarized by identifying key themes in the reviewed literature. Results Twenty-nine articles meeting the eligibility criteria were reviewed. The literature was predominantly quantitative (n = 27), with only one qualitative study and one systematic review, respectively. Five themes were identified, including (1) use of contraception among women in larger bodies; (2) knowledge, attitudes towards and beliefs about contraception; (3) contraceptive (dis)satisfaction among women in larger bodies; (4) contraceptive counseling; and (5) barriers to contraception. The findings revealed that women in larger bodies may have unmet contraceptive care needs. Despite many articles addressing the need to improve contraceptive counseling for women in larger bodies (n = 26), few explored how women felt about their care (n = 2). Finally, only two articles focused on emergency contraception, indicating a need for further research. Conclusion This scoping review emphasizes the pressing need for qualitative research to explore women in larger bodies’ experiences with routine and emergency contraception, as well as receiving contraceptive counseling and care. Future research exploring the lived experiences of women in larger bodies is necessary to better characterize their contraceptive needs and identify avenues to improve patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01139-2. As obesity becomes more prevalent, more women of reproductive age will be living in larger bodies. This review highlights what is known about women in larger bodies’ experiences with contraception and suggests where future research is needed. We searched four databases for papers published in English from 2010 to 2020. Our review included 29 articles. Nearly all of the studies were quantitative, with one qualitative study and one review. Most articles talked about contraceptive use, but few of them included emergency contraception. Some papers highlighted women’s knowledge and opinions about contraception, whereas others talked about their contraceptive (dis)satisfaction. Many articles discussed contraceptive counseling. Finally, some papers considered potential barriers to contraception. Our findings suggest that women in larger bodies have unmet contraceptive needs. Notably, this review aimed to focus on patient experiences but women’s voices were rarely represented. Future qualitative research on women’s lived experiences will provide a better understanding of women in larger bodies’ contraceptive needs and suggest how care can be improved.
Collapse
Affiliation(s)
- Tierney M Boyce
- School of Public Health and Health Systems, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Elena Neiterman
- School of Public Health and Health Systems, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| |
Collapse
|
4
|
Têtu C, Gaubil-Kaladjian I, Barbe C, Diaz Cives A, Barrois M, Bertin E, Delemer B, Fèvre A. [Contraception after bariatric surgery: Importance of a specific gynecologic course]. ACTA ACUST UNITED AC 2021; 49:709-715. [PMID: 33766790 DOI: 10.1016/j.gofs.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
- C Têtu
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France.
| | - I Gaubil-Kaladjian
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France; Centre spécialisé de l'obésité de Champagne Ardenne (CSO CA), CHU Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - C Barbe
- CHU de Reims, Unité d'aide méthodologique, Pôle recherche et santé publique, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - A Diaz Cives
- Centre spécialisé de l'obésité de Champagne Ardenne (CSO CA), CHU Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France; Service de chirurgie générale digestive et endocrinienne, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - M Barrois
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France; Centre spécialisé de l'obésité de Champagne Ardenne (CSO CA), CHU Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - E Bertin
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France; Centre spécialisé de l'obésité de Champagne Ardenne (CSO CA), CHU Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - B Delemer
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - A Fèvre
- Service d'endocrinologie diabète nutrition, CHU de Reims, Hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| |
Collapse
|
5
|
Mudaliar J, Nusair P, McCudden L, Melville P, Rouse I, Black K. A cross-sectional study exploring obesity and pregnancy planning among women attending an antenatal clinic in Suva, Fiji. Aust N Z J Obstet Gynaecol 2020; 61:42-47. [PMID: 32744353 DOI: 10.1111/ajo.13221] [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: 02/15/2020] [Accepted: 06/22/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pregnancy planning enables maternal health optimisation which is particularly important for women who have obesity and are at increased risk of adverse perinatal outcomes. AIMS The prevalence of pregnancy planning and its relationship to body mass index (BMI) was investigated in a cohort of women attending antenatal clinics in the main referral hospital in Suva, Fiji. MATERIALS AND METHODS The questionnaire captured health and socio-demographic data, anthropometry and asked about pregnancy planning. RESULTS Two thousand, two hundred and three pregnant women presenting for their first booking at the antenatal clinic were enrolled; 721 (37.4%) out of 1926 women with complete data reported they did not plan their pregnancy. A third of women (n = 633, 32.8%) had overweight and 805 (41.7%) had obesity. In multivariable analyses parity, employment status, marital status, and BMI were significantly associated with pregnancy planning. Compared to women of a healthy weight or underweight, women who have obesity were less likely to plan their pregnancy (adjusted odds ratio 0.742; 95% CI 0.569-0.967). CONCLUSION Tackling the cycle of obesity will require attention to preconception care and optimising weight before pregnancy.
Collapse
Affiliation(s)
- Jyotishna Mudaliar
- Murdoch Children's Research Institute, Northern Division Scabies Control Program, Labasa, Fiji
| | - Pushpa Nusair
- Department of Obstetrics and Gynaecology, Fiji National University, Suva, Fiji
| | - Lucy McCudden
- Department of Women's Health, Neonatology and Paediatrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health University of Sydney, Sydney, New South Wales, Australia
| | - Peter Melville
- Department of Midwifery, Auckland Hospital, Auckland, New Zealand
| | - Ian Rouse
- Department of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kirsten Black
- Department of Women's Health, Neonatology and Paediatrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Berkemeier S, Cheney K, Farber R, Sim KA, Black KI. The influence of maternal obesity on pregnancy intention: A cross-sectional analysis. Aust N Z J Obstet Gynaecol 2020; 60:474-478. [PMID: 32227338 DOI: 10.1111/ajo.13148] [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: 11/11/2019] [Accepted: 02/21/2020] [Indexed: 11/30/2022]
Abstract
This prospective cross-sectional study of 1498 pregnant women in early pregnancy sought to investigate the prevalence of pregnancy intention between women of differing body mass index (BMI) categories. There was no difference in the risk of unintended pregnancy between women who were in the healthy weight, overweight or obesity BMI categories. The study identifies and highlights the potential missed opportunities for all women to engage in healthy reproductive life planning behaviours to support health in pregnancy and beyond.
Collapse
Affiliation(s)
- Sophia Berkemeier
- Discipline of Obstetrics Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia
| | - Kate Cheney
- Discipline of Obstetrics Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia.,RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rachel Farber
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kyra A Sim
- Charles Perkins Centre, Boden Collaboration, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kirsten I Black
- Discipline of Obstetrics Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia.,RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Sundell M, Ginstman C, Månsson A, Forslund I, Brynhildsen J. Patterns of prescription and discontinuation of contraceptives for Swedish women with obesity and normal-weight women. EUR J CONTRACEP REPR 2019; 24:192-197. [PMID: 31112059 DOI: 10.1080/13625187.2019.1610873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: This study aimed to explore the prescription of different contraceptive methods to Swedish women with obesity and to compare the pattern of prescription and adherence to treatment between this group and normal-weight women. Materials and methods: This study included 371 women with obesity and 744 matched normal-weight women, aged 18-40. Medical records were scrutinised for the period 1 January 2010 to 31 December 2014. The retrieved variables included: background characteristics, prescribed contraceptive methods, adverse effects, duration of treatment, reason for discontinuation and bleeding pattern. Result: Progestin-only pills were mainly prescribed to women with obesity (44% vs. 20%, p = 0.001) whereas combined hormonal contraception was mainly prescribed to normal-weight women (60% vs. 21%, p < 0.0001). Thirty-three percent vs. 25% (p = 0.003) discontinued their contraceptive method within 1 year. The most commonly declared reason for discontinuation was bleeding disturbance (14.7% vs. 9.6%, p = 0.008). Conclusion: The most commonly prescribed contraceptive method in women with obesity was progestin-only pills, but surprisingly many women with obesity were prescribed combined hormonal contraception despite current Swedish and European guidelines. Incident users with obesity were significantly more likely to discontinue their contraceptive method within the first year of the study period, compared with incident normal-weight users.
Collapse
Affiliation(s)
- Micaela Sundell
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Charlotte Ginstman
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Agnes Månsson
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Ingrid Forslund
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Jan Brynhildsen
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| |
Collapse
|
8
|
Lang AY, Harrison CL, Boyle JA. Preconception Lifestyle and Weight-Related Behaviors by Maternal Body Mass Index: A Cross-Sectional Study of Pregnant Women. Nutrients 2019; 11:nu11040759. [PMID: 30935152 PMCID: PMC6521092 DOI: 10.3390/nu11040759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 01/24/2023] Open
Abstract
Obesity is a rising global health challenge, particularly for reproductive-aged women. Our cross-sectional study of pregnant women (n = 223) examined associations between preconception body mass index (BMI) and socio-demographics, weight perceptions and lifestyle behaviors. Over half of women were overweight (33.2%) or obese (22.0%), 49.6% of which perceived their weight as normal. High proportions of women reported planning their pregnancies (70.0%) and were actively trying to lose or maintain their weight preconception (72.7%). Weight management approaches varied from reducing discretionary foods (63.7%) to professional support (8.1%). Obese women had significantly greater odds of reducing discretionary foods (odds ratio (OR) = 6.69 95% confidence interval (CI) 2.13–21.00, p = 0.001) and using structured diets (adjusted odds ratio (AOR) = 9.13 95% CI 2.90–28.81, p < 0.001) compared to normal-weight women. After adjusting for socio-demographics, compared to normal-weight women, overweight (AOR = 5.24 95% CI 2.19–12.56, p < 0.001) and obese (AOR = 2.85 95% CI 1.06–7.67, p = 0.04) women had significantly increased odds of exercising for weight management and significantly lower odds of taking folic-acid preconception (overweight: AOR = 0.40 95% CI 0.18–0.90, p = 0.01, obese: AOR = 0.38 95% CI 0.16–0.91, p = 0.03). Large proportions of women planning a pregnancy have an overweight/obese BMI, with associated suboptimal health behaviors and reduced health professional engagement preconception. Further research exploring women’s perspectives regarding preconception lifestyles is needed to inform effective preconception health promotion strategies.
Collapse
Affiliation(s)
- Adina Y Lang
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia.
| |
Collapse
|
9
|
Rottenstreich M, Sela HY, Loitner L, Smorgick N, Vaknin Z. Recurrent unintended pregnancies among young unmarried women serving in the Israeli military. Isr J Health Policy Res 2018; 7:42. [PMID: 30595133 PMCID: PMC6311894 DOI: 10.1186/s13584-018-0239-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/24/2018] [Indexed: 12/02/2022] Open
Abstract
Background Unintended pregnancy is a major public health problem with known risk factors, however, little is known about the prevalence of variables associated with recurrent unintended pregnancy (RUP) among young, unmarried women. Methods A retrospective cohort study of unmarried women aged 18–21 serving in the Israeli military between 2013 and 2015. Multivariable logistic regression analysis was used to examine associations between RUP and women’s education, IQ, immigration status, country of origin, socioeconomic status and history of psychiatric illness. Results Of 129,638 women drafted by the Israeli military during the study period, 1720 women with unintended pregnancies had a follow up period of at least a year. Three hundred and eighty-nine of them had RUP (22.6%). Multivariable models comparing women with no unintended pregnancies and women with RUP revealed that RUP was more common among (adjusted relative risk; 95% confidence interval) women who had not graduated from high school (6.9; 4.99–9.55), who had low (90–99) IQ scores (3.9; 2.88–5.39) those reporting Africa as the country of origin (2.5; 1.37–4.59) and those from a lower socioeconomic neighborhood (1.6; 1.18–2.05). Multivariate regression modeling comparing women with single unintended pregnancies and women with RUPs showed that recurrent unintended pregnancy was more common among women who had not graduated from high school (3.2; 2.04–4.84) and those who had a low (90–99) IQ score (1.9; 1.32–2.61). Conclusion Rate of RUP is high among women serving in the Israeli military. These women have unique epidemiological characteristics. This may serve in identifying populations at high risk and thus may enable policy maker to offer at least to this population Long-Acting Reversible Contraception (LARC) methods. We encourage policy makers to consider the provision of LARC methods to all servicewomen who had an unintended pregnancy.
Collapse
Affiliation(s)
- Misgav Rottenstreich
- Medical Corps, Israel Defense Forces, Jerusalem, Israel.,Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Limor Loitner
- Medical Corps, Israel Defense Forces, Jerusalem, Israel
| | - Noam Smorgick
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, affiliated to Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Beer Yakov, Israel
| | - Zvi Vaknin
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, affiliated to Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Beer Yakov, Israel.
| |
Collapse
|
10
|
Mark KS, Bragg B, Talaie T, Chawla K, Murphy L, Terplan M. Risk of complication during surgical abortion in obese women. Am J Obstet Gynecol 2018; 218:238.e1-238.e5. [PMID: 29074080 DOI: 10.1016/j.ajog.2017.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Surgical abortion is a generally safe procedure. Obesity is a known risk factor for complications in other surgical procedures, but insufficient information exists to determine the effects of increasing body mass index on the risk of surgical abortions. OBJECTIVE The purpose of this study was to determine whether obesity is a risk factor for major complications in surgical abortions. METHODS A quality control database from a single outpatient center was analyzed to determine rates of major complications during surgical abortions in relation to obesity class. Complications included hemorrhage, need for repeat evacuation, uterine perforation, cervical laceration, medication reaction, unexpected surgery, or unplanned admission to the hospital. Chi-squared and analysis of variance were used for analysis. RESULTS We included 2468 procedures: 1475 procedures (59.8%) in the first trimester and 993 procedures (40.2%) in the second trimester. The overall complications rate was 2.2%. Second-trimester procedures were more likely than those in the first trimester to have complications (3.1% vs 1.6%; P=.009). Overall, 39.6% of the women were obese, and 9.6% of them met criteria for class 3 obesity (body mass index, >40 kg/m2). Women who underwent second-trimester abortions with class 3 obesity had a rate of complication of 8.7%, which was significantly more than normal weight women (odds ratio, 5.90; 95% confidence interval, 1.93-8.07; P<.001). COMMENT Surgical abortions are overall safe procedures, but class 3 obesity increases the rate of complication in second-trimester procedures.
Collapse
|
11
|
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
|
12
|
Vigoureux S. Épidémiologie de l’interruption volontaire de grossesse en France. ACTA ACUST UNITED AC 2016; 45:1462-1476. [DOI: 10.1016/j.jgyn.2016.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
|
13
|
Lopez LM, Bernholc A, Chen M, Grey TW, Otterness C, Westhoff C, Edelman A, Helmerhorst FM. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database Syst Rev 2016; 2016:CD008452. [PMID: 27537097 PMCID: PMC9063995 DOI: 10.1002/14651858.cd008452.pub4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Obesity has reached epidemic proportions around the world. Effectiveness of hormonal contraceptives may be related to metabolic changes in obesity or to greater body mass or body fat. Hormonal contraceptives include oral contraceptives (OCs), injectables, implants, hormonal intrauterine contraception (IUC), the transdermal patch, and the vaginal ring. Given the prevalence of overweight and obesity, the public health impact of any effect on contraceptive efficacy could be substantial. OBJECTIVES To examine the effectiveness of hormonal contraceptives in preventing pregnancy among women who are overweight or obese versus women with a lower body mass index (BMI) or weight. SEARCH METHODS Until 4 August 2016, we searched for studies in PubMed (MEDLINE), CENTRAL, POPLINE, Web of Science, ClinicalTrials.gov, and ICTRP. We examined reference lists of pertinent articles to identify other studies. For the initial review, we wrote to investigators to find additional published or unpublished studies. SELECTION CRITERIA All study designs were eligible. The study could have examined any type of hormonal contraceptive. Reports had to contain information on the specific contraceptive methods used. The primary outcome was pregnancy. Overweight or obese women must have been identified by an analysis cutoff for weight or BMI (kg/m(2)). DATA COLLECTION AND ANALYSIS Two authors independently extracted the data. One entered the data into RevMan and a second verified accuracy. The main comparisons were between overweight or obese women and women of lower weight or BMI. We examined the quality of evidence using the Newcastle-Ottawa Quality Assessment Scale. Where available, we included life-table rates. We also used unadjusted pregnancy rates, relative risk (RR), or rate ratio when those were the only results provided. For dichotomous variables, we computed an odds ratio with 95% confidence interval (CI). MAIN RESULTS With 8 studies added in this update, 17 met our inclusion criteria and had a total of 63,813 women. We focus here on 12 studies that provided high, moderate, or low quality evidence. Most did not show a higher pregnancy risk among overweight or obese women. Of five COC studies, two found BMI to be associated with pregnancy but in different directions. With an OC containing norethindrone acetate and ethinyl estradiol (EE), pregnancy risk was higher for overweight women, i.e. with BMI ≥ 25 versus those with BMI < 25 (reported relative risk 2.49, 95% CI 1.01 to 6.13). In contrast, a trial using an OC with levonorgestrel and EE reported a Pearl Index of 0 for obese women (BMI ≥ 30) versus 5.59 for nonobese women (BMI < 30). The same trial tested a transdermal patch containing levonorgestrel and EE. Within the patch group, obese women in the "treatment-compliant" subgroup had a higher reported Pearl Index than nonobese women (4.63 versus 2.15). Of five implant studies, two that examined the six-capsule levonorgestrel implant showed differences in pregnancy by weight. One study showed higher weight was associated with higher pregnancy rate in years 6 and 7 combined (reported P < 0.05). In the other, pregnancy rates differed in year 5 among the lower weight groups only (reported P < 0.01) and did not involve women weighing 70 kg or more.Analysis of data from other contraceptive methods indicated no association of pregnancy with overweight or obesity. These included depot medroxyprogesterone acetate (subcutaneous), levonorgestrel IUC, the two-rod levonorgestrel implant, and the etonogestrel implant. AUTHORS' CONCLUSIONS The evidence generally did not indicate an association between higher BMI or weight and effectiveness of hormonal contraceptives. However, we found few studies for most contraceptive methods. Studies using BMI, rather than weight alone, can provide information about whether body composition is related to contraceptive effectiveness. The contraceptive methods examined here are among the most effective when used according to the recommended regimen.We considered the overall quality of evidence to be low for the objectives of this review. More recent reports provided evidence of varying quality, while the quality was generally low for older studies. For many trials the quality would be higher for their original purpose rather than the non-randomized comparisons here. Investigators should consider adjusting for potential confounding related to BMI or contraceptive effectiveness. Newer studies included a greater proportion of overweight or obese women, which helps in examining effectiveness and side effects of hormonal contraceptives within those groups.
Collapse
Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Alissa Bernholc
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | | | - Carolyn Westhoff
- Columbia UniversityDept of Obstetrics and Gynecology630 West 168 StreetNew YorkNew YorkUSANY 10032
| | - Alison Edelman
- Oregon Health & Science UniversityDept. of Obstetrics and GynecologyPortlandOregonUSA
| | - Frans M Helmerhorst
- Leiden University Medical CenterDept. of Clinical EpidemiologyPO Box 9600Albinusdreef 2LeidenNetherlandsNL 2300 RC
| | | |
Collapse
|