INUTERO EXPOSURE TO STEROID-CONTRACEPTIVES AND SURVIVAL DURING INFANCY

被引:19
作者
GRAY, RH [1 ]
PARDTHAISONG, T [1 ]
机构
[1] UNIV CHIANG MAI,DEPT COMMUNITY MED,CHIANG MAI,THAILAND
关键词
CONTRACEPTIVE AGENTS; CONTRACEPTIVES; ORAL; FETAL DEATH; INFANT; LOW BIRTH WEIGHT; INFANT MORTALITY; MEDROXYPROGESTERONE;
D O I
10.1093/oxfordjournals.aje.a116153
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
A cohort study was conducted in Chiang Mai, northern Thailand, in 1,431 children of women who had used the injectable contraceptive Depo-Provera(R) (The Upjohn Company, Kalamazoo, Michigan), 565 children of women who had used oral contraceptives during pregnancy, and a group of 2,307 control infants with no hormonal contraceptive exposures. In follow-up interviews, information was obtained on stillbirths and deaths. Cause of death was ascertained by interview, death certificate, or medical record, and underlying causes of death were ascribed by a panel. The children exposed in utero to Depo-Provera had higher neonatal and infant mortality rates (44.3 and 62.9 per 1,000 live births, respectively) than did the controls (19.8 and 29.1 per 1,000 live births). Mortality in infants exposed in utero to oral contraceptives was intermediate between that in the other two groups. Adjustment by logistic regression showed no significantly increased risk of mortality among infants exposed to oral contraceptives, but the odds ratio for death was significantly increased with Depo-Provera exposures due to accidental pregnancy (odds ratio (OR) = 1.8 (95% confidence interval (CI) 1.1-3.0) for neonatal deaths; OR = 2.0 (95% CI 1.3-3.2) for infant deaths). Adjustment for low birth weight reduced the risks, suggesting that low birth weight may act as an intermediate determinant of Depo-Provera-associated mortality. Among the accidental pregnancies with Depo-Provera, there was a relation between shorter injection-to-conception intervals, when maternal blood levels of the drug are high, and an increased risk of mortality. The odds ratios for neonatal mortality were 2.5 (95% CI 1.1-5.7), 2.1 (95% CI 1.0-4.6), and 0.9 (95% CI 0.4-2.4) for injection-to-conception intervals of less-than-or-equal-to 4, 5-8, and greater-than-or-equal-to 9 weeks, respectively. Adjustment for low birth weight reduced these risks. Chi-square tests for trend were highly significant. Similar associations were also observed between Depo-Provera accidental pregnancies and risks of low birth weight. Thus, infants from accidental pregnancies that occur 1-2 months after a 150-mg Depo-Provera injection may be at increased risk for low birth weight and death. However, the attributable risk is low, because such pregnancies are uncommon.
引用
收藏
页码:804 / 811
页数:8
相关论文
共 15 条
[1]  
BESCH DK, 1966, AM J OBSTET GYNECOL, V95, P228
[2]  
Breslow NE, 1980, IARC SCI PUBLICATION, V1
[3]   EFFECTS OF PRENATAL SEX-HORMONES ON GENDER-RELATED BEHAVIOR [J].
EHRHARDT, AA ;
MEYERBAHLBURG, HFL .
SCIENCE, 1981, 211 (4488) :1312-1318
[4]   METABOLISM OF INJECTABLE FORMULATIONS OF CONTRACEPTIVE STEROIDS IN OBESE AND THIN WOMEN [J].
FOTHERBY, K ;
KOETSAWANG, S .
CONTRACEPTION, 1982, 26 (01) :51-58
[5]  
FOTHERBY K, 1980, FERTIL STERIL, V34, P131
[6]   LONG-TERM EFFECTS OF MPA ON HUMAN PROGENY - INTELLECTUAL-DEVELOPMENT [J].
JAFFE, B ;
HARLAP, S ;
BARAS, M ;
GORDON, L ;
LIEBLICH, A ;
MAGIDOR, S ;
SANCHEZ, M .
CONTRACEPTION, 1988, 37 (06) :607-619
[7]   MEDROXYPROGESTERONE ACETATE IN HUMAN-SERUM [J].
MATHRUBUTHAM, M ;
FOTHERBY, K .
JOURNAL OF STEROID BIOCHEMISTRY AND MOLECULAR BIOLOGY, 1981, 14 (08) :783-786
[8]   SERUM MEDROXYPROGESTERONE ACETATE (MPA) CONCENTRATIONS AND OVARIAN-FUNCTION FOLLOWING INTRAMUSCULAR INJECTION OF DEPO-MPA [J].
ORTIZ, A ;
HIROI, M ;
STANCZYK, FZ ;
GOEBELSMANN, U ;
MISHELL, DR .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1977, 44 (01) :32-38
[9]   INUTERO EXPOSURE TO STEROID-CONTRACEPTIVES AND OUTCOME OF PREGNANCY [J].
PARDTHAISONG, T ;
GRAY, RH .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1991, 134 (08) :795-803
[10]  
PARDTHAISONG T, 1980, LANCET, V1, P509