Advertisement

Safety and effectiveness data for emergency contraceptive pills among women with obesity: a systematic review

      Abstract

      Objective

      This study aims to determine whether emergency contraceptive pills (ECPs) are less safe and effective for women with obesity compared with those without obesity.

      Study design

      We searched PubMed for articles through November 2015 regarding the safety and effectiveness of ECPs [ulipristal acetate (UPA), levonorgestrel (LNG) and combined estrogen and progestin] among obese users. We assessed study quality using the United States Preventive Services Task Force evidence grading system.

      Results

      We identified four pooled secondary analyses (quality: poor to fair), two of which examined UPA and three examined LNG formulations. Three analyses pooled overlapping data from a total of three primary studies and demonstrated significant associations between obesity and risk of pregnancy after ECP use. One analysis reported a 4-fold increased risk of pregnancy among women with obesity (BMI30 kg/m2) compared with women within normal/underweight categories (BMI<25 kg/m2) after use of LNG ECPs [odds ratio (OR) 4.4; 95% confidence interval (CI) 2.0–9.4]. Further analysis of the same LNG data found that, at an approximate weight of 80 kg, the rate of pregnancy rose above 6%, which is the estimated pregnancy probability without contraception; at weights less than 75 kg, the rate of pregnancy was less than 2%. Two analyses examining UPA suggested an approximate 2-fold increased risk of pregnancy among women with obesity compared with either normal/underweight women or nonobese (BMI<30 kg/m2) women (OR 2.6; 95% CI 0.9–7.0 and OR 2.1; 95% CI 1.0–4.3, respectively), but CIs were wide. Finally, the fourth secondary analysis pooled data from three separate randomized controlled trials on LNG ECPs and found no increase in pregnancy risk with increasing weight or BMI and found no consistent association between pregnancy and both factors when adjusted for other covariates.

      Conclusion

      While data are limited and poor to fair quality, findings suggest that women with obesity experience an increased risk of pregnancy after use of LNG ECP compared with those normal/underweight. Women with obesity may also experience an increased risk of pregnancy compared with women without obesity after use of UPA ECP, though differences did not reach statistical significance. Providers should counsel all women at risk for unintended pregnancy, including those with obesity, about the effectiveness of the full range of emergency contraception options in order for them to understand their options, to receive advanced supplies of emergency contraception as needed and to understand how to access an emergency copper intrauterine device if desired.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Edelman AB
        • Cherala G
        • Stanczyk FZ
        Metabolism and pharmacokinetics of contraceptive steroids in obese women: a review.
        Contraception. 2010; 82: 314-323
        • Lopez LM
        • Grimes DA
        • Chen M
        • Otterness C
        • Westhoff C
        • Edelman A
        • et al.
        Hormonal contraceptives for contraception in overweight or obese women.
        Cochrane Database Syst Rev. 2013; 4CD008452
        • Trussell J
        • Schwarz EB
        • Guthrie K
        Obesity and oral contraceptive pill failure.
        Contraception. 2009; 79: 334-338
        • Yamazaki M
        • Dwyer K
        • Sobhan M
        • Davis D
        • Kim MJ
        • Soule L
        • et al.
        Effect of obesity on the effectiveness of hormonal contraceptives: an individual participant data meta-analysis.
        Contraception. 2015; 92: 445-452
        • Brunner Huber LR
        • Hogue CJ
        The association between body weight, unintended pregnancy resulting in a livebirth, and contraception at the time of conception.
        Matern Child Health J. 2005; 9: 413-420
        • 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: 265-271
        • Kaneshiro B
        • Edelman A
        • Carlson N
        • Nichols M
        • Jensen J
        The relationship between body mass index and unintended pregnancy: results from the 2002 National Survey of family growth.
        Contraception. 2008; 77: 234-238
        • World Health Organization
        Reproductive health and research. Medical eligibility criteria for contraceptive use.
        4th ed. Department of Reproductive Health and Research, World Health Organization, Geneva2010
        • U S. Medical Eligibility Criteria for Contraceptive Use
        MMWR Recomm Rep. 2010; 59 ([2010]): 1-86
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman DG
        • Group P
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Harris RP
        • Helfand M
        • Woolf SH
        • Lohr KN
        • Mulrow CD
        • Teutsch SM
        • et al.
        Current methods of the US preventive services task force: a review of the process.
        Am J Prev Med. 2001; 20: 21-35
        • Glasier A
        • Cameron ST
        • Blithe D
        • Scherrer B
        • Mathe H
        • Levy D
        • et al.
        Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel.
        Contraception. 2011; 84: 363-367
        • Moreau C
        • Trussell J
        Results from pooled phase III studies of ulipristal acetate for emergency contraception.
        Contraception. 2012; 86: 673-680
        • Kapp N
        • Abitbol JL
        • Mathe H
        • Scherrer B
        • Guillard H
        • Gainer E
        • et al.
        Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception.
        Contraception. 2015; 91: 97-104
        • Gemzell-Danielsson K
        • Kardos L
        • von Hertzen H
        Impact of bodyweight/body mass index on the effectiveness of emergency contraception with levonorgestrel: a pooled-analysis of three randomized controlled trials.
        Curr Med Res Opin. 2015; 31: 2241-2248
        • Creinin MD
        • Schlaff W
        • Archer DF
        • Wan L
        • Frezieres R
        • Thomas M
        • et al.
        Progesterone receptor modulator for emergency contraception: a randomized controlled trial.
        Obstet Gynecol. 2006; 108: 1089-1097
        • Glasier AF
        • Cameron ST
        • Fine PM
        • Cullins V
        • Morfesis J
        • Gainer E
        • et al.
        Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.
        Lancet. 2010; 375: 555-562
        • Fine P
        • Mathe H
        • Ginde S
        • Cullins V
        • Morfesis J
        • Gainer E
        Ulipristal acetate taken 48–120 hours after intercourse for emergency contraception.
        Obstet Gynecol. 2010; 115: 257-263
      1. Lancet. 1998; 352: 428-433
        • von Hertzen H
        • Piaggio G
        • Ding J
        • Chen J
        • Song S
        • Bartfai G
        • et al.
        Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial.
        Lancet. 2002; 360: 1803-1810
        • Dada OA
        • Godfrey EM
        Piaggio G, von Hertzen H, Nigerian network for reproductive health R, training. A randomized, double-blind, noninferiority study to compare two regimens of levonorgestrel for emergency contraception in Nigeria.
        Contraception. 2010; 82: 373-378
        • Trussell J
        • Rodriguez G
        • Ellertson C
        New estimates of the effectiveness of the Yuzpe regimen of emergency contraception.
        Contraception. 1998; 57: 363-369
        • Brunner Huber LR
        Validity of self-reported height and weight in women of reproductive age.
        Matern Child Nurs J. 2007; 11: 137-144
        • Edelman AB
        • Cherala G
        • Blue SW
        • Erikson DW
        • Jensen JT
        Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing.
        Contraception. 2016; 94: 52-57
        • Marchi J
        • Berg M
        • Dencker A
        • Olander EK
        • Begley C
        Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews.
        Obes Rev. 2015; 16: 621-638
        • Cleland K
        • Zhu H
        • Goldstuck N
        • Cheng L
        • Trussell J
        The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience.
        Hum Reprod. 2012; 27: 1994-2000
        • Raymond EG
        • Cleland K
        Clinical practice. Emergency contraception.
        N Engl J Med. 2015; 372: 1342-1348
        • Cleland K
        • Raymond EG
        • Westley E
        • Trussell J
        Emergency contraception review: evidence-based recommendations for clinicians.
        Clin Obstet Gynecol. 2014; 57: 741-750