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Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4539 (Published 13 August 2013) Cite this as: BMJ 2013;347:f4539

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Re: Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years

Reynold’s and colleagues report that adult offspring of mothers who were obese during pregnancy have an increased premature mortality from cardiovascular disease but fail to mention that that hormonal contraceptives can cause rapid weight gain and obesity.1,2

In 1962 we reported that in the first year weight gain was the most frequent side effect with norethisterone acetate 4 mg and ethinyl oestradiol 0.05 mgs (Anovlar). 45% of women gained more than 1.4 kg and 13% gained 3.2 kg in weight.3

In 2013 a study of 30 etonorgestrlel (ENG) implant users, 130 levonorgestrel intrauterine system (LNG-IUS) users, 67 depot medroxy progesterone acetate (DMPA) users and 100 copper intrauterine device (IUD) users, the mean weight change (in kilograms) over 12 months was 2.1 for ENG implant users [SD=6.7]; 1.0 for LNG-IUS users (SD=5.3); 2.2 for DMPA users (SD=4.9) and 0.2 for copper IUD users (SD=5.1).4

Rapid weight gain is an important reason why one in three women stop DMPA use in the first year. Up to 54% of adolescents receiving DMPA gained weight which was the primary reason for discontinuation in 41% of users. Subjects with early weight gain had a mean increase in BMI of 7.6 kg/m2 over 18 months with 85% being overweight or obese. Among adolescents and young women up to age 33 years weight gain at 6 months is a robust predictor of excessive weight gain on longer exposure to DMPA.5-7

As most studies concentrate on the weight gain with individual hormonal contraceptives, the cumulative weight gain due to frequent stopping and restarting different types of hormonal contraceptives is often ignored and even described as mythical.

In reality, the prevalence of maternal obesity has risen rapidly in the past two decades in Europe and in the United States (about 64% of women of reproductive age being overweight and 35% obese)8,9 The belief that obese women need to continue to use progestogens to prevent further pregnancies is unjustifiable. Non-hormonal methods of contraception are available which, if used responsibly, can give women the opportunity to lose weight and have healthier children.

1 Reynolds RM, Raja EA, Bhattacharya S, et al. Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years. BMJ 2013; 347:f4539.

2 Anon. Editorial Changing oral contraceptives. BMJ 1969;4:789-91.

3 Mears E, Grant ECG. Anovlar as an oral contraceptive. BMJ 1962;2:75-79.

4 Vickery Z, Madden T, Zhao Q, Secura GM, Allsworth JE, Peipert JF. Weight change at 12 months in users of three progestin-only contraceptive methods. Contraception 2013. pii: S0010-7824(13)00090-5.

5 Harel Z, Biro FM, Kollar LM, Rauh JL. Adolescents' reasons for and experience after discontinuation of the long-acting contraceptives Depo-Provera and Norplant. J Adolesc Health. 1996;19:118–23.

6 O'Dell CM, Forke CM, Polaneczky MM, Sondheimer SJ, Slap GB. Depot medroxyprogesterone acetate or oral contraception in postpartum adolescents. Obstet Gynecol. 1998;91:609–14.

7 Bonny AE, Secic M, Cromer B. Early weight gain related to later weight gain in adolescents on depot medroxyprogesterone acetate. Obstet Gynecol 2011;117:793–797.

8 Heslehurst N, Rankin J, Wilkinson JR, Summerbell CD. A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619 323 births, 1989-2007. Int J Obes (Lond) 2010;34:420-8.

9 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012;307:491-7.

Competing interests: No competing interests

27 August 2013
Ellen CG Grant
Physician and medical gynaecologist
Retired
Kingston-uon0Thames, KT2 7JU, UK