In a study, they found that many pregnant women still take medications long known to cause birth defects.

Some medications with known fetal risk, such as drugs that control epilepsy, are essential during pregnancy, Dr. Anick Berard, at the University of Montreal in Quebec, noted in an email correspondence to Reuters Health.

Other medications, such as those that treat severe acne, anxiety and psychiatric drugs, antibiotics, and many drugs prescribed for heart disease and medical conditions, “can and should be avoided,” according to Berard.

Women should understand the side effects of any drug they are taking — especially drugs treating a chronic condition — and plan pregnancies to avoid or minimize risks such drugs pose to babies, Berard added.

For the 5 years between January 1998 and the last day of 2002, Berard and colleagues analyzed the prescriptions filled by pregnant women for drugs available at the time and known to pose fetal risks.

Their report, in BJOG: An International Journal of Obstetrics and Gynecology, shows 56 percent of 109,344 pregnant women filled at least one medication prescription. A total of 6.3 percent (6,871 women) did so for at least one medication known to pose a risk to the fetus.

“These pregnancies were associated with an elevated number of (pregnancy terminations) and babies born with major (birth defects) in comparison with the expected numbers in the population,” they note.

Specifically, terminations occurred in 47 percent of the pregnancies exposed to drugs with known fetal risks. Six percent of these pregnancies ended in miscarriage.

By contrast, in the much larger non-exposed group about 36 percent of the pregnancies had been terminated and fewer than 5 percent ended in miscarriage.

Berard’s team further identified birth defects in 8.2 percent of 2,842 infants exposed to risky drugs during gestation and available for assessment, compared with 7.1 percent of the 59,287 infants not exposed. This is “a statistically significant difference,” they note.

They emphasize, however, that it cannot be concluded that the drug exposure caused the birth defects. These pregnancies may have also been exposed to other harmful agents or maternal health conditions, they point out.

The investigators call on doctors caring for women of childbearing age to conduct a thorough medication review prior to a planned pregnancy, or as soon as an unplanned pregnancy is recognized.

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The recent studies taken on low-dose (low estrogen) pills have indicated the nominal change in the weight. Weight gain while taking pills could be possible in few but not necessarily be at alarming situation. If the weight gain is due to pills then it could be a temporary phenomena and certainly not permanent. Analysts have pointed out that 5-10% women adding few pounds while they are taking birth control pills but there is similar number of women who are gaining weight but not on pills at all. Weight gain could be due to fluid retention in the body (occurs other than the pills) and fat deposition. Some women may be sensitive to either of these and experience weight gain regardless of birth control pills.

How much weight gain could be possible on birth control pills?

It is usually argued that birth control pills, specially higher dose of estrogen pills (more than 30 mcgm), cause more weight than birth control injection like Depo Provera. Studies have revealed that women using high dose pills tend to gain 5.3 lb in a year compared to women who are taking Depo Provera as contraception and gaining 6.6 lb (2.2 kg) in a year’s time. However, analysts have further found that only 7% women who were taking pills got more than 10% of they body weight. But women who were taking shots for Depo Provera, 25% of them gained more than 10% of their body weight. If you compare 5.3 lb weight due to pills with 6.6 lb weight gained due to birth control injection, you will notice that not only women who are on birth control pills get lesser weight in a year than birth control injection method but also at lesser risk of weight gain.

Moreover, most of the recent studies on lower estrogen hormone based pills (30 mcgm or less) have shown weight loss or no change, if continued to take for a year.

But birth control pills may cause fluid retention, isn’t it true?
It can not denied that pills containing high doses of estrogen may cause fluid retention in the body, specially if the pill has 50 mcgm estrogen or more. How it happens? Well, high doses of estrogen stimulate kidney-substances like renin-angiotensin, which is responsible for water retention that again causes sodium (salt) retention that ultimately causes the weight gain. Studies on different levels of estrogen based birth control pills revealed that pills having less than 20 mcgm estrogen reduce weight, 30 mcgm pills make no difference in the weight or nominal loss of weight whereas 50 mcgm pills cause fluid retention and weight gain.

If you are on birth control pill and experiencing more than 5% of your body weight gain in a year, it may be due to your body’s reaction to insulin resistance or abnormal glucose metabolism. You need to consult your healthcare professional to adopt low carbohydrate diet because high amount of sugar in any meal will offset your weight control efforts.

Besides, low estrogen, what other types of birth control pills can affect on weight?
The combined pills containing desogestrel type of progestin and low dose of estrogen would cause very little weight gain compared to the pills containing norethindrone (like Ortho Novum 7/7/7). This is possibly due to specific progestin causing weight gain mainly due to lesser insulin resistance. Low estrogen can be found in the birth control pills like Alesse, Loestrin Fe, Mircette etc. If you are experiencing weight gain or fluid retention symptoms from your present birth control pills, you can consult your healthcare professional or doctor to know which birth control pills are suitable for you.

You may also visit the site to look at the comparative study of the different level of hormones used in various birth control pills. The above article is for general information on weight gain and fluid retention problems associated with birth control pills and should not be taken as medical advice. If it is so, please consult your doctor or physician for treatment purpose.

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Researcher Jennifer Frost, DrPH, with the Guttmacher Institute in New York, analyzed data from women ages 15 to 44 who were surveyed as part of the National Survey of Family Growth. Information collected in 1995 from 10,847 women was compared with data on 7,643 women in 2002.

The findings are published in the October issue of the American Journal of Public Health.

Women were asked whether they had received 13 sexual and reproductive health care services from a doctor or from other medical care providers in the year prior to the interviews. Services included birth control prescriptions and counseling, pregnancy tests, Pap tests, prenatal and postpartum care, and testing and treatment for sexually transmitted diseases (STDs).

The percentage of women who received contraceptive services increased from 36% in 1995 to 41% in 2002. Frost writes that the increase mainly occurred in adolescents, women older than 30, and women with household incomes greater than 150% of the federal poverty level.

In 2002, 74% of women interviewed said they got at least one sexual or reproductive health care service in the year before. That’s similar to results from 1995, when 72% of respondents said they received at least one sexual-care or reproductive-care service.

Frost writes that since the mid-1990s there have been changes on the birth control front, with more demand for contraceptive services and insurance more often covering the cost of birth control.

SOURCES: Frost, J. American Journal of Public Health, October 2008; vol 98, no10. News release, American Public Health Association.

©2008 WebMD, LLC. All Rights Reserved.

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Each five-year interval of oral contraceptive use cuts a woman’s ovarian cancer risk by up to 29%. The longer a woman uses the pill, the lower her risk of ovarian cancer, find Valerie Beral, MD, director of the Cancer Research Epidemiology Unit at Oxford University, England, and colleagues.

“We can say the longer women take it, the longer the protection, which lasts 30 years after they stop,” Beral tells WebMD. “This does outweigh any other cancer risk from taking the pill. So the net effect is to reduce cancer overall. Women on the pill do not need to worry they are putting themselves at long-term risk of cancer.”

It’s been known for a long time that oral contraceptives cut a woman’s lifetime risk of ovarian cancer. It’s also known that the drug increases a woman’s risk of breast and cervical cancer while she’s on the pill. Now Beral and colleagues have been able to put numbers on these risks.

“In breast and cervical cancer there is increased risk, but these effects disappear and are not persistent after a woman discontinues oral contraceptives,” Beral says. “Whereas ovarian cancer protection lasts for decades — into the ages when this cancer becomes more common for a woman.”
Pill’s Anticancer Effect ‘Definitive’

An astonishing amount of data went into the study. Beral and colleagues combined data from 45 high-quality studies that included detailed data on 23,257 women with ovarian cancer and on 87,303 women without ovarian cancer.

They calculate that over the 50 years oral contraceptives have been on the market, the drugs have prevented at least 200,000 ovarian cancers and prevented 100,000 deaths. Because use of the pill is increasing, they predict that the pill will prevent at least 30,000 cases of ovarian cancer each year for the next several decades.

It’s an “unequivocal protective effect,” says Eduardo Franco, DrPH, director of the division of cancer epidemiology at Montreal’s McGill University. Franco’s editorial accompanies the Beral paper in the Jan. 26 issue of The Lancet.

“This study decides once and for all there is a real protective effect against ovarian cancer that is strong and cuts across all demographic groups,” Franco tells WebMD.
Over-the-Counter Birth Control Pills?

Another editorial, by the editors of The Lancet, argues that the time has come for “more widespread over-the-counter access to an agent that can not only prevent cancers but also demonstrably save the lives of tens of thousands of women.”

Beral says the call for over-the-counter availability of oral contraceptives stems from the high rate of teen pregnancy in the U.K. She does not endorse taking birth control pills solely to prevent ovarian cancer.

“People should take the pill for other reasons than cancer prevention,” she says. “But there is a bonus when they do use the pill for these reasons: They will be at reduced risk of cancer.”

Franco, too, says it would be unwise for women to take birth control pills just for cancer prevention.

Franco opposes over-the-counter availability of oral contraceptives.

“There are harmful effects from oral contraceptives as well as good ones. It is a balancing act between risks and benefits,” he says. “That is why it is a prescription medication. Women who take oral contraceptives should be monitored, and there is advice that goes with prescribing them. It is not a simple matter, so a doctor has to be part of the equation.”

SOURCES: Beral, V. The Lancet, Jan. 26, 2008; vol 371: pp 303-314. Franco, E.L. and Duarte-Franco, E. The Lancet, Jan. 26, 2008; vol 371: pp 277-278. Editors, The Lancet, Jan. 26, 2008; vol 371: pp 278-279. Valerie Beral, MD, director, Cancer Research UK Epidemiology Unit, Oxford University, Oxford, England. Eduardo Franco, DrPH, professor and director, division of cancer epidemiology, McGill University, Montreal.

© 2008 WebMD Inc. All rights reserved.

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The impact that using the birth control pill has on future fertility has been debated for years. Some studies have shown women have difficulty getting pregnant once they stop oral contraceptives, while other research has found they have an easier time.

“Studies have been mixed,” says Maureen Cronin, MD, PhD, a researcher for the new study, presented at the 55th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists. “The majority of studies suggest there is a slight delay in return to fertility after using birth control pills,” she says, “and that within 6 to 12 months fertility is normalized.”

But her study found no such lag and no substantial differences in pregnancy rates between pill users and nonusers.  “We did the study to lay the question to rest,” says Cronin, the head of global medical affairs for women’s health care for Bayer Schering Pharma in Berlin. The pharmaceutical giant, which makes two types of birth control pills, Yasmin and Yaz, funded the study.

In the past, some experts have also suggested that after taking hormones such as the pill a woman shouldn’t or couldn’t get pregnant right away after stopping. A delay in trying to conceive, some say, allows the body to get back to normal. Cronin says her study also proves that notion incorrect. “Your body does not need to ‘recover’ from the pill,” she says.
The Study

Cronin’s team followed 2,064 women for two years; all were participating in the European Active Surveillance Study on Oral Contraceptives and had stopped taking birth control pills to become pregnant.

One cycle after stopping the pill, 21.2% of the women were pregnant, Cronin found. This is comparable to the naturally occurring pregnancy rate per cycle, which experts say is between 20% and 25%.

A year after stopping the oral contraceptives, 79.4% of the women were pregnant; again the rate corresponds with those reported in women planning a pregnancy who had not used the pill.

In the study, the median time to conception was three months after stopping the pill (half the women got pregnant earlier, half conceived later).

“The effect of age [on fertility] was not amplified by oral contraceptive use,” Cronin tells WebMD.

Nor did long-term use of the pill have a major impact on fertility, Cronin’s team found. While 79.3% of women on the pill less than two years became pregnant in the year after stopping it, 81% of women on the pill more than two years got pregnant in the first year after stopping it.
No Need to Wait

The new study seems to refute previous research that the pregnancy rate is lower than normal in the first few months after women stop the pill, says Richard Frieder, MD, attending physician at Santa Monica-UCLA and Orthopaedic Hospital in California and assistant clinical professor of obstetrics and gynecology at the University of California Los Angeles David Geffen School of Medicine. “This study suggests even in the initial couple of months [after stopping the pill], there is no difference in pregnancy rates [among past pill users and nonusers],” he says.

In the past, Frieder says, some doctors may have advised women to wait before trying to get pregnant for a number of reasons. That time lag, for instance, would allow the woman to ovulate and have a menstrual period, and the obstetrician could more easily gauge the delivery date.

“In these times, we have ultrasound [to date the beginning of the pregnancy],” he says. “So there’s really no reason to wait [a while after going off the pill to try to get pregnant].”

SOURCES: Maureen Cronin, MD, PhD, head of global medical affairs for women’s health care, Bayer Schering Pharma, Berlin, Germany. 55th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists, San Diego, May 5-9, 2007. Richard Frieder, MD, attending physician, Santa Monica-UCLA and Orthopaedic Hospital, Santa Monica, Calif.; assistant clinical professor of obstetrics and gynecology, UCLA David Geffen School of Medicine, Los Angeles.

© 2007 WebMD Inc. All rights reserved.

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