Clinical GuidelinesContraceptive considerations in obese women
Section snippets
Background
The rate of obesity worldwide is at epidemic proportions with 1 billion and 300 million adults meeting the criteria for overweight and obese, respectively [1]. Currently, the obesity rate in Europe and the United States is approximately 30% and rising [1], [2]. The prevalence of unintended pregnancy rivals that of obesity. Forty-nine percent of all pregnancies per year in the United States are unintended (3.1 million), and roughly half a million of these are related to oral contraceptive
1. Are obese women at increased risk for pregnancy as compared to their normal BMI counterparts?
Abnormalities in metabolism and extremes in body weight can adversely affect the reproductive system. Obesity is a known risk factor for reduced fertility because of menstrual abnormalities, anovulation, polycystic ovarian disease and insulin resistance [40], [41]. However, the majority of women, both thin and obese, ovulate on a regular basis and are at risk for pregnancy [40].
The rate of sexual activity and use of contraception also affect the risk of pregnancy. Many assume that obese women
Conclusions and recommendations
The following recommendation is based on good and consistent scientific evidence (Level A):
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Use of contraception prevents more pregnancies in women regardless of BMI than nonuse of contraception.
The following recommendation is based on limited or inconsistent scientific evidence (Level B):
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Obese women, both adults and adolescents, appear to be at increased risk for pregnancy as compared to their normal BMI counterparts due to higher rates of contraceptive nonuse.
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Effectiveness of oral
Important questions to be answered
Although contraception has been scrutinized since its inception, there are many unanswered questions in regard to obesity and contraception. Previous contraceptive studies have deliberately excluded obese women. This practice is no longer conscionable, as obese individuals make up a significant portion of our population. Future contraceptive studies, in particular efficacy studies, must be a better reflection of our current population.
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2016, ContraceptionCitation Excerpt :The early postoperative period presents unique risks because of continued morbid obesity and associated comorbidities as well as new nutritional and metabolic changes that raise concerns for maternal morbidity and fetal development [4,8]. Further compounding this problem is that unintended pregnancy risk may increase after bariatric surgery due to restoration of normal ovulation and enhanced fertility, and obese women are less likely to use contraception compared to women with normal BMI [6,7]. Oral contraceptives are commonly used but are suboptimal as they may fail more frequently after malabsorptive bariatric procedures [7,8,9,10].
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