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Study of developmental abnormalities and deaths after human zygote exposure.

Experimental studies indicated that the mouse zygote is susceptible to experimental induction of developmental anomalies including defects (mainly hydrops), growth retardation and mid- and late-gestational death with certain mutagenic agents. The material of the Hungarian Optimal Family Planning Program is appropriate to check this finding in a human material because participants were asked to visit the coworkers of the Program immediately after the first missed menstrual period and data concerning potentially hazardous environmental factors were obtained. At that time participants were immediately after the pre- and implantation period and they had no knowledge about their pregnancy outcomes. In 1994 the data of their pregnancy outcomes are available. Of 5453 evaluated pregnancies, 1167 were selected for this study because they visited the coworkers of the Program within 28 days post conception. Of 1167 pregnancies, 316 (27%) were exposed to some environmental factors, mainly drugs. A mild intrauterine growth retardation was found in the exposed group. The rate of congenital abnormalities and infant death did not differ between the exposed and unexposed groups. The detailed analysis of different congenital abnormality groups also did not show any significant difference between the exposed and unexposed groups. These negative results are explained by the fact that the observed environmental factors are not mutagenic, at least not in the dosage which was used, or the human zygote is not sensitive to mutagenic agents in the post-conceptional days.

Abnormalities, Drug-Induced↗

Barrier contraceptive practice and male infertility as related factors to breast cancer in married women.

A case-control study was conducted in order to test the hypothesis that a reduced exposure to human seminal factors in the early reproductive life of women is a risk factor in breast cancer. The relative risk of exposure to the hypothetical semen-factor deficiency is 4.7 times greater for breast-cancer patients than for the controls. When the contraceptive methods alone are taken into account, the relative risk increases up to 5.3. About 16 percent of the women using barrier methods (condom, and other) and 3.4 percent of women using non-barrier contraceptive methods (diaphragm, pill, IUDs, rhythm, tubal ligation, and other) would develop breast cancer. The risk of developing breast cancer within the same population in the U.S. is 5 times greater in women who use barrier methods than in women who use non-barrier contraceptive methods. The reduction in the incidence of breast cancer by eliminating the barrier contraceptive techniques would be not less than 50 percent in married women in the entire population. The possibility of preventive measures within an adequate family planning program is emphasized.

Adult↗

Violence against women associated with arrests for sex trade but not drug charges.

The current study was designed to examine associations between gender-based violence and arrests due to sex trade or drug-related charges among a statewide sample of incarcerated women in Rhode Island. Incarcerated women were asked to participate in brief pre- and posttest surveys of their experiences of violence, sexual risk and substance use behaviors, as part of a study on the effectiveness of a family planning program in a state correctional facility; data from pretest surveys (N=447) were used for current analyses. Logistic regression analyses adjusted for demographics were used to assess significant associations between gender-based violence variables (i.e., adolescent intimate partner violence (IPV), adult IPV, childhood sexual assault (SA), adolescent SA, and adult SA) and arrests due to sex trade or drug-related charges. Significant relationships were observed between arrests for sex trade and adult SA (OR=2.1, 95%CI=1.2-3.6), adolescent IPV (OR=2.5, 95%CI=1.5-4.1), and adult IPV (OR=1.7, 95%CI=1.1-2.6); no significant associations were observed for drug-related charges. Findings from the current study demonstrate that experiences of gender-based violence are associated with arrests for sex trade but not drug-related charges. Interventions for incarcerated women are needed to consider and address history of victimization from gender-based violence and its relation to women's historic and future sex trade involvement.

Adolescent↗

The Pap smear: take two.

The results of two "pancervical" Pap smears taken sequentially at the same sitting were evaluated on 2,823 patients in a Family Planning Program as part of a national sample to evaluate abnormal cervical cytology and method of contraception. It was found that obtaining two smears increased the detection of abnormal cytology in these patients by 86 per cent. Every group participating in this national study found a large increase in sensitivity, though not to the degree noted in our population. The importance of this result for case-finding and subsequent rescreening procedures is evident, and emphasizes that the single "pancervical" Pap smear is an insensitive procedure for detecting abnormal cervical cytology.

Adult↗

Acceptability and performance of the levonorgestrel-releasing intrauterine system (Mirena) in Campinas, Brazil.

The objectives of this study were to evaluate the acceptability of the LNG-IUS Mirena(R), when offered as an additional option in a free choice context, and to evaluate the possibility of using this method in women with increased bleeding wanting an IUD and in copper IUD users requesting removal of the device for bleeding problems. A total of 256 women chose Mirena and were accepted into the study during the enrollment period. This represents 23.3% of all new acceptors of contraceptive methods in the clinic during the same period. Discontinuations were fairly evenly distributed among expulsion, bleeding changes, pain, and personal reasons. Bleeding changes were decreased bleeding, oligomenorrhea or amenorrhea. Comparing the performance in the group of women who chose the LNG-IUS as a first option with those having heavy bleeding, the only difference found was a higher expulsion rate in the group with bleeding problems. No pregnancies occurred and continuation rate was slightly over 75% in the total sample and in both groups. The characteristics of the LNG-IUS (Mirena) allow predicting that this method can effectively contribute to the increase in contraceptive options when introduced to family planning programs in Brazil.

Brazil↗

Multinational comparative clinical trial of long-acting injectable contraceptives: norethisterone enanthate given in two dosage regimens and depot-medroxyprogesterone acetate. Final report.

Final results are presented from a two-year WHO multinational comparative trial of three regimens: depot-medroxyprogesterone acetate (DMPA) given at 90-day intervals, norethisterone enanthate (NET-EN) given at 60-day intervals for the entire study period (NET-EN (60-day)), and NET-EN given at 60-day intervals for six months and thereafter at 84-day intervals (NET-EN (84-day)). 1587 DMPA subjects were observed for 20,550 woman-months, 789 NET-EN (60-day) subjects were observed for 10,361 woman-months, and 796 NET-EN (84-day) subjects were observed for 10,331 woman-months. This clinical trial represents the largest clinical trial undertaken on injectable contraceptives. After two years, the pregnancy rate with NET-EN (84-day) was 1.4 (+/- 0.6 S.E.) per 100 women, as compared with the two-year rates of 0.4 (+/- 0.3 S.E.) per 100 women observed with DMPA and 0.4 (+/- 0.2 S.E.) with NET-EN (60-day). Both discontinuation rates for amenorrhea and the prevalence of amenorrhea lasting more than 90 days were significantly higher with DMPA than with either NET-EN regimen. Terminations for bleeding problems were similar with the three treatments, despite a better cyclic pattern for the first six months with the NET-EN regimens. The three treatments were comparable with respect to discontinuation rates for other medical or personal reasons, and for all reasons combined. For family planning programs, NET-EN (60-day) has the advantage of low pregnancy rates compared to NET-EN (84-day), and a schedule of administration that does not change. Both NET-EN regimens produce less amenorrhea than DMPA. However, the NET-EN (60-day) regimen has the logistic and economic disadvantage of requiring more frequent injections. All three injectable regimens compare favourably with oral contraceptives in terms of pregnancy and total continuation rates observed in clinical trial settings.

Adult↗

The evaluation of determinants of early postpartum low mood: the importance of parity and inter-pregnancy interval.

OBJECTIVES: The aim of this study is to determine the extent of early postpartum low mood and possible relevant variables in our population. STUDY DESIGN: Depressive symptoms were examined in a sample of 85 women in the first week of postpartum period using Beck Depression Inventory (BDI). The relevant sociodemographic variables were tested by multiple logistic regression analysis. RESULTS: The rate of postpartum low mood (BDI score >10) was found 35.2%. High parity, long marriage period and low education level were all significantly associated with low mood in the postpartum first week. When logistic regression analysis was used to eliminate confounding effect of the parameters; grandmultiparity, short inter-pregnancy interval and low educational level were found to have important effect on postpartum low mood. CONCLUSION: Pregnant women with risk factors for postpartum low mood such as grandmultiparity, short inter-pregnancy interval and low educational level should be identified early during antenatal period. Educational and social support should be given to those in such a risk. We believe that effective family planning programs and improvement of women's educational level are important preventive factors for postpartum low mood and subsequently developing depression.

Adult↗

Maternal influence on the decision to adopt Norplant.

PURPOSE: To examine maternal influence and related variables on adolescents' decision to adopt Norplant. METHODS: A prospective study of 121 adolescent females who received Norplant through a hospital-based outpatient adolescent gynecology service. Each patient completed self-report questionnaires about her decision process, sexual behaviors and standardized measures of depression and anxiety at their insertion appointment or first-follow-up appointment. RESULTS: Almost 40% of the sample reported that their mother significantly influenced their decision to use Norplant and 61% of all patients stated that they had informed their mother of their choice of this contraceptive method. Through logistic regression, six variables were found to be significantly associated with mother as the most important decision source. These included: obtaining information about Norplant from a parent, maintaining the same sexual partner, past pill use, and not knowing other adolescents who boast about using the Norplant system. CONCLUSION: These data suggest that when parental consent is not required, adolescent females disclose sensitive information regarding choice-making to their mothers when they decided to adopt Norplant.

Adolescent↗

A hazard logit model analysis of covariates of childhood mortality in Matlab, Bangladesh.

In a prospective study in Matlab, a rural area in Bangladesh, the relationship between a variety of covariates and childhood mortality was examined. Economic status of household, education of mother, sex of the children, health intervention programmes, age of mother, and live birth order of the children were identified as having a statistically significant impact on child survival when the effect of age was controlled. The effects of sex of the children, health programmes, age of mother, and birth order were found to be dependent on the age of the children, but the effect of mother's education was dependent on sex of the children.

Adolescent↗

Sterilisation: characteristics of vasectomy acceptors in Delhi.

The place of vasectomy within the sterilisation programme in Delhi over the period 1983-88 is reviewed and data on vasectomy acceptance and characteristics of acceptors are analysed. Findings suggest a need to improve the strategy for the promotion of vasectomy within the metropolis.

Adolescent↗

Current status of injectable hormonal contraception, with special reference to the monthly method.

Injectable contraceptives are a valid option in every family planning program. Contraceptives which are administered every 2 or 3 months, containing only progestogen agents (DepoProvera, Noristerat) have proven efficacious and do not show long-term safety problems. They differ from other contraceptives in their long lasting action and by not presenting the contraindications of the estrogens. Their most prominent side-effect is the irregularity of cyclic bleeding. Although bleeding irregularities are not life threatening, many users stop the treatment for that reason. Monthly contraceptives comprising progestogens and estrogens, maintain or improve the high efficacy of the earlier forms and have the added benefit of allowing bleeding to resemble the physiologic one. This increases acceptability and the continuation rate. There is no long-term inconvenience. At this point, the greatest experience is with the formulation known as Topasel or Perlutal. Other formulations (Cyclofem, Mesigyna) are beginning to be commercialized and their characteristics must still be confirmed through daily use. Indications, contraindications, precautions and warnings for the use of monthly injectable contraceptives are basically identical to those of the combined oral contraceptives, as are the side-effects. Efficacy, though, proves to be superior, which can be correlated to a simpler method of use and less risk of error when using it. Main motivation factors are: efficacy, simplicity in usage, reversibility and confidentiality.

Contraceptive Agents, Female↗