In Utero Exposure to Hormonal Contraception and Mortality in Offspring with and without Cancer: A Nationwide Cohort Study

Abstract

Approximately 400 million women of reproductive age use hormonal contraceptives worldwide. Eventually, pregnancy sometimes occurs due to irregular use. Use in early pregnancy is found to be associated with child morbidities including cancer, the main reason for disease-related death in children. Here, we add the missing piece about in utero exposure to hormonal contraception and mortality in offspring, including assessments of prognosis in children with cancer. In utero exposure to hormonal contraception may be associated with death since we found a hazard ratio (HR) of 1.22 (95% confidence interval (CI) 1.01–1.48) compared to children of mothers with previous use. The HRs were 1.22 (95% CI 0.99–1.13) for oral combined products and 2.92 (95% CI 1.21–7.04) for non-oral progestin-only products. A poorer prognosis was also found in exposed children with leukemia (3.62 (95% CI: 1.33–9.87)). If causal, hormonal contraception in pregnancy seems detrimental for offspring health and a marker of poorer prognosis in children with leukemia.

Molecular Assessment of Proadipogenic Effects for Common-Use Contraceptives and Their Mixtures

“…Other studies have reported positive relationships between progestin-only contraceptive use in the year prior to pregnancy and increased offspring wheezing at age 6 to 8 months ( 37 ), as well as increased childhood attention-deficit/hyperactivity disorder (ADHD) incidence (highest with greatest recency to time of conception and for progestin products, specifically) ( 38 ). An increased risk for specific cancers (eg, nonlymphoid leukemia) ( 39 ) has also been observed, along with research suggesting poorer prognosis associated with these cancers and higher mortality risk ( 40 ). Many of these outcomes have been demonstrated only in single cohorts, often with other studies reporting negative outcomes; thus, these preliminary developmental effects should be interpreted with caution (though they warrant further research).…”