Long-term use of oral contraceptives increases the risk of miscarriage

García-Enguidanos, A.; Martı́nez, David; Calle, Marı́a Elisa; Luna, Sonsoles; Bernabe, Javier; Domínguez-Rojas, V.

doi:10.1016/j.fertnstert.2004.11.085

Cited by 17 publications

(14 citation statements)

References 11 publications

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“…Five of these pregnancies involved maternal MCMs of the uterus, which is an established risk factor for miscarriage in the general population. 17 Our observation that women with undetermined or unclassified epilepsy were at increased risk of pregnancy loss has no clear explanation, although the possibility exists that inability to classify the epilepsy reflected a poorer quality of care in general that might affect pregnancy outcomes. A previous study of 1,587 pregnancies among 582 women with epilepsy evaluated by telephone survey and review of medical records in the United States reported higher rates of spontaneous abortions among women with localization-related epilepsy, 18 a finding that we could not confirm.…”

Section: Methodsmentioning

confidence: 73%

Antiepileptic drugs and intrauterine death

et al. 2015

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Objective: To compare the risk of spontaneous abortions and stillbirth associated with maternal use of different antiepileptic drugs (AEDs). Methods:The EURAP registry is an observational international cohort study primarily designed to determine the risk of major congenital malformations (MCMs) after prenatal AED exposure. Using EURAP data, we prospectively monitored pregnancies exposed to the 6 most common AED monotherapies and to polytherapy. Intrauterine death (spontaneous abortion and stillbirth combined) was the primary endpoint.Results: Of 7,055 pregnancies exposed to monotherapy with lamotrigine (n 5 1,910), carbamazepine (n 5 1,713), valproic acid (n 5 1,171), levetiracetam (n 5 324), oxcarbazepine (n 5 262), or phenobarbital (n 5 260), and to polytherapy (n 5 1,415), 632 ended in intrauterine deaths (592 spontaneous abortions and 40 stillbirths). Rates of intrauterine death were similar across the different monotherapies (8.2%; 95% confidence interval [CI] 7.5%-8.9%), higher with polytherapy (12.1%; 95% CI 10.5%-13.9%), but showed no relationship with AED dose in monotherapy at conception. Multivariable analysis including 11 covariates in addition to the different AED exposures showed that the risk was greater with polytherapy vs monotherapy (risk ratio [RR] 1.38; 95% CI 1.14-1.66), parental history of MCMs (RR 1.92; 1.20-3.07), maternal age (RR 1.06; 1.04-1.07), and number of previous intrauterine deaths (RR 1.09; 1.00-1.19). The risk was greater with early enrollment and decreased with later gestational week at enrollment (RR 0.84; 0.82-0.86). Conclusions:The most important risk factors for intrauterine death in pregnancies of women with epilepsy include maternal exposure to AED polytherapy and the presence of MCMs in at least one of the parents. Neurology ® 2015;85:580-588 GLOSSARY AED 5 antiepileptic drug; CBZ 5 carbamazepine; CI 5 confidence interval; EURAP 5 International Registry of Antiepileptic Drugs and Pregnancy; LTG 5 lamotrigine; MCM 5 major congenital malformation; RR 5 risk ratio; VPA 5 valproic acid.Ever since the first report of major congenital malformations (MCMs) in the offspring of women taking antiepileptic drugs (AEDs) in pregnancy, 1 research has been dedicated to the assessment of teratogenic risks associated with AEDs. Concerns focused primarily on the risk of MCMs 2,3 and, more recently, on impaired cognitive and behavioral development after prenatal AED exposure. 4,5 Registries set up in the late 1990s have enrolled thousands of pregnancies and enabled comparisons of MCM rates between different AEDs at different dose levels. [6][7][8][9] Other observational studies have revealed differences in postnatal cognitive development.5 For both *These authors contributed equally to this work.

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Section: Methodsmentioning

confidence: 73%

Antiepileptic drugs and intrauterine death

et al. 2015

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“…Although the relationship between antidepressant use during pregnancy and the risk of adverse perinatal events has been investigated widely, very few studies have attempted to evaluate the impact of antidepressant use during gestation on the risk of spontaneous abortion. Spontaneous abortion is the most common pregnancy outcome affecting up to 15% of recognized pregnancies [12,13]. Spontaneous abortion is defined as the spontaneous loss of a fetus weighing less than 500 grams before 20 weeks gestation counted from the first day of the last menstrual period [14].…”

Section: Introductionmentioning

confidence: 99%

“…The term "spontaneous abortion" is often used synonymously with "miscarriage", "spontaneous pregnancy loss", "early pregnancy failure" or "spontaneous termination of pregnancy". Two etiologies for spontaneous abortions include congenital uterine malformations and parental balanced chromosomal rearrangements, such a trisomy [12].…”

Section: Introductionmentioning

confidence: 99%

Gestational Exposure to Antidepressants and the Risk of Spontaneous Abortion: A Review

Broy

Bérard

2010

CDD

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“…On the other hand a Spanish retrospective [59] case-control study (N = 300) did actually identify taking oral contraceptives for more than 2 years before pregnancy as a risk factor of miscarriage (OR: 2.56, 95% CI: 1.16-5.67); the statistical methods included a step-wise regression, a controverted statistical procedure known for its risk of spurious associations. The authors hypothesized that the endometrial atrophy associated to taking (modern) low-dose oral contraceptives for extended periods of time could cause miscarriage or that acquired activated protein C resistance could be the link between oral contraceptives use and miscarriage.…”

Section: Pregnancy Complications and Outcomesmentioning

confidence: 99%

Contraceptive Methods and the Subsequent Search for a Pregnancy

Balbás¹,

Balbás²,

Rivera³

2018

Family Planning

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Many women are concerned about their future fertility, about pregnancy complications and about the health of their future child when choosing a contraceptive method and sometimes women want to interrupt the contraception -maybe after years of use -in order to attempt pregnancy. Return to fertility, has been thoroughly analyzed in the literature. This chapter provides evidence-based information and discusses the potential doubts of women. Return to fertility has been consistently found to be sure, albeit sometimes slightly slow in the short term: pregnancy rates after 1 year of contraceptive interruption are 79-95% for oral contraceptives, 79-96% for levonorgestrel IUD, 71-91% for copper IUDs, around 80% for implants and 75-80% for injectable contraceptives. About 50% women are pregnant 3-6 months after contraceptive discontinuation; around 90-95% of women had achieved pregnancy 2 years after stopping their contraceptive method.Some studies have found associated risks of fetal malformations when women take oral contraceptive pills after conception (though other studies disputed these results). However the offspring of women who used oral contraceptives before conception does not show an increased risk of fetal death, miscarriage, gestational hypertension, major newborn structural defects or hypospadias. The effect on birth weight seems small and inconclusive.

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Long-term use of oral contraceptives increases the risk of miscarriage

Cited by 17 publications

References 11 publications

Antiepileptic drugs and intrauterine death

Antiepileptic drugs and intrauterine death

Gestational Exposure to Antidepressants and the Risk of Spontaneous Abortion: A Review

Contraceptive Methods and the Subsequent Search for a Pregnancy

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