Oral Contraceptives and Neutropenia: A Population-Based Cohort Study
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Oral contraceptives (OCs) are one of the most commonly used classes of drugs worldwide. A case of neutropenia and associated infections in a young woman using OCs that settled after discontinuation and reappeared upon re-challenge, has led us to investigate a potential association between oral contraceptives and neutropenia.
To compare rates of neutropenia among women receiving OCs to a matched control group of women not exposed to the “pill”.
Patients and Methods
In this population-based cohort study we used a large computerized database of a health fund, comparing women prescribed OCs and a control group not using the pill. We selected a cohort of 51,394 OC users aged 16–40 years who purchased their first monthly pack of OCs between 2010 and 2018. Controls included all non-pregnant women aged 16–40 years for whom OC was not dispensed (n = 140,932). Neutrophil count before and during OC were compared.
Prior to OC exposure, 1.3% of the women were neutropenic, compared to 1.6% after exposure to OC (RR 1.22; 95% CI 1.1–1.35). Mean neutrophil count changed from 3.87 × 103 to 3.82 × 103 mm3 (p < 0.001). In the control group (n = 140,932) no difference was seen in the proportion of neutropenic women between the first complete blood count (1.7%) compared to the second (1.8%) count (p = 0.305). In all severity levels, neutropenia was significantly more common in the OC group. The relative risk was higher for severe (RR 1.63) than for mild neutropenia (RR 1.13) (p = 0.034 for trend).
There is a significant increase in the proportion of neutropenic women after initiating OCs. More research is needed in order to evaluate the effect of neutropenia in this group of women.
YR conceptualized the research, conducted the research and wrote the first draft of the paper. GC participated in overseeing the research, AR and HSR participated in data analysis, VS participated in critical appraisal, GK oversaw all stages of the research
Compliance with Ethical Standards
The study was approved by Assuta Hospital Research Ethics Committee, Tel Aviv.
No sources of funding were used to conduct this research.
Conflict of interest
Yael Rosenthal, Gabi Chodick, Adam Rosenthal,Varda Shalev, Hila Shalev Ram and Gideon Koren have no potential conflicts of interest to report.
Anonymous data will be shared upon reasonable request from a qualified investigator, pending approval from Maccabi Health Services and the Assuta Research Ethics Committee.
As this study is based on anonymous data, the ethics committee waived informed consent.
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