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Adolescents Who Are Obese

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Contraception for Adolescent and Young Adult Women

Abstract

Recent estimates place the prevalence of obesity in adolescent women at approximately 18 %. Thus, providing contraception for adolescents and young women who are obese represents an increasingly common clinical scenario. Unfortunately, there is little research regarding hormonal contraceptive efficacy in obese adult women and almost no research which includes adolescents. While all contraceptives appear to be safe in obese teens, studies of hormonal contraceptives in adults suggest efficacy may be slightly impaired with increasing weight for the combined oral contraceptive pill and the transdermal contraceptive patch. Most contraceptives are not associated with weight gain; however, there may be a subset of adolescents who are susceptible to weight gain with depot medroxyprogesterone acetate (DMPA).

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References

  1. Centers for Disease Control. Obesity trends. 2010. Available from: http://www.cdc.gov/obesity/data/trends.html

  2. National Institutes of Health (NIH), National Heart, Lung, and Blood Institute’s (NHLBI), North American Association for the Study of Obesity (NAASO). The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Rockville: National Institutes of Health; 2000.

    Google Scholar 

  3. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.

    Google Scholar 

  4. Razak F, Anand SS, Shannon H, Vuksan V, Davis B, Jacobs R, et al. Defining obesity cut points in a multiethnic population. Circulation. 2007;115(16):2111–8.

    Article  PubMed  Google Scholar 

  5. Gray LJ, Yates T, Davies MJ, Brady E, Webb DR, Sattar N, et al. Defining obesity cut-off points for migrant South Asians. PLoS One. 2011;6(10):e26464.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.

    Article  Google Scholar 

  7. Deurenberg P, Weststrate JA, Seidell JC. Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. Br J Nutr. 1991;65(2):105–14.

    Article  CAS  PubMed  Google Scholar 

  8. Ogden C, Carroll M. Prevalence of obesity among children and adolescents: United States, trends 1963–1965 through 2007–2008. Center for Disease Control. 2010. Available from: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Cited 19 Apr 2011.

  9. Madsen KA, Weedn AE, Crawford PB. Disparities in peaks, plateaus, and declines in prevalence of high BMI among adolescents. Pediatrics. 2010;126(3):434–42.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Haas JS, Lee LB, Kaplan CP, Sonneborn D, Phillips KA, Liang SY. The association of race, socioeconomic status, and health insurance status with the prevalence of overweight among children and adolescents. Am J Public Health. 2003;93(12):2105–10.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA. 2012;307(5):483–90.

    Article  PubMed  Google Scholar 

  12. Gordon CM. Menstrual disorders in adolescents. Excess androgens and the polycystic ovary syndrome. Pediatr Clin North Am. 1999;46(3):519–43.

    Article  CAS  PubMed  Google Scholar 

  13. Pelusi C, Pasquali R. Polycystic ovary syndrome in adolescents: pathophysiology and treatment implications. Treat Endocrinol. 2003;2(4):215–30.

    Article  PubMed  Google Scholar 

  14. Eisenberg ME, Neumark-Sztainer D, Lust KD. Weight-related issues and high-risk sexual behaviors among college students. J Am Coll Health. 2005;54(2):95–101.

    Article  PubMed  Google Scholar 

  15. Halpern C, King RB, Oslak SG, Udry JR. Body mass index, dieting, romance, and sexual activity in adolescent girls: relationships over time. J Res Adolesc. 2005;15(4):535–59.

    Article  Google Scholar 

  16. Akers AY, Lynch CP, Gold MA, Chang JC, Doswell W, Wiesenfeld HC, et al. Exploring the relationship among weight, race, and sexual behaviors among girls. Pediatrics. 2009;124(5):e913–20.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Higginbotham S. Contraceptive considerations in obese women: release date 1 September 2009, SFP Guideline 20091. Contraception. 2009;80(6):583–90.

    Article  PubMed  Google Scholar 

  18. Stuart GS, Grimes DA. Social desirability bias in family planning studies: a neglected problem. Contraception. 2009;80(2):108–12.

    Article  PubMed  Google Scholar 

  19. Westhoff CL, Torgal AT, Mayeda ER, Shimomi N, Stanczyk FZ, Pike MC. Predictors of noncompliance in an oral contraceptive clinical trial. Contraception. 2012;85(5):465–9.

    Article  PubMed  Google Scholar 

  20. Grimes DA, Shields WC. Family planning for obese women: challenges and opportunities. Contraception. 2005;72(1):1–4.

    Article  PubMed  Google Scholar 

  21. Brunner Huber LR, Hogue CJ, Stein AD, Drews C, Zieman M. Body mass index and risk for oral contraceptive failure: a case-cohort study in South Carolina. Ann Epidemiol. 2006;16(8):637–43.

    Article  PubMed  Google Scholar 

  22. Brunner Huber LR, Toth JL. Obesity and oral contraceptive failure: findings from the 2002 National Survey of Family Growth. Am J Epidemiol. 2007;166(11):1306–11.

    Article  PubMed  Google Scholar 

  23. Dinger J, Minh TD, Buttmann N, Bardenheuer K. Effectiveness of oral contraceptive pills in a large U.S. cohort comparing progestogen and regimen. Obstet Gynecol. 2011;117(1):33–40.

    Article  CAS  PubMed  Google Scholar 

  24. Dinger JC, Cronin M, Mohner S, Schellschmidt I, Minh TD, Westhoff C. Oral contraceptive effectiveness according to body mass index, weight, age, and other factors. Am J Obstet Gynecol. 2009;201(3):263.e1–9.

    Google Scholar 

  25. Holt VL, Cushing-Haugen KL, Daling JR. Body weight and risk of oral contraceptive failure. Obstet Gynecol. 2002;99(5 Pt 1):820–7.

    Article  PubMed  Google Scholar 

  26. Holt VL, Scholes D, Wicklund KG, Cushing-Haugen KL, Daling JR. Body mass index, weight, and oral contraceptive failure risk. Obstet Gynecol. 2005;105(1):46–52.

    Article  PubMed  Google Scholar 

  27. Kaneshiro B, Edelman A, Carlson N, Nichols M, Jensen J. The relationship between body mass index and unintended pregnancy: results from the 2002 National Survey of Family Growth. Contraception. 2008;77(4):234–8.

    Article  PubMed  Google Scholar 

  28. Vessey M. Oral contraceptive failures and body weight: findings in a large cohort study. J Fam Plann Reprod Health Care. 2001;27(2):90–1.

    Article  CAS  PubMed  Google Scholar 

  29. Burkman RT, Fisher AC, Wan GJ, Barnowski CE, LaGuardia KD. Association between efficacy and body weight or body mass index for two low-dose oral contraceptives. Contraception. 2009;79(6):424–7.

    Article  CAS  PubMed  Google Scholar 

  30. Westhoff CL, Hait HI, Reape KZ. Body weight does not impact pregnancy rates during use of a low-dose extended-regimen 91-day oral contraceptive. Contraception. 2012;85(3):235–9.

    Article  CAS  PubMed  Google Scholar 

  31. Edelman AB, Cherala G, Stanczyk FZ. Metabolism and pharmacokinetics of contraceptive steroids in obese women: a review. Contraception. 2010;82(4):314–23.

    Article  CAS  PubMed  Google Scholar 

  32. Fishman J, Boyar RM, Hellman L. Influence of body weight on estradiol metabolism in young women. J Clin Endocrinol Metab. 1975;41(5):989–91.

    Article  CAS  PubMed  Google Scholar 

  33. Stadel BV, Sternthal PM, Schlesselman JJ, Douglas MB, Hall WD, Kaul L, et al. Variation of ethinylestradiol blood levels among healthy women using oral contraceptives. Fertil Steril. 1980;33(3):257–60.

    CAS  PubMed  Google Scholar 

  34. Speerhas R. Drug metabolism in malnutrition and obesity: clinical concerns. Cleve Clin J Med. 1995;62(1):73–5.

    Article  CAS  PubMed  Google Scholar 

  35. Ravussin E, Burnand B, Schutz Y, Jequier E. Twenty-four-hour energy expenditure and resting metabolic rate in obese, moderately obese, and control subjects. Am J Clin Nutr. 1982;35(3):566–73.

    CAS  PubMed  Google Scholar 

  36. Segall-Gutierrez P, Taylor D, Liu X, Stanzcyk F, Azen S, Mishell Jr DR. Follicular development and ovulation in extremely obese women receiving depo-medroxyprogesterone acetate subcutaneously. Contraception. 2010;81(6):487–95.

    Article  CAS  PubMed  Google Scholar 

  37. Edelman AB, Carlson NE, Cherala G, Munar MY, Stouffer RL, Cameron JL, et al. Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity. Contraception. 2009;80(2):119–27.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Gilliam MWS, Chan LN, Mistretta E, Kantor A, Neustadt A. Pharmacokinetics of the etonorgestrel contraceptive implant in obese women (abstract). Contraception. 2011;84(3):305–6.

    Article  Google Scholar 

  39. Westhoff CL, Torgal AH, Mayeda ER, Pike MC, Stanczyk FZ. Pharmacokinetics of a combined oral contraceptive in obese and normal-weight women. Contraception. 2010;81(6):474–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Edelman AB, Cherala G, Murnarb MY, Dubois B, McInnis M, Stanczyk FZ, et al. Prolonged monitoring of ethinyl estradiol and levonorgestrel levels confirms an altered pharmacokinetic profile in obese oral contraceptives users. Contraception. 2013;87(2):220–6. Epub 2012 Nov 12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011;84(4):363–7.

    Article  CAS  PubMed  Google Scholar 

  42. Ortho Evra Patch Package Label. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021180s026lbl.pdf. Cited 21 Apr 2011.

  43. Zieman M, Guillebaud J, Weisberg E, Shangold GA, Fisher AC, Creasy GW. Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data. Fertil Steril. 2002;77(2 Suppl 2):S13–8.

    Article  PubMed  Google Scholar 

  44. Mornar S, Chan LN, Mistretta S, Neustadt A, Martins S, Gilliam M. Pharmacokinetics of the etonogestrel contraceptive implant in obese women [Comparative Study Research Support, Non-U.S. Gov’t Validation Studies]. Am J Obstet Gynecol. 2012;207(2):110.e1–6.

    CAS  Google Scholar 

  45. Sivin I, Wan L, Ranta S, Alvarez F, Brache V, Mishell Jr DR, et al. Levonorgestrel concentrations during 7 years of continuous use of Jadelle contraceptive implants. Contraception. 2001;64(1):43–9.

    Article  CAS  PubMed  Google Scholar 

  46. Sivin I. Contraception with NORPLANT implants. Hum Reprod. 1994;9(10):1818–26.

    CAS  PubMed  Google Scholar 

  47. Centers for Disease Control. Medical eligibility criteria for contraceptive use. CDC. 2010. Cited 2 Jan 2012.

    Google Scholar 

  48. Lensen RP, Rosendaal FR, Koster T, Allaart CF, de Ronde H, Vandenbroucke JP, et al. Apparent different thrombotic tendency in patients with factor V Leiden and protein C deficiency due to selection of patients. Blood. 1996;88(11):4205–8.

    CAS  PubMed  Google Scholar 

  49. Stein PD, Kayali F, Olson RE. Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr. 2004;145(4):563–5.

    Article  PubMed  Google Scholar 

  50. Heinemann LA, Dinger JC. Range of published estimates of venous thromboembolism incidence in young women. Contraception. 2007;75(5):328–36.

    Article  PubMed  Google Scholar 

  51. Abdollahi M, Cushman M, Rosendaal FR. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost. 2003;89(3):493–8.

    CAS  PubMed  Google Scholar 

  52. Nightingale AL, Lawrenson RA, Simpson EL, Williams TJ, MacRae KD, Farmer RD. The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives. Eur J Contracept Reprod Health Care. 2000;5(4):265–74.

    Article  CAS  PubMed  Google Scholar 

  53. Larsen TB, Sorensen HT, Gislum M, Johnsen SP. Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res. 2007;120(4):505–9.

    Article  CAS  PubMed  Google Scholar 

  54. Medical Eligibility Criteria for Contraceptive Use. http://www.who.int/reproductive-health/publications/mec/. Cited 25 Mar 2012.

  55. Farr S, Folger SG, Paulen M, Tepper N, Whiteman M, Zapata L, et al. U S. medical eligibility criteria for contraceptive use, 2010: adapted from the World Health Organization medical eligibility criteria for contraceptive use, 4th edition. MMWR Recomm Rep. 2010;59:1–86.

    Google Scholar 

  56. Bonny AE, Secic M, Cromer B. Early weight gain related to later weight gain in adolescents on depot medroxyprogesterone acetate. Obstet Gynecol. 2011;117(4):793–7.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Emans SJ, Grace E, Woods ER, Smith DE, Klein K, Merola J. Adolescents’ compliance with the use of oral contraceptives. JAMA. 1987;257(24):3377–81.

    Article  CAS  PubMed  Google Scholar 

  58. Reubinoff BE, Grubstein A, Meirow D, Berry E, Schenker JG, Brzezinski A. Effects of low-dose estrogen oral contraceptives on weight, body composition, and fat distribution in young women. Fertil Steril. 1995;63(3):516–21.

    CAS  PubMed  Google Scholar 

  59. Lloyd T, Lin HM, Matthews AE, Bentley CM, Legro RS. Oral contraceptive use by teenage women does not affect body composition. Obstet Gynecol. 2002;100(2):235–9.

    Article  CAS  PubMed  Google Scholar 

  60. Tuchman LK, Huppert JS, Huang B, Slap GB. Adolescent use of the monthly contraceptive injection. J Pediatr Adolesc Gynecol. 2005;18(4):255–60.

    Article  PubMed  Google Scholar 

  61. Tankeyoon M, Dusitsin N, Poshyachinda V, Larsson-Cohn U. A study of glucose tolerance, serum transaminase and lipids in women using depot-medroxyprogesterone acetate and a combination-type oral contraceptive. Contraception. 1976;14(2):199–214.

    Article  CAS  PubMed  Google Scholar 

  62. Bonny AE, Secic M, Cromer BA. A longitudinal comparison of body composition changes in adolescent girls receiving hormonal contraception. J Adolesc Health. 2009;45(4):423–5.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Bonny AE, Britto MT, Huang B, Succop P, Slap GB. Weight gain, adiposity, and eating behaviors among adolescent females on depot medroxyprogesterone acetate (DMPA). J Pediatr Adolesc Gynecol. 2004;17(2):109–15.

    Article  PubMed  Google Scholar 

  64. Le YC, Rahman M, Berenson AB. Early weight gain predicting later weight gain among depot medroxyprogesterone acetate users. Obstet Gynecol. 2009;114(2 Pt 1):279–84.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  65. Tsai WS, Inge TH, Burd RS. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Arch Pediatr Adolesc Med. 2007;161(3):217–21.

    Article  PubMed  Google Scholar 

  66. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120 Suppl 4:S164–92.

    Article  PubMed  Google Scholar 

  67. Allen SR, Lawson L, Garcia V, Inge TH. Attitudes of bariatric surgeons concerning adolescent bariatric surgery (ABS). Obes Surg. 2005;15(8):1192–5.

    Article  PubMed  Google Scholar 

  68. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 392, December 2007. Intrauterine device and adolescents. Obstet Gynecol. 2007;110(6):1493–5.

    Article  Google Scholar 

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Correspondence to Alison Edelman M.D., M.P.H. .

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Kaneshiro, B., Edelman, A. (2014). Adolescents Who Are Obese. In: Whitaker, A., Gilliam, M. (eds) Contraception for Adolescent and Young Adult Women. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6579-9_8

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  • DOI: https://doi.org/10.1007/978-1-4614-6579-9_8

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