Abstract:
BACKGROUND:Obesity has reached epidemic proportions around the world. Metabolic changes in obesity and greater body mass may lead to reduced effectiveness of hormonal contraceptives, such as the skin patch, vaginal ring, implants, and injectables. We systematically reviewed the evidence on the effectiveness of hormonal contraceptives among overweight and obese women. OBJECTIVES:To examine the effectiveness of hormonal contraceptives in preventing unplanned pregnancies among women who are overweight or obese versus women of lower weight or body mass index (BMI). SEARCH STRATEGY:We searched MEDLINE, CENTRAL, POPLINE, EMBASE, ClinicalTrials.gov, and ICTRP. We also contacted investigators to identify other trials. SELECTION CRITERIA:All study designs were eligible. Any type of hormonal contraceptive could have been examined. The primary outcome was pregnancy. Overweight or obese women must have been identified by an analysis cutoff for weight or BMI (kg/m(2)). DATA COLLECTION AND ANALYSIS:Data were abstracted by two authors; life-table rates were included where available. For dichotomous variables, we computed an odds ratio with 95% confidence interval. The main comparisons were between overweight or obese women and women of lower weight or BMI. MAIN RESULTS:We found 7 reports with data from 11 trials that included 39,531 women. One of three studies using BMI found a higher pregnancy risk for overweight or obese women. In the trial of two combination oral contraceptives, women with BMI >= 25 had greater pregnancy risk compared to those with BMI < 25 (OR 1.91; 95% CI 1.01 to 3.61). Among skin patch users, body weight was associated with pregnancy (reported P < 0.001) but BMI was not. Studies of a vaginal ring (never marketed) and a six-rod implant showed higher pregnancy rates for women weighing >= 70 kg versus those weighing < 70 kg (reported P values: 0.0013 and < 0.05, respectively). However, two implant studies showed no trend by body weight, and trials of an injectable had no pregnancies. AUTHORS' CONCLUSIONS:Body weight addresses overall body size, while BMI generally reflects the amount of fat. Only one of three studies using BMI found a higher pregnancy risk for overweight women. The efficacy of implants and injectable contraceptives may be unaffected by body mass. The field could use trials of contraceptive methods with groups stratified by BMI. The current evidence on effectiveness by BMI is limited. However, the contraceptive methods examined here are still among the most effective when the recommended regimen is followed.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Lopez LM,Grimes DA,Chen-Mok M,Westhoff C,Edelman A,Helmerhorst FMdoi
10.1002/14651858.CD008452.pub2subject
Has Abstractpub_date
2010-07-07 00:00:00pages
CD008452issue
7issn
1469-493Xpub_type
杂志文章,评审abstract:BACKGROUND:Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. OBJECTIVES:To evaluate the effec...
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doi:10.1002/14651858.CD008349.pub2
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doi:10.1002/14651858.CD004339.pub4
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更新日期:2014-02-20 00:00:00
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doi:10.1002/14651858.CD006322.pub3
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doi:10.1002/14651858.CD000494.pub3
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doi:10.1002/14651858.CD009510.pub2
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