Postpartum weight loss among overweight and obese patients using the etonogestrel subdermal implant

Project: Research project

Project Details

Description

Obesity is a major public health issue in the United States and is newly recognized as a disease by the National Institutes of Health. The 2009-2010 National Health and Examination Survey (NHES) revealed that 63.7% of reproductive age women in the U.S. are classified as overweight or obese (body mass index ≥ 25 kg/m²). The NHES highlights the ongoing nature of the obesity epidemic as the rate of overweight or obese adult women steadily increases: 37% in 1999, 59.5% in 2008, and 63.7% in 2010.1

Reproductive health providers and advocates must recognize the risks of obesity in young women. Research clearly documents the negative impact of increasing body mass index (BMI) on both maternal and neonatal health outcomes.2 Long-term health complications for the obese patient, outside of the acute obstetrical period, including a higher risk of cardiovascular disease, diabetes, orthopedic conditions, and cancer have been well documented.3 To prevent excessive pregnancy weight gain in a vulnerable population, the American Congress of Obstetricians and Gynecologists recommends a weight gain range of 15-25 lbs. for overweight and 11-20 lbs. for obese women.4 This acute pregnancy-related weight gain recommendation is accompanied by the caveat expectation of weight loss postpartum.

The postpartum period is a life stage characterized not only by weight retention, but also by susceptibility to excessive weight gain secondary to acute life stressors.5 Gestational weight retention may be particularly harmful as it tends to be centrally rather than peripherally deposited, compounding the risk for future obesity and related morbidity across the reproductive cycle.5 In line with these concerns, a recent study demonstrated short inter-pregnancy intervals (<12 months), with or without excessive pregnancy weight gain, produces a 2.43-fold increased risk of obesity after childbirth compared to longer inter-pregnancy intervals (≥ 18 months).6

Contraceptive provision in overweight and obese women presents a special challenge to providers. Research points to suboptimal use of contraception in obese women, and alludes to higher contraceptive failure rates. A retrospective cohort study from the Group Health Cooperative of Puget Sound found that women in the highest body-weight quartile (>70.5kg) taking oral contraception experienced more unintended pregnancies, compared with their normal-weight counterparts.7 Obesity has been linked with higher failure rates among users of the transdermal contraceptive patch.8 Depot medroxyprogesteorne acetate (DMPA, Depo Provera®), while an effective contraceptive in all BMI classes, was found in a previous 36-month longitudinal study of 703 women to be associated with a 5.1-kg weight gain compared to 1.5-kg gain among oral contraception users and 2.1-kg gain among non-hormonal contraceptive users, with the greatest concerns stemming from an increase in total body fat and percent body fat.9 A recent sub-study analysis of the prospective Contraceptive CHOICE Project demonstrated mean weight change at 12 months was greater among ENG-implant and DMPA users compared to copper IUD users (+2.1-kg and +2.2-kg respectively).10 However, in a recent RCT examining contraceptive effect on breast milk supply and infant weight gain in immediate insertion of ENG-implant compared with DMPA in normal BMI Brazilian postpartum women, a secondary outcome of decreased mean maternal weight in ENG-implant users during the first 6 weeks postpartum was observed.11

The contraception method for postpartum overweight and obese
StatusFinished
Effective start/end date6/1/144/30/16

Funding

  • Society of Family Planning Research Fund (SFPRF14-17)

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