Post-Placental Intrauterine Device Insertion in Brazilian Adolescents: Clinical Outcomes at 12 Months.

STUDY OBJECTIVE: To assess the acceptability, expulsion and continuation rates, satisfaction, and complications associated with post-placental intrauterine device insertion (PPIUDI) in Brazilian adolescents DESIGN: Prospective cohort SETTING: A single public, tertiary teaching hospital PARTICIPANTS: Adolescents (≤ 19 years) giving birth by vaginal delivery or cesarean section INTERVENTION: PPIUDI MAIN OUTCOME MEASURES: Primary outcomes were PPIUDI acceptability, expulsion, continuation, and user satisfaction. Secondary outcomes were changes in menstrual bleeding and pain, infection, uterine perforation, and repeat pregnancy up to 12 months after PPIUDI. RESULTS: Of 1710 adolescents who delivered during the study period, 294 accepted PPIUDI (acceptability 17.2%). There were no cases of infection or uterine perforation among the 91 adolescents who completed the 12-month follow-up. Overall expulsion rate was 28.6%, and most cases (54%) occurred in the first 6 weeks after insertion. At 12 months, 85.7% of users were satisfied with the method, and continuation rate was 69.2%. At the end of 12 months, there were no repeat pregnancies among the adolescents who remained with the device in place. CONCLUSION: PPIUDI can be an effective and safe method to reduce repeat unplanned pregnancies in adolescents who have just given birth.

Sleep quality in women who use different contraceptive methods.

BACKGROUND: Both menstrual cycle and hormone alterations influence sleep pattern. The aim of this study was to evaluate sleep quality in women who use different contraceptive methods. MATERIAL AND METHODS: This study was a descriptive, cross-sectional survey. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and a questionnaire was used to obtain sociodemographic, clinical, lifestyle, and contraceptive use data. RESULTS: The study population comprised 235 women in reproductive age. Regarding lifestyle, 25.5% of the women were physically active, 12.3% were tobacco-smoking, and 70.6% drank coffee daily. Sleep quality was good in 34% of the studied population and poor in 66% of the population. The population was divided into two groups: hormonal (57.1%) and non-hormonal (42.9%) contraceptive users. Sleep quality in the users of non-hormonal contraceptive methods was similar to that in the users of hormonal methods (6.1±3.2 versus 5.9±2.9; p=0.5). Sleep efficiency was statistically higher among the users of non-hormonal contraceptive methods (94.7±17.7) than among the users of hormonal methods (90.0±15.3; p=0.03). The patients who had irregular or altered menstrual cycles reported poorer sleep quality. The absence of routine physical activity negatively influenced sleep quality (p=0.05). The women who snored reported worse sleep quality (p=0.002). CONCLUSIONS: Nearly half of the studied population was users of hormonal contraception, and most of these women reported poor sleep quality. Sleep efficiency was higher among the users of non-hormonal contraceptives. No differences in subgroups (hormonal contraceptive users) were observed.

Contraceptive practices in women with sickle-cell disease.

This was a cross-sectional study of sexually active women with sickle-cell disease (SCD) managed at São Paulo Federal University during a one-year period. A total of 54 women were included. Mean age was 32.0 (11.2, standard deviation) years and almost 95% were black or of mixed racial ancestry. Almost 80% reported a history of multiple blood transfusions, 50% had kidney disease and 17% had a history of thrombosis. Over 80% of them had used some form of contraception, mostly combined hormonal contraceptive (52%) or progestin-only contraceptives (46%). Although most women had multiple comorbidities which would contraindicate the use of combined hormonal contraceptives, this was the most popular method used by them. We did not identify an association between the use of combined hormonal contraceptives and major complications. Larger, prospective studies are needed to evaluate the use and the effects of contraceptive methods in women with SCD.

Effects of extended regimens of the contraceptive vaginal ring on carbohydrate metabolism.

BACKGROUND: There are few publications on the metabolic effects of extended regimens of the contraceptive vaginal ring. The aim of this study was to assess changes in fasting plasma glucose levels and insulin concentration of women using the contraceptive vaginal ring continuously over a 1-year period. STUDY DESIGN: This prospective cohort enrolled 75 women (ages 18-37 years) who used a contraceptive vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily continuously for 84 days, followed by a 7-day ring-free interval, during 1 year. Fasting glucose and insulin levels were measured, and homeostatic model assessment was calculated at baseline and every 3 months during the 1-year study period. The repeated-measures analysis of variance test was used to analyze differences in the results of these exams over time. RESULTS: None of the 75 participants had results outside the normal range in any of the assessments. There were no pregnancies during the 1-year period, and a total of 62 participants completed the study. There were no significant changes in mean fasting glucose levels (79.3 and 78.9 mg/dL at baseline and after 12 months, respectively), mean fasting insulin concentration (9.6 and 10.1 µU/mL) or mean homeostatic model assessment results (1.88% and 1.97%). CONCLUSION: Fasting plasma glucose concentration, insulin levels and homeostatic model assessment values of women using the vaginal ring on an extended regimen did not change significantly over a 1-year period.

Metabolic effects of contraceptive implants in adolescents.

BACKGROUND: This prospective study analyzed the metabolic effects of an etonogestrel implant used for 1 year by adolescents. STUDY DESIGN: The study population comprised 47 postpartum adolescents (mean 17.2 years old) managed at the Family Planning Sector of São Paulo Federal University. Participants received an implant containing etonogestrel (68 mg) within 6 months of delivery (on average 102 days after giving birth) and were followed for 1 year. Blood was collected at baseline and 12 months later to assess total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), hemogram, urea, creatinine, sodium, potassium, fasting glucose, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and bilirubin. RESULTS: Three adolescents did not return after receiving the implant despite telephone messages and a telegram and were excluded from the clinical and final laboratory analyses. All 44 patients completed the 12 months of follow-up, resulting in a study discontinuation rate of 0%. No implants were removed. Laboratory analyses were completed in 37 adolescents. After 1 year of using the implant, there was a significant increase in mean hemoglobin, hematocrit and indirect bilirubin concentrations and of the HDL-C/TC and HDL-C/LDL-C ratios. Additionally, there was a significant decrease in mean TC level as well as LDL-C, very low-density lipoprotein cholesterol, TG, SGOT and SGPT. These results suggest that the etonogestrel implant does not interfere directly with the risk of cardiovascular diseases because it improves the lipid profile. There were no pregnancies during the study. CONCLUSION: Our results indicate that an etonogestrel implant used by adolescents for 1 year is associated with changes in the lipid profile and hepatic function without adverse clinical effects.

Etonogestrel implant in adolescents: evaluation of clinical aspects.

BACKGROUND: This prospective noncomparative observational study evaluated the clinical aspects of adolescents who received an etonogestrel implant within 6 months of delivery. STUDY DESIGN: The study population comprised 44 adolescents managed at the Family Planning Sector of São Paulo Federal University. The implant was inserted, on average, 102 days after delivery and patients were followed during 1 year. At each monthly visit to the clinic, the participants were weighed, had their blood pressure measured and were asked to report on symptoms experienced during the last 30 days. RESULTS: Approximately one-third (38.6%) of the participants reported symptoms, mostly headaches. There were no complaints of dysmenorrhea, breast tenderness or lower leg edema throughout the 12 months of follow-up. Mean body weight dropped 1.2 kg on average, from 56.4 kg at implant insertion to 55.3 kg at the end of the 1-year period. Body mass index also decreased 0.5 kg/m(2) on average, although these changes did not reach statistical significance. Systolic and diastolic blood pressure remained unchanged throughout the study period. There were no pregnancies and none of the participants discontinued the method (528 women-months). CONCLUSION: These findings suggest that the etonogestrel implant is a safe and effective contraceptive method that is well accepted by adolescents after a pregnancy.

Prematurity and low birth weight among Brazilian adolescents and young adults.

STUDY OBJECTIVE: To compare the incidence of preterm birth and low birth weight infants in young and older primiparous adolescents versus young adults. DESIGN: Cross-sectional study. SETTING: Maternity hospital in Vitória, ES, Brazil. PARTICIPANTS: During a 5-year period, young primiparous women who delivered a singleton liveborn infant over 22 weeks were interviewed while in the postpartum ward. INTERVENTIONS: A single investigator performed all the individual interviews to collect sociodemographic variables and obtained gestational age and birth weight from the patients' charts before discharge. MAIN OUTCOME MEASURES: Participants were divided into 3 groups according to age: young adolescents (10-15 years), older adolescents (16-19 y) and young adults (20-24 y). The chi(2) test was used to compare the rate of preterm birth and low birth weight between the groups and analyze differences in sociodemographic characteristics between the 3 groups. P<0.05 was considered significant. RESULTS: A total of 1124 participants were included: 164 young adolescents, 537 older adolescents and 423 adults. The rate of preterm birth was similar in the 3 groups: 4.3%, 3.5% and 4.5%, for young adolescents, older adolescents and adults, respectively (P=0.48). The rate of low birth weight was significantly higher among young adolescents (9.7%) compared to older adolescents (6.1%) and young adults (3.5%) (P=0.012). CONCLUSIONS: The rate of preterm birth was similar in adolescents and young adults. Adolescent mothers under 16 years of age have a significantly higher incidence of low birth weight infants.

Contraceptive counseling and use among 197 female kidney transplant recipients.

BACKGROUND: There is growing interest about the quality of life of female transplant recipients, including their sexual and reproductive health. Although menstrual irregularity and infertility are common in women with advanced chronic diseases, most regain their reproductive function shortly after transplantation. Because an unplanned pregnancy soon after transplantation can expose both mother and fetus to considerable risk, it is recommended that these women should receive contraceptive counseling. However, the actual implementation and effectiveness of this recommendation has not been extensively studied. METHODS: A total of 197 reproductive age, female, stable kidney graft recipients attending a large Brazilian transplantation clinic were interviewed. They were asked about menstrual pattern, sexual activity, counseling, and their use of contraceptive methods both before and after the transplant. RESULTS: Before transplantation 70.6% reported menstrual irregularity, 91.9% of them were sexually active, 74.1% were counseled to use contraception and 86.3% used some contraceptive method. After the graft, 50.2% had menstrual irregularity, 79.7% were sexually active, 48.7% were advised to use contraceptives and 72.1% were actually using a method. After transplantation, there were 14 pregnancies in 11 women and 92.9% (13/14) of these were unplanned. CONCLUSIONS: Although most female kidney transplant recipients were sexually active both before and after transplantation, many were not counseled about the need for contraception and did not use any form of birth control. Health professionals involved in the management of these patients need to include contraceptive counseling as part of their routine care.

Long-term evaluation of lipid profile and oral glucose tolerance test in Norplant users.

PURPOSE: This study reports the results of the lipid profile and oral glucose tolerance test (OGTT) in 46 normal patients tested before and after 5 years of Norplant use. RESULTS: After 5 years, there was a substantial decrease of 28.9% in high-density lipoprotein cholesterol levels and a similar but less pronounced fall of 7.1% in the total cholesterol levels. The Castelli 1 index did not vary, and the triglycerides and low-density lipoprotein cholesterol levels remained normal and unchanged throughout the study period. All the mean values of OGTT were significantly lower after 5 years, except for the 90-min glycemia. CONCLUSION: These findings indicate that long-term Norplant use does not increase cardiovascular risks.

Prenhez ectópica em adolescente: relato de um caso / Ectopic pregnancy in adolescent: report of a case

Os autores relatam um caso excepcional de prenhez tubária em paciente de 15 anos. Discutem o problema médico e social da gestaçäo na adolescência e as implicaçöes de uma gravidez ectópica sobre a funçäo reprodutiva futura neste grupo etário