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Does follow-up with serum hCG simplify medical abortion? A randomized controlled trial
Abstracts / Contraception 84 (2011) 302–336
305
Dayananda I Planned Parenthood League of Massachusetts, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA
complete fat biopsy and weight data. Six-month weight gain (6.7% White, 4.0% Black, −2.7% Hispanic) differed significantly by race (p=.005). High FAS mRNA levels at baseline (p=.007), higher 3-month cell count (p=.03) and increase in minimum cell volume from baseline to 3 months (p=.03) were all associated with percent 6-month weight gain. Conclusions: These data continue to build the case that adipocytes behave differently in individuals who are at increased risk for weight gain on DMPA.
Maurer R, Fortin J, Goldberg A
O10
O8
DOES FOLLOW-UP WITH SERUM HCG SIMPLIFY MEDICAL ABORTION? A RANDOMIZED CONTROLLED TRIAL
Objective: The objective was to investigate if follow-up with serum hCG testing simplifies the medical abortion protocol by resulting in fewer additional visits and interventions than follow-up with ultrasound. Methods: Women were randomized to either serum hCG or ultrasound follow-up after medical abortion. The primary outcome, additional intervention or follow-up, was measured as a composite binary outcome including additional clinic or emergency room visits, repeat dosing of misoprostol and surgical evacuation of the uterus. Surveys were administered at initial follow-up and again 1 month after abortion to inquire about additional interventions and patient satisfaction. Medical record reviews were also performed. Results: A total of 376 subjects were randomized. There were no significant demographic differences between arms, and most participants were white (56%), were single (83%), were nulliparous (63%) and had completed high school (96%). Average participant age was 26±6 years, and average gestational age was 46±6 days. Within 2 weeks of abortion, 8.2% (13/159) of women in the hCG arm and 6.6% (10/151) of those in the ultrasound arm had additional intervention (p=.60). By 4 weeks postabortion, 4.4% (6/135) in the ultrasound arm and 1.4% (2/142) in the hCG arm had undergone surgical evacuation (p=.16). The majority of women in both the hCG (88%) and ultrasound (95%) arms were satisfied with their assigned follow-up method. Conclusions: Medical abortion follow-up with serum hCG did not result in fewer additional interventions than follow-up with ultrasound. Overall, the number of additional interventions were low, and both methods of follow-up were acceptable to women.
O9
BIOLOGICAL BEHAVIOR OF ADIPOCYTES IN ADOLESCENTS ON DEPOT MEDROXYPROGESTERONE ACETATE: IS IT RELATED TO WEIGHT GAIN? Bonny A Nationwide Children's Hospital, Columbus, OH, USA
FACTORS ASSOCIATED WITH 12-MONTH CONTINUATION AMONG ORAL CONTRACEPTIVE PILL AND CONTRACEPTIVE VAGINAL RING USERS Stuart J Washington University in St. Louis School of Medicine, St. Louis, MO, USA Secura G, Zhao Q, Pittman M, Peipert J Objective: The objective was to examine whether 12-month continuation rates differ for oral contraceptive pill (OCP) and contraceptive vaginal ring (CVR) users and to determine whether demographic, behavioral and contraceptive-method-related factors such as side effects and access are associated with discontinuation. Methods: Women enrolled in the Contraceptive CHOICE Project who selected OCP or CVR at enrollment and completed 12-months of follow-up were included in this analysis. Women who reported discontinuation of OCP or CVR for longer than 1 month during a follow-up survey were considered discontinuers. Women who stopped their method to attempt pregnancy were censored; women lost to follow-up were censored at their last available survey. We adjusted for demographic, behavioral and method-related factors in the Cox proportional hazard models. Results: Discontinuation rates by 12 months were similar among 478 OCP users (44%) and 431 CVR users (45%), p=.85. Oral contraceptive pill users who were living with a partner (HR=0.23, 95% CI 0.08–0.67) or very/ somewhat satisfied with their method (HR=0.17, 95% CI 0.08–0.37) were less likely to discontinue. Oral contraceptive pill users who reported difficulty obtaining the method were nearly three times more likely to discontinue (HR=2.7, 95% CI 1.6–4.8). Contraceptive vaginal ring users who experienced breast tenderness were nearly two times more likely to discontinue (HR=1.9, 95% CI 1.1–3.3). Conclusions: Despite selecting their method and obtaining it at no cost, almost half of the OCP and CVR users discontinued their method by 12 months. To promote contraceptive method continuation, counseling must address access issues and method satisfaction.
Mesiano S, Kaufman B, O′Riordan M, Reed M, Blumer J, Cromer B O11 Objective: The objective of this study was to evaluate peripheral adipocyte mRNA expression, cell number and size in adolescents on depot medroxyprogesterone acetate (DMPA) and determine the relationship between adipocyte characteristics and DMPA-associated weight gain. Methods: Weight was assessed at baseline and 6 months in adolescents (12 to 21 years) initiating DMPA. Peripheral fat biopsies were obtained at baseline and 3 months to measure the abundance of mRNAs encoding for lipoprotein lipase, fatty acid synthase (FAS), leptin, adiponectin, progesterone, estrogen and glucocorticoid receptors by real-time quantitative reverse transcriptase polymerase chain reaction. Paraffin sections were also prepared to determine average fat cell number and size by computerized digital image analyses. The mRNA levels were dichotomized into either high or low for each specific measure as driven by the data. Associations of subject and adipocyte characteristics and percent 6-month weight gain were assessed by correlation coefficients, t tests and analysis of variance, as appropriate. Results: Twenty-eight subjects (mean age 16.1 years; mean gynecologic age 4.0 years; White 36.5%, Black 36.5%, Hispanic 27.0%) provided
PHARMACOKINETICS OF THE ETONOGESTREL CONTRACEPTIVE IMPLANT IN OBESE WOMEN Gilliam M University of Chicago, Chicago, IL, USA Mornar S, Chan LN, Mistretta S, Kantor E, Neustadt A Objectives: We examined the pharmacokinetic profile of the etonogestrel contraceptive implant in obese women during the first 6 months of use. Methods: We developed and validated an assay to detect plasma etonogestrel concentrations. We then enrolled two cohorts of women: obese [body mass index (BMI)N30] and normal weight (BMIb25). Data from normal-weight participants validated the assay and ensured comparability of results to historical controls. Etonogestrel concentrations were determined in all women starting 50 h after insertion and at 50-h intervals until 300 h postinsertion. Etonogestrel measurements at 3 and 6 months
305
Dayananda I Planned Parenthood League of Massachusetts, Boston, MA, USA Brigham and Women's Hospital, Boston, MA, USA
complete fat biopsy and weight data. Six-month weight gain (6.7% White, 4.0% Black, −2.7% Hispanic) differed significantly by race (p=.005). High FAS mRNA levels at baseline (p=.007), higher 3-month cell count (p=.03) and increase in minimum cell volume from baseline to 3 months (p=.03) were all associated with percent 6-month weight gain. Conclusions: These data continue to build the case that adipocytes behave differently in individuals who are at increased risk for weight gain on DMPA.
Maurer R, Fortin J, Goldberg A
O10
O8
DOES FOLLOW-UP WITH SERUM HCG SIMPLIFY MEDICAL ABORTION? A RANDOMIZED CONTROLLED TRIAL
Objective: The objective was to investigate if follow-up with serum hCG testing simplifies the medical abortion protocol by resulting in fewer additional visits and interventions than follow-up with ultrasound. Methods: Women were randomized to either serum hCG or ultrasound follow-up after medical abortion. The primary outcome, additional intervention or follow-up, was measured as a composite binary outcome including additional clinic or emergency room visits, repeat dosing of misoprostol and surgical evacuation of the uterus. Surveys were administered at initial follow-up and again 1 month after abortion to inquire about additional interventions and patient satisfaction. Medical record reviews were also performed. Results: A total of 376 subjects were randomized. There were no significant demographic differences between arms, and most participants were white (56%), were single (83%), were nulliparous (63%) and had completed high school (96%). Average participant age was 26±6 years, and average gestational age was 46±6 days. Within 2 weeks of abortion, 8.2% (13/159) of women in the hCG arm and 6.6% (10/151) of those in the ultrasound arm had additional intervention (p=.60). By 4 weeks postabortion, 4.4% (6/135) in the ultrasound arm and 1.4% (2/142) in the hCG arm had undergone surgical evacuation (p=.16). The majority of women in both the hCG (88%) and ultrasound (95%) arms were satisfied with their assigned follow-up method. Conclusions: Medical abortion follow-up with serum hCG did not result in fewer additional interventions than follow-up with ultrasound. Overall, the number of additional interventions were low, and both methods of follow-up were acceptable to women.
O9
BIOLOGICAL BEHAVIOR OF ADIPOCYTES IN ADOLESCENTS ON DEPOT MEDROXYPROGESTERONE ACETATE: IS IT RELATED TO WEIGHT GAIN? Bonny A Nationwide Children's Hospital, Columbus, OH, USA
FACTORS ASSOCIATED WITH 12-MONTH CONTINUATION AMONG ORAL CONTRACEPTIVE PILL AND CONTRACEPTIVE VAGINAL RING USERS Stuart J Washington University in St. Louis School of Medicine, St. Louis, MO, USA Secura G, Zhao Q, Pittman M, Peipert J Objective: The objective was to examine whether 12-month continuation rates differ for oral contraceptive pill (OCP) and contraceptive vaginal ring (CVR) users and to determine whether demographic, behavioral and contraceptive-method-related factors such as side effects and access are associated with discontinuation. Methods: Women enrolled in the Contraceptive CHOICE Project who selected OCP or CVR at enrollment and completed 12-months of follow-up were included in this analysis. Women who reported discontinuation of OCP or CVR for longer than 1 month during a follow-up survey were considered discontinuers. Women who stopped their method to attempt pregnancy were censored; women lost to follow-up were censored at their last available survey. We adjusted for demographic, behavioral and method-related factors in the Cox proportional hazard models. Results: Discontinuation rates by 12 months were similar among 478 OCP users (44%) and 431 CVR users (45%), p=.85. Oral contraceptive pill users who were living with a partner (HR=0.23, 95% CI 0.08–0.67) or very/ somewhat satisfied with their method (HR=0.17, 95% CI 0.08–0.37) were less likely to discontinue. Oral contraceptive pill users who reported difficulty obtaining the method were nearly three times more likely to discontinue (HR=2.7, 95% CI 1.6–4.8). Contraceptive vaginal ring users who experienced breast tenderness were nearly two times more likely to discontinue (HR=1.9, 95% CI 1.1–3.3). Conclusions: Despite selecting their method and obtaining it at no cost, almost half of the OCP and CVR users discontinued their method by 12 months. To promote contraceptive method continuation, counseling must address access issues and method satisfaction.
Mesiano S, Kaufman B, O′Riordan M, Reed M, Blumer J, Cromer B O11 Objective: The objective of this study was to evaluate peripheral adipocyte mRNA expression, cell number and size in adolescents on depot medroxyprogesterone acetate (DMPA) and determine the relationship between adipocyte characteristics and DMPA-associated weight gain. Methods: Weight was assessed at baseline and 6 months in adolescents (12 to 21 years) initiating DMPA. Peripheral fat biopsies were obtained at baseline and 3 months to measure the abundance of mRNAs encoding for lipoprotein lipase, fatty acid synthase (FAS), leptin, adiponectin, progesterone, estrogen and glucocorticoid receptors by real-time quantitative reverse transcriptase polymerase chain reaction. Paraffin sections were also prepared to determine average fat cell number and size by computerized digital image analyses. The mRNA levels were dichotomized into either high or low for each specific measure as driven by the data. Associations of subject and adipocyte characteristics and percent 6-month weight gain were assessed by correlation coefficients, t tests and analysis of variance, as appropriate. Results: Twenty-eight subjects (mean age 16.1 years; mean gynecologic age 4.0 years; White 36.5%, Black 36.5%, Hispanic 27.0%) provided
PHARMACOKINETICS OF THE ETONOGESTREL CONTRACEPTIVE IMPLANT IN OBESE WOMEN Gilliam M University of Chicago, Chicago, IL, USA Mornar S, Chan LN, Mistretta S, Kantor E, Neustadt A Objectives: We examined the pharmacokinetic profile of the etonogestrel contraceptive implant in obese women during the first 6 months of use. Methods: We developed and validated an assay to detect plasma etonogestrel concentrations. We then enrolled two cohorts of women: obese [body mass index (BMI)N30] and normal weight (BMIb25). Data from normal-weight participants validated the assay and ensured comparability of results to historical controls. Etonogestrel concentrations were determined in all women starting 50 h after insertion and at 50-h intervals until 300 h postinsertion. Etonogestrel measurements at 3 and 6 months