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Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

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PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm

Ambivalence

Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception

Contraceptivetechnology.com New and Improved

Center of the Storm
February 2016

 

Birth control, even today, inhabits the center of the storm on some issues. In the ongoing microcephaly epidemic that may be linked to Zika virus epidemic, call for better access to reproductive health services such as birth control are under heavy debate. And a recent guidance issued by the Centers for Disease Control and Prevention on using birth control as part of  a strategy to reduce a woman’s risk for fetal-alcohol syndrome sparked angry media responses. Controversy is not new to reproductive health providers, but buried in this particular set of controversies is an important message: contraceptives can help reduce the risk for birth defects.

The northeast regions of Brazil experienced an outbreak mosquito-borne Zika virus infection in early 2015, By September 2015, reports of microcephaly in the affected areas of Brazil roused concern, and investigations suggested a link to Zika virus infection during pregnancy. As Zika virus affected more Latin American nations, officials in Colombia, Ecuador, El Salvador, and Jamaica cautioned women to delay getting pregnant.[1] Similar advice could apply to other affected areas. Contraceptive use to delay pregnancies potentially at risk could be an important part of the strategy to reduce the risk of microcephaly. Controversy has erupted because women many Latin American nations have limited access to contraception, sometimes due in part to religious proscription.

Here in the United States on February 2, the CDC issued the statement that “Sexually active women who stop using birth control should stop drinking alcohol…”[2] Of course, public health advisories could lose effect if issued with fine print containing all the relevant caveats and exceptions. In this case, however, the unfootnoted pronouncement stirred up the proverbial hornet’s nest as media and women complained that the paternalistic tone was outrageous.[3],[4] Despite what may have been an awkward presentation of its message, CDC’s advice tells us what we know to be true: heavy drinking increases women’s risk of poor reproductive health outcomes such as STD and unintended pregnancy, as well as the birth defects and other disorders of fetal alcohol syndrome.[5]

Beyond Zika virus or alcohol, many other exogenous factors can cause birth defects. And contraception could play a valuable role in buying time for women to avoid the risk from these exposures or to get treated for certain conditions:

1. Maternal infections such as:

Cytomegalovirus

Herpes simplex

HIV

Rubella

Toxoplasmosis

Varicella zoster virus

2. Teratogenic agents such as:

Alcohol

Angiotensins

Antibiotics (some)

Anti-convulsant medications (some)

Cocaine

Isotretinoin

Lead

Mercury

Radiation

3. Maternal health conditions such as:

Diabetes

Hypothyroidism

Severe obesity

The good news is that and a recent study again confirms that oral contraceptives do not cause birth defects. This Danish observational study of 22,013 infants born with major birth defects showed that women who took birth control pills just before or during the beginning of their pregnancies showed no increased risk of birth defects.[6]

—Deborah Kowal, MA, PA, Executive editor of Contraceptive Technology


[1] BBC World News. Zika virus triggers pregnancy delay calls. Accessed 2/5/16 at http://www.bbc.com/news/world-latin-america-35388842

[2] Centers for Disease Control and Prevention. More than 3 million US women at risk for alcohol-exposed pregnancy. Accessed Feb. 2, 2016 at http://www.cdc.gov/media/releases/2016/p0202-alcohol-exposed-pregnancy.html

[3] Khazan O, Beck J. Protect your womb from the devil drink. Atlantic Magazine  Accessed Feb. 2, 2016 at http://www.theatlantic.com/health/archive/2016/02/protect-your-womb-from-the-devil-drink/459813/

[4] Tolentin J. an unrealisitic warning from the CDC to women: don’t drink unless you’re using birth control. Jezebel magazine. Accessed Feb. 2, 2016 at http://jezebel.com/an-unrealistic-warning-from-the-cdc-to-women-dont-drin-1756823580?utm_campaign=socialfow_jezebel_twitter&utm_source=jezebel_twitter&utm_medium=socialflow

[5] Centers for Disease Cosntrol and Prevention. Facts about FASDs. Accessed Feb. 2, 2016 at http://www.cdc.gov/ncbddd/fasd/facts.html

[6] Charlton BM, Molgaard-Nielson D, Svanstrom H, et al. maternal use of oral contracewptives and risk of birth defects in Denmark: prospective, nationwide cohort study. BMJ 2016;352:h6712. http://www.bmj.com/content/352/bmj.h6712?ijkey=c40fffcd8601829ab819f486dab837a894e7335b&keytype2=tf_ipsecsha