تغییرات وزن 18-12 ماه پس از استفاده از DMPA و IUD: یک مطالعه کوهورت گذشتهنگر

نوع مقاله : اصیل پژوهشی

نویسندگان

1 مربی گروه مامایی، دانشکده علوم پزشکی سیرجان، سیرجان، ایران.

2 استادیار گروه بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تهران، تهران، ایران.

چکیده

مقدمه: IUD و DMPA از روش­های مؤثر تنظیم خانواده هستند که ممکن است استفاده از آنها به‌دلیل وقوع عوارض جانبی ادامه نیابد. مطالعه حاضر با هدف بررسی تغییرات وزن در استفاده‌کنندگان این دو روش انجام شد.
روش‌کار: این مطالعه کوهورت گذشته‌نگر در سال 1396 بر روی 150 زن با IUD و 150 زن با DMPA و با نمونه­گیری تصادفی ساده از 34 مرکز بهداشتی شهر تهران انجام شد. وزن اولیه (W1)، 6 ماه (W2) و سپس 18-12 ماه (W3) پس از مصرف IUD و DMPA ارزیابی گردید. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 20) انجام شد. برای مقایسه اختلاف وزن بین دو مرحله زمانی از آزمون تی مستقل و در سه مرحله زمانی از آزمون اندازه‌گیری تکراری استفاده گردید. میزان p کمتر از 05/0 معنادار در نظر گرفته ‌شد.
یافته‌ها: وزن اولیه در گروه IUD به‌طور معناداری بیشتر از گروه DMPA بود (003/0=p). 6 ماه بعد، افزایش وزن در دو گروه برعکس شده و میانگین اختلاف وزن W2-W1، حاکی از افزایش معنی‌دار وزن در گروه DMPA نسبت به گروه IUD بود (001/0>p). همچنین 18-12 ماه بعد، میانگین اختلاف وزن W3-W1 نشان‌دهنده افزایش معنی‌دار وزن در گروه DMPA نسبت به گروه IUD بود (001/0>p). افزایش وزن در گروه DMPA طی 18-12 ماه در حدود 2 کیلوگرم گزارش شد. بر اساس نتایج آزمون اندازه‌گیری تکراری، تغییرات وزن بین دو گروه در طول زمان معنی‌دار بود (001/0>p). استفاده از DMPA (39/2=B، 0001/0=p) و سزارین (72/0=B، 029/0=p) دو عامل اثرگذار بر افزایش وزن بودند.
نتیجه‌گیری: افزایش وزن، هرچند اندک یکی از عوارض احتمالی استفاده از DMPA است و باید مورد توجه قرار گیرد.

کلیدواژه‌ها

عنوان مقاله [English]

Weight changes 12-18 months after IUD and DMPA usage: A retrospective cohort study

نویسندگان [English]

  • Fatemeh Alavi-Arjas 1
  • Farnaz Farnam 2
1 Instructor, Department of Midwifery, Sirjan School of Medical Sciences, Sirjan, Iran.
2 Assistant Professor, Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Intra Uterine Device (IUD) and Depo-medroxy Progesterone Acetate (DMPA) are effective contraceptive methods that their usage may not be continued due to the occurrence of side effects. This study was performed with aim to evaluate the weight changes in DMPA compared to IUD users.
Method: This retrospective cohort study was performed in 2017 on 150 IUD consumers and 150 DMPA users. Samples were collected from 34 health centers in Tehran by simple random sampling. Baseline weight) W1), 6 months (W2) and then 12 to 18 months (W3) after IUD and DMPA usage was measured. Data were analyzed by SPSS software (version 20). Independent t-test was used to compare the weight difference between the two time stages and repeated measures test was used in three time stages. p < 0.05 was considered statistically significant.
Results: Baseline weight in IUD group was significantly higher than DMPA group (P=0.003). After 6 months, weight gain reversed in two groups and mean difference between W2-W1 showed significant increases in DMPA group in comparison of IUD users (P˂0.001). Also, 12-18 months later, mean difference between W3-W1 indicated significant weight gain in DMPA users than IUD consumers (P˂0.001). Weight gain during 12-18 months in DMPA users was about 2 Kg. Repeated measure analysis showed significant differences between two groups during time (P˂0.001). DMPA usage (P= 0.0001, B=2.39) and Cesarean delivery (P= 0.029, B=0.72) were two significant factors on weight gain.
Conclusion: Weight gain, albeit small is one of the complications of DMPA usage that should be considered.

کلیدواژه‌ها [English]

  • Adverse Effects
  • Contraceptive
  • Copper Intrauterine Device
  • Depo-Medroxy Progesterone Acetate
  • Weight Gain

مراجع

  1. World Health Organization, Johns Hopkins Bloomberg School of Public Health. Center for Communication P. Family planning: a global handbook for providers: evidence-based guidance developed through worldwide collaboration. 3nd ed. Geneva: World Health Organization; 2018.
  2. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetricia. 25nd ed. McGraw-Hill Education; 2018.
  3. Robabi H, Arbabisarjou A, Navidian A, Gourkani H. Analysis of the continuation rates of Intrauterine Device (IUD) and three-month injectable Depot Medroxyprogesterone Acetate (DMPA) uses and reasons for their discontinuation in women referred to health centers. Der Pharmacia Lettre 2016; 8(4):233-8.
  4. McNicoll G. United Nations Department Of Economic and Social Affairs, Population Division: Population, Resources, Environment and Development Database, Version 4.0. Population and Development Review 2006; 32(4):790-1.
  5. Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012; 366(21):1998-2007.
  6. Tavakolianfar T, Ramezanzadeh F, Shariat M, Hosseini FS, Hossein Rashidi B, Montazeri A, et al. Comparing Dysmenorrhea in Women Using Copper T and Mirena IUD as Contraceptive Method. Iran J Obstet Gynecol Infertil 2011; 13(6):11-16.
  7. Nourani Saadodin Sh, Goudarzi M, Peyman N, Esmaily H. Prediction of Intrauterine Device Insertion among Women of Childbearing Age based on the Theory of Planned Behavior. Iran J Obstet Gynecol Infertil 2013; 16(45):13-19.
  8. Health WHOR. Family planning: a global handbook for providers: evidence-based guidance developed through worldwide collaboration. Johns Hopkins Ccp-Info; 2007.
  9. Nations U. Trends in Contraceptive Use Worldwide. Obtenido de The Department of Economic and Social Affairs; 2015.
  10. Jirakittidul P, Somyaprasert C, Angsuwathana S. Prevalence of Documented Excessive Weight Gain Among Adolescent Girls and Young Women Using Depot Medroxyprogesterone Acetate. J Clin Med Res 2019; 11(5):326‐331.
  11. Lotfalizadeh M, Khademi Z, Maleki A, Najaf Najafi M. Comparison of the duration of pregnancy in administration of progesterone suppository and Duphaston tablet in pregnant women with preterm labor after stopping delivery process. Iran J Obstet Gynecol Infertil 2019; 22(10):1–11.
  12. Basu T, Bao P, Lerner A, et al. The Effect of Depo Medroxyprogesterone Acetate (DMPA) on Cerebral Food Motivation Centers: A Pilot Study using Functional Magnetic Resonance Imaging. Contraception 2016; 94(4):321‐327. 
  13. Silva P, Qadir S, Fernandes A, Bahamondes L, Peipert JF. Dietary intake and eating behavior in depot medroxyprogesterone acetate users: a systematic review. Braz J Med Biol Res 2018; 51(6):e7575.
  14. Lopez LM, Ramesh S, Chen M, et al. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev 2016; 2016(8):CD008815.
  15. Bonny AE, Lange HL, Hade EM, Kaufman B, Reed MD, Mesiano S. Serum adipocytokines and adipose weight gain: a pilot study in adolescent females initiating depot medroxyprogesterone acetate. Contraception 2015; 92(4):298‐300.
  16. Lange HL, Manos BE, Gothard MD, Rogers LK, Bonny AE. Bone mineral density and weight changes in adolescents randomized to 3 doses of depot medroxyprogesterone acetate. Journal of Pediatric and Adolescent Gynecology 2017; 30(2):169-75.
  17. Dianat S, Fox E, Ahrens KA, et al. Side Effects and Health Benefits of Depot Medroxyprogesterone Acetate: A Systematic Review. Obstet Gynecol 2019; 133(2):332‐341. 
  18. Rakhshani F, Mohammadi M. Contraception continuation rates and reasons for discontinuation in Zahedan, Islamic Republic of Iran. East Mediterr Health J 2004; 10(3):260‐267.
  19. dos Santos Pde N, Modesto WO, Dal'Ava N, Bahamondes MV, Pavin EJ, Fernandes A. Body composition and weight gain in new users of the three-monthly injectable contraceptive, depot-medroxyprogesterone acetate, after 12 months of follow-up. Eur J Contracept Reprod Health Care 2014; 19(6):432‐438. 
  20. Modesto W, de Nazaré Silva dos Santos P, Correia VM, Borges L, Bahamondes L. Weight variation in users of depot-medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine system and a copper intrauterine device for up to ten years of use. Eur J Contracept Reprod Health Care 2015; 20(1):57-63.
  21. Bahamondes L, Del Castillo S, Tabares G, Arce XE, Perrotti M, Petta C. Comparison of weight increase in users of depot medroxyprogesterone acetate and copper IUD up to 5 years. Contraception 2001; 64(4):223‐225. 
  22. Kariman N, Pahlavani Sheykhi  Z, Majd Alavi  H. Comparison of Effects of Injectable Contraceptives (Cyclofem and Depot Medroxyprogesterone Acetate) on Short Time Side Effects, Acceptability and Continuation Rates. Iran J Obstet Gynecol Infertil 2014; 17(91):12-20.
  23. Lopez LM, Ramesh S, Chen M, et al. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev 2016; 2016(8):CD008815.
مجله زنان، مامایی و نازایی ایران
دوره 23، شماره 7
مهر 1399
صفحه 39-46

فایل ها

هم رسانی

ارجاع به این مقاله

آمار