Depot medroxyprogesterone results in increased weight gain compared to oral contraceptives
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strongest conclusions of this study are that rapid influenza testing adds very little to clinical decision-making, and that influenza-vaccinated children had lower costs and better health outcomes than non-vaccinated children, regardless of treatment strategy chosen. The latter result was curiously downplayed in this report; in my view, it is perhaps the most important one! Geoffrey A. Weinberg, MD University of Rochester School of Medicine & Dentistry Rochester, NY 14642 REFERENCES 1. Poehling KA, Walker F, Copeland J, Edwards KM, Szilagyi P, Hall C, et al. Epidemiology of outpatient visits for influenza infections in young children. Pediatr Res 2004;55(4 part 2):241A. 2. Poehling KA, Griffin MR, Dittus RS, Tang YW, Holland K, Li H, et al. Bedside diagnosis of influenzavirus infections in hospitalized children. Pediatrics 2002;110:83-8. 3. Griffin MR, Walker FJ, Iwane MK, Weinberg GA, Staat MA, Erdman DD, et al. Epidemiology of respiratory infections in young children: insights from the new vaccine surveillance network. Pediatr Infect Dis J 2004:S188-92. 4. Centers for Disease Control and Prevention. High levels of adamantane resistance among influenza A (H3N2) viruses and interim guidelines for use of antiviral agents–United States, 2005-06 influenza season. MMWR Morb Mortal Wkly Rep 2006;55:44-6. 5. Ison MG, Gubareva LV, Atmar RL, Treanor J, Hayden FG. Recovery of drug-resistant influenza virus from immunocompromised patients: a case series. J Infect Dis. 2006;193:760-4. 6. Monto AS. The threat of an avian influenza pandemic. N Engl J Med 2005;352:323-5. Depot medroxyprogesterone results in increased weight gain compared to oral contraceptives Bonny AE, Ziegler J, Harvey R, Debanne SM, Secic M, Cromer BA. Weight gain in obese and nonobese adolescent girls initiating depot medroxyprogesterone, oral contraceptive pills, or no hormonal contraceptive method. Arch Pediatr Adolesc Med 2006;160:40-5. Question Does the initiation of depot medroxyprogesterone acetate (DMPA) result in significant weight gain in obese and nonobese adolescent girls, when compared with an oral con- traceptive (OC), or no hormonal contraceptive method (con- trol)? Design Non-randomized, prospective study. Setting Four urban health clinics. Participants 450 adolescent girls, aged 12 to 18 years. Intervention The adolescents were treated with DMPA, OC, or control, based on their preferences. Outcomes Weight was assessed at 6, 12, and 18 months and also as a mean change over 18 months. Results Adolescent girls who were obese at initiation of DMPA gained significantly more weight than did obese girls starting OC or control (P.001 for both). At 18 months, mean weight gain was 9.4, 0.2, and 3.1 kg for obese girls receiving DMPA, receiving OC, and control, respectively. Weight gain in obese girls receiving DMPA was also greater than weight gain in all nonobese categories (4.0 kg, DMPA; 2.8 kg, OC; 3.5 kg, control; P.001). A significant interac- tion (P.006) between length of time receiving DMPA and weight gain was evident for obese subjects. Conclusions Over 18 months, DMPA use was associated with increasing rates of weight gain in obese subjects. The potential contribution to severe obesity in this population is concerning. Comment This is another interesting study that shows an increase in weight gain in adolescents using hormonal con- traception. The investigators used data that had been col- lected from a 2-year prospective cohort study evaluating hor- monal contraception and bone mineral density changes in adolescents. The participants were followed for 18 months, which is longer than most studies in the field. Unfortunately, the baseline characteristics of the cohorts have significant differences. The control group had a younger age, lower baseline weight, and decreased rate of sexual activity when compared to both treatment groups. The DMPA cohort had a higher rate of prior pregnancy than the OC group (5.1% vs 2.9%). The attrition rate was high for all groups; consistent with other studies evaluating contraception in adolescents, however it was particularly high for the OC group (46.3% OC, 37.4% DMPA, 25% controls). This is a well-designed study, but the baseline differences do raise some caution. For example, the effect of prior pregnancy on the decision to continue DMPA despite weight gain is unknown. Also, the higher dropout rate in the OC group may have been second- ary to perceived weight gain. Ultimately, it is unclear what impact the baseline differences have had on final data inter- pretation. The excess weight gain seen in these obese adoles- cents using DMPA is concerning. However, this concern must be balanced with the social and medical complications of unplanned teen pregnancy. Further study with well-matched cohorts will be of great benefit. Pamela Davis, MD University of Michigan Ann Arbor, MI 48109 Placement of ear ventilation tubes does not improve long-term hearing threshholds and increases scarring Stenstrom R, Pless IB, Bernard P. Hearing thresholds and tympanic membrane sequelae in children managed medically or surgically for otitis media with effusion. Arch Pediatr Adolesc Med 2005;159:1151-6. Question Does the use of ventilation tube insertion in children with otitis media with effusion have an effect on hearing thresholds and tympanic membrane pathologic ab- normalities? Clinical Research Abstracts For Pediatrics 699
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Transcript of Depot medroxyprogesterone results in increased weight gain compared to oral contraceptives
strongest conclusions of this study are that rapid influenzatesting adds very little to clinical decision-making, and thatinfluenza-vaccinated children had lower costs and betterhealth outcomes than non-vaccinated children, regardless oftreatment strategy chosen. The latter result was curiouslydownplayed in this report; in my view, it is perhaps the mostimportant one!
Geoffrey A. Weinberg, MDUniversity of Rochester School of Medicine & Dentistry
Rochester, NY 14642
REFERENCES1. Poehling KA, Walker F, Copeland J, Edwards KM, Szilagyi P, Hall C,et al. Epidemiology of outpatient visits for influenza infections in youngchildren. Pediatr Res 2004;55(4 part 2):241A.2. Poehling KA, Griffin MR, Dittus RS, Tang YW, Holland K, Li H, etal. Bedside diagnosis of influenzavirus infections in hospitalized children.Pediatrics 2002;110:83-8.3. Griffin MR, Walker FJ, Iwane MK, Weinberg GA, Staat MA, ErdmanDD, et al. Epidemiology of respiratory infections in young children: insightsfrom the new vaccine surveillance network. Pediatr Infect Dis J2004:S188-92.4. Centers for Disease Control and Prevention. High levels of adamantaneresistance among influenza A (H3N2) viruses and interim guidelines for useof antiviral agents–United States, 2005-06 influenza season. MMWR MorbMortal Wkly Rep 2006;55:44-6.5. Ison MG, Gubareva LV, Atmar RL, Treanor J, Hayden FG. Recoveryof drug-resistant influenza virus from immunocompromised patients: a caseseries. J Infect Dis. 2006;193:760-4.6. Monto AS. The threat of an avian influenza pandemic. N Engl J Med2005;352:323-5.
Depot medroxyprogesterone results inincreased weight gain compared to oralcontraceptivesBonny AE, Ziegler J, Harvey R, Debanne SM, Secic M,Cromer BA. Weight gain in obese and nonobese adolescentgirls initiating depot medroxyprogesterone, oral contraceptivepills, or no hormonal contraceptive method. Arch PediatrAdolesc Med 2006;160:40-5.
Question Does the initiation of depot medroxyprogesteroneacetate (DMPA) result in significant weight gain in obese andnonobese adolescent girls, when compared with an oral con-traceptive (OC), or no hormonal contraceptive method (con-trol)?
Design Non-randomized, prospective study.
Setting Four urban health clinics.
Participants 450 adolescent girls, aged 12 to 18 years.
Intervention The adolescents were treated with DMPA,OC, or control, based on their preferences.
Outcomes Weight was assessed at 6, 12, and 18 monthsand also as a mean change over 18 months.
Results Adolescent girls who were obese at initiation ofDMPA gained significantly more weight than did obese girlsstarting OC or control (P�.001 for both). At 18 months,
mean weight gain was 9.4, 0.2, and 3.1 kg for obese girlsreceiving DMPA, receiving OC, and control, respectively.Weight gain in obese girls receiving DMPA was also greaterthan weight gain in all nonobese categories (4.0 kg, DMPA;2.8 kg, OC; 3.5 kg, control; P�.001). A significant interac-tion (P�.006) between length of time receiving DMPA andweight gain was evident for obese subjects.
Conclusions Over 18 months, DMPA use was associatedwith increasing rates of weight gain in obese subjects. Thepotential contribution to severe obesity in this population isconcerning.
Comment This is another interesting study that shows anincrease in weight gain in adolescents using hormonal con-traception. The investigators used data that had been col-lected from a 2-year prospective cohort study evaluating hor-monal contraception and bone mineral density changes inadolescents. The participants were followed for 18 months,which is longer than most studies in the field. Unfortunately,the baseline characteristics of the cohorts have significantdifferences. The control group had a younger age, lowerbaseline weight, and decreased rate of sexual activity whencompared to both treatment groups. The DMPA cohort hada higher rate of prior pregnancy than the OC group (5.1% vs2.9%). The attrition rate was high for all groups; consistentwith other studies evaluating contraception in adolescents,however it was particularly high for the OC group (46.3%OC, 37.4% DMPA, 25% controls). This is a well-designedstudy, but the baseline differences do raise some caution. Forexample, the effect of prior pregnancy on the decision tocontinue DMPA despite weight gain is unknown. Also, thehigher dropout rate in the OC group may have been second-ary to perceived weight gain. Ultimately, it is unclear whatimpact the baseline differences have had on final data inter-pretation. The excess weight gain seen in these obese adoles-cents using DMPA is concerning. However, this concernmust be balanced with the social and medical complications ofunplanned teen pregnancy. Further study with well-matchedcohorts will be of great benefit.
Pamela Davis, MDUniversity of MichiganAnn Arbor, MI 48109
Placement of ear ventilation tubes does notimprove long-term hearing threshholds andincreases scarringStenstrom R, Pless IB, Bernard P. Hearing thresholds andtympanic membrane sequelae in children managed medicallyor surgically for otitis media with effusion. Arch PediatrAdolesc Med 2005;159:1151-6.
Question Does the use of ventilation tube insertion inchildren with otitis media with effusion have an effect onhearing thresholds and tympanic membrane pathologic ab-normalities?
Clinical Research Abstracts For Pediatrics 699
