Relationship between Congenital Anomalies and Contraception

Abstract

Most contraceptive methods are associated with defined maternal risks. These risks can be balanced against the benefits with individual users arriving at informed decisions concerning propriety of using a given method. Physicians and patients alike have grown accustomed to benefits/risks analysis of this type. In the past decade increasing attention has been given to allegations that various forms of contraception pose fetal risks. Sometimes risks are claimed as a result of exposure during pregnancy (teratogenesis). At other times long-term risks are claimed after discontinuation of the contraceptive agent. That is there are risks due to exposure prior to pregnancy (mutagenesis). Some studies have claimed to show that oral contraceptives are teratogenic. The most common anomalies cited are hypospadias cardiac anomalies limb reduction deformities anencephaly and spina bifida (neural tube disorders). Other studies claim mutagenic effects from oral contraceptives Gene mutations at specifie loci numerical and structural chromosome abnormalities are the most intensely studied of these mutagenic effects. IUDs have also been implicated as teratogens especially for limb reduction deformities. Vaginal spermicides have been implicated in a wide variety of mutagenic disorders including limb reduction defects neoplasms chromosomal abnormalities hypospadias cardiac defects and Downs syndrome. Infrequent coitus associated with users of the rhythm method has been implicated in causing chromosomal abnormalities supposedly due to the aging sperm and/or aging ovum. Although many contraceptive methods are implicated as teratogens or mutagens the evidence is not yet convincing. Insufficient data lack of controls and recall bias are just some of the reasons for remaining skeptical of the aforementioned studies.