Abstract
Hormonal contraceptives (HC) are thought to play a role in the pathogenesis of cardiovascular diseases. The study evaluated the use of HC as a primary cause of preeclampsia (PE) among Ghanaians. This study comprised 30 preeclamptic women and 30 healthy normotensive pregnant women with over 20 weeks of gestation at the Comboni Hospital, Ghana using a randomized case-control study. Blood pressure, weight, height, socio-demographics, medical and previous obstetric history were taken and recorded. Blood samples were collected for the estimation of homocysteine and fasting lipids. Estimated foetal weight (EFW) and infant birthweight (BWT) were obtained from maternal records. This study was carried out in 2019. 80.0% of women with PE used the hormonal contraceptive “depot medroxyprogesterone acetate” (DMPA) prior to pregnancy. The use of DMPA was associated with about thirty-fold increase in the odds of developing PE (OR = 29.71, p 0.001). Systolic blood pressure (P 0.001), diastolic blood pressure (P 0.001), triglycerides (P = 0.024), LDL-C (P = 0.026), and homocysteine levels (P 0.001) were significantly elevated in the PE cases than the normal pregnant (NP) women, whilst EFW (P 0.001), BWT (P 0.001) and HDL-C levels (P = 0.001) were significantly reduced in the PE cases when compared to NP women. 50% and 47% of PE cases had intrauterine growth restriction and low birthweight infants, respectively. In conclusion, DMPA use predisposes women to a high risk of developing PE. DMPA could partly contribute to endothelial dysfunction, hyperhomocysteinaemia, dyslipidaemia and excessive weight gain, all of which characterize PE.
Highlights
Hormonal contraception generally refers to birth control methods that act on the endocrine system
Systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), triglycerides (P = 0.024), low density lipoprotein cholesterol (LDL-C) (P = 0.026), and homocysteine levels (P < 0.001) were significantly elevated in the PE cases than the normal pregnant (NP) women, whilst Estimated foetal weight (EFW) (P < 0.001), BWT (P < 0.001) and high density lipoprotein cholesterol (HDL-C) levels (P = 0.001) were significantly reduced in the PE cases when compared to NP women. 50% and 47% of PE cases had intrauterine growth restriction and low birthweight infants, respectively
depot medroxyprogesterone acetate” (DMPA) could partly contribute to endothelial dysfunction, hyperhomocysteinaemia, dyslipidaemia and excessive weight gain, all of which characterize PE
Summary
Hormonal contraception generally refers to birth control methods that act on the endocrine system. There are two main types of hormonal contraceptive formulations. These are combined methods that contain both estrogen and progestin, and progestogen-only methods which contain only progesterone or one of its synthetic analogues (progestins) [1]. HC use is associated with hypertension, dyslipidemia, and insulin resistance, all of which characterize hypertensive disorders of pregnancy (HDP) [2]. HDP (which includes preeclampsia) is one of the commonest causes of maternal mortality [3] and accounted for 37,000 deaths in 1990 and 29,000 in 2013 [4]. Preeclampsia (PE) is characterized by hypertension and significant proteinuria [5]. In Ghana, the incidence of PE was reported to be 7.03% [7]. Another study conducted in Ghana showed that the prevalence of PE was 6.55% [8]
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