The long-term growth and development of children exposed to Depo-Provera during pregnancy or lactation

Abstract

Children exposed to the injectable contraceptive Depo-Provera (DMPA) during pregnancy (N = 1,207), and/or during breastfeeding (N = 1,215) were exposures during pregnancy or breastfeeding. Weights and heights were measured for all children, and information on signs of puberty obtained for children aged ten and over. Cross-sectional weights and heights by age of DMPA-exposed children were similar to those for controls. Children with DMPA exposure during pregnancy and lactation had an increased risk of suboptimal growth in height, defined as less than two Z scores on NCHS standards (RR = 1.4, 95% CI 1.2-1.8). However, after adjustment for socioeconomic factors by multiple logistic regression, there was no increased risk of impaired growth among the DMPA-exposed children (RR = 1.1, 95% CI 0.8 - 1.6). With the exception of a delay in onset of reported pubic hair growth among DMPA-exposed girls, there were no significant effects on attainment of puberty. We conclude that use of DMPA during pregnancy or breastfeeding does not adversely affect the long-term growth and development of children.

PIP: In Chiang Mai, Thailand, community physicians followed 2422 women who used the contraceptive injectable, Depo-Provera (DMPA), either during pregnancy and/or while breast feeding. They compared the longterm growth of the children exposed to DMPA with that of 1167 children who were not exposed to hormones during pregnancy or lactation. Multiple logistic regression revealed that DMPA exposure did not adversely affect mean height and weight by age for either sex. In fact, the height and weight curves of DMPA exposed children paralleled cross-sectional growth charts of the general population of Chiang Mai. DMPA did not significantly alter breast milk volume or composition. WHO has reported that some DMPA does pass into the breast milk (maternal plasma: milk ratios range from 100:60 to 1:1), but, according to these findings, this passively transferred DMPA dose not adversely affect child development. DMPA exposure in utero did not delay puberty among boys. DMPA-exposed girls experienced a slight but insignificant delay in menarche and breast development (20.6 vs. 22.8% and 57.4 vs. 58.3%, respectively). The hormone appeared to significantly delay appearance of pubic hair among DMPA exposed girls (9.3% of cases had pubic hair by 15 vs. 14.4% of controls; p = .05), but the researchers had to depend on reports of the mothers and children, since cultural sensitivities precluded them from directly observing pubic hair development. In addition, the numbers of children older than 10 years were small. The researchers planned to prospectively follow a larger sample of DMPA-exposed children to more precisely determine puberty-related changes. In conclusion, breast-feeding mothers can safely use Depo-Provera.