单避孕药:对体重的影响。

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陈洛佩兹LM,拉梅什S, M,埃德尔曼,Otterness C, Trussell J, Helmerhorst调频

单避孕药:对体重的影响。

科克伦数据库系统启2016年8月28日;(8):CD008815。cd008815.pub4 doi: 10.1002/14651858.。

PubMed ID
27567593 (在PubMed
]
文摘

背景:单避孕药(poc)适合许多妇女不能或者不应该采用雌激素。poc包括注射剂、子宫内避孕,植入物,口服避孕药。许多poc长效,成本效益的方法防止怀孕。不过,担心体重增加可以阻止避孕的起始和引起早期停用用户。目的:主要目的是评估之间的联系单避孕和体重的变化。必威国际app搜索方法:到2016年8月4日,我们搜查了MEDLINE,中央,POPLINE,紫丁香,ClinicalTrials.gov, ICTRP。对于最初的审查,我们联系了调查人员确定其他试验。选择标准:我们认为比较研究,研究了POC和另一个避孕方法或没有避孕。主要结果是平均体重的变化或平均身体成分的变化。我们也认为这两个结果的损失或获得指定数量的重量的。 DATA COLLECTION AND ANALYSIS: Two authors extracted the data. Non-randomized studies (NRS) need to control for confounding factors. We used adjusted measures for the primary effects in NRS or the results of matched analysis from paired samples. If the report did not provide adjusted measures for the primary analysis, we used unadjusted outcomes. For RCTs and NRS without adjusted measures, we computed the mean difference (MD) with 95% confidence interval (CI) for continuous variables. For dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% CI. MAIN RESULTS: We found 22 eligible studies that included a total of 11,450 women. With 6 NRS added to this update, the review includes 17 NRS and 5 RCTs. By contraceptive method, the review has 16 studies of depot medroxyprogesterone acetate (DMPA), 4 of levonorgestrel-releasing intrauterine contraception (LNG-IUC), 5 for implants, and 2 for progestin-only pills.Comparison groups did not differ significantly for weight change or other body composition measure in 15 studies. Five studies with moderate or low quality evidence showed differences between study arms. Two studies of a six-rod implant also indicated some differences, but the evidence was low quality.Three studies showed differences for DMPA users compared with women not using a hormonal method. In a retrospective study, weight gain (kg) was greater for DMPA versus copper (Cu) IUC in years one (MD 2.28, 95% CI 1.79 to 2.77), two (MD 2.71, 95% CI 2.12 to 3.30), and three (MD 3.17, 95% CI 2.51 to 3.83). A prospective study showed adolescents using DMPA had a greater increase in body fat (%) compared with a group not using a hormonal method (MD 11.00, 95% CI 2.64 to 19.36). The DMPA group also had a greater decrease in lean body mass (%) (MD -4.00, 95% CI -6.93 to -1.07). A more recent retrospective study reported greater mean increases with use of DMPA versus Cu IUC for weight (kg) at years 1 (1.3 vs 0.2), 4 (3.5 vs 1.9), and 10 (6.6 vs 4.9).Two studies reported a greater mean increase in body fat mass (%) for POC users versus women not using a hormonal method. The method was LNG-IUC in two studies (reported means 2.5 versus -1.3; P = 0.029); (MD 1.60, 95% CI 0.45 to 2.75). One also studied a desogestrel-containing pill (MD 3.30, 95% CI 2.08 to 4.52). Both studies showed a greater decrease in lean body mass among POC users. AUTHORS' CONCLUSIONS: We considered the overall quality of evidence to be low; more than half of the studies had low quality evidence. The main reasons for downgrading were lack of randomizations (NRS) and high loss to follow-up or early discontinuation.These 22 studies showed limited evidence of change in weight or body composition with use of POCs. Mean weight gain at 6 or 12 months was less than 2 kg (4.4 lb) for most studies. Those with multiyear data showed mean weight change was approximately twice as much at two to four years than at one year, but generally the study groups did not differ significantly. Appropriate counseling about typical weight gain may help reduce discontinuation of contraceptives due to perceptions of weight gain.

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