Initiation of Oral Contraceptives and Changes in Blood Pressure and Body Mass Index in Healthy Adolescents

Abstract

Objectives To describe changes in systolic blood pressure (SBP), diastolic blood pressure (DBP) and body mass index (BMI) associated with initiation and continued use of combined oral contraceptives (COCs) in healthy adolescents. Study design This observational, matched cohort study was conducted in two large health systems. Utilizing claims and electronic medical records, we identified adolescents 14-17.9 years of age initiating medium-dose COCs (containing 30 or 35 micrograms of ethinyl estradiol or equivalent and a progestin) between 7/1/07-12/31/09 with a baseline and at least one follow-up BP and BMI. COC-users were matched 1:2 by age, race/ethnicity and site to controls (COC-non-users). All BPs and BMIs recorded during outpatient visits starting 1 month prior to COC initiation (index date for controls), through 12/31/2010 were collected. Mixed model linear regression with random intercepts and slopes were then used to estimate changes in SBP, DBP and BMI over time. Results The 510 adolescent COC-users and 912 controls did not differ significantly by age, race/ethnicity, insurance, baseline SBP, DBP or BMI. After adjusting for baseline values, over a median of 18 months follow-up, COC-users had an decrease in SBP of 0.07 mmHG/month, and controls had an increase of 0.02 mmHG/month (p=.65). Similarly, DBP decreased by 0.007 mmHG/month in COC-users versus 0.006 mmHG/month in controls (p=.99). BMI increased by 0.04 (kg/m2)/month in COC-users versus 0.025(kg/m2)/month in controls (p=.09). Conclusions These data should provide reassurance to patients and providers regarding the lack of significant associations between COC-use and BMI or BP changes in adolescents.

Factors Affecting Tracking of Blood Pressure from Childhood to Adulthood: The Childhood Determinants of Adult Health Study

“…19 Similar trends were observed for cardiorespiratory fitness in our article, although nonsignificant. Previous studies have demonstrated an association between hormonal contraceptive use and elevated BP, 20 yet recent cross-sectional literature shows that the influence of oral contraceptives in development of BP during adolescence is nonsignificant, 21 in agreement with our results. Further literature supports the detrimental effect of lower SES in childhood on health in adulthood.…”

Considerations for the analysis of longitudinal electronic health records linked to claims data to study the effectiveness and safety of drugs

“…Our search returned 542 unique articles/abstracts, among which nine journal articles and six abstracts were selected. Most of the articles were excluded because they did not investigate drug effectiveness or safety ( n = 350), some for using only EHR ( n = 47) or claims data ( n = 10), some for using both types of datasets without data linkage ( n = 55).…”

FSRH Guideline (January 2019, amended October 2023) Combined Hormonal Contraception

“…One matched cohort study published since this review found no significant changes in blood pressure among adolescents using COC during 18 months of follow-up when compared with controls 369. No studies were identified that examined changes in blood pressure with time among patch users.…”

“…In one matched cohort study of adolescents using COC published since this review,369 BMI increased by a mean of 0.04 kg/m 2 per month among COC users versus 0.025 kg/m 2 per month among controls. If BMI is ≥35 kg/m 2 at follow-up, women should be advised to switch to an alternative method of contraception.…”