Contraindications to Combined Oral Contraceptives Among Over-the-Counter Compared With Prescription Users
Contraindications to Combined Oral Contraceptives Among Over-the-Counter Compared With Prescription Users
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DOI：
10.1097/aog.0b013e31820b0244
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发表时间：
2011-03-01
影响因子：
7.2
通讯作者：
Potter, Joseph E.
中科院分区：
文献类型：
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作者：
Grossman, Daniel;White, Kari;Potter, Joseph E.
目的：比较在美国公共诊所获得复方口服避孕药的女性与在墨西哥药店获得复方口服避孕药的女性之间的禁忌症估计比例。方法：我们招募了501名德克萨斯州埃尔帕索的女性居民，在墨西哥获得非处方复方口服避孕药的妇女和在埃尔帕索计划生育诊所获得复方口服避孕药的514名妇女。根据自我报告的世界卫生组织第3和第4类禁忌症和采访者测量的血压，我们估计的比例禁忌症，并使用多变量调整的logistic回归，确定可能的预测因素的禁忌症。相对禁忌症（第3类）在非处方药使用者中更常见（13%，而在诊所使用者中为9%，P= 0.006）。绝对禁忌症（第4类）在两组之间没有差异（诊所使用者为5%，OTC使用者为7%，P= 0.162）。高血压是最常见的禁忌症（5.6%的门诊使用者和9.8%的OTC使用者）。多变量校正后，OTC使用者有禁忌症的几率高于诊所使用者（比值比[OR] 1.59，95%置信区间[CI] 1.11-2.29）。年龄在35岁或以上的妇女（OR 5.30，95%CI 3.59-7.81）和那些身体质量指数30.0或以上（OR 2.24，95%CI 1.40-3.56）也有较高的几率有禁忌症。结论：相对联合口服避孕药禁忌症是更常见的OTC用户在这种情况下。考虑到其较少的禁忌症，仅孕激素药丸可能是第一个OTC产品的更好候选者。（Obstet Gynecol 2011;117：558-65）DOI：10.1097/AOG.0b013e31820b0244
OBJECTIVE: To compare the estimated proportion of contraindications to combined oral contraceptives between women who obtained combined oral contraceptives in U.S. public clinics compared with women who obtained combined oral contraceptives over the counter (OTC) in Mexican pharmacies.METHODS: We recruited a cohort of 501 women who were residents of El Paso, Texas, who obtained OTC combined oral contraceptives in Mexico and 514 women who obtained combined oral contraceptives from family planning clinics in El Paso. Based on self-report of World Health Organization category 3 and 4 contraindications and interviewer-measured blood pressure, we estimated the proportion of contraindications and, using multivariable-adjusted logistic regression, identified possible predictors of contraindications.RESULTS: The estimated proportion of any category 3 or 4 contraindication was 18%. Relative contraindications (category 3) were more common among OTC users (13% compared with 9% among clinic users, P=.006). Absolute contraindications (category 4) were not different between the groups (5% for clinic users compared with 7% for OTC users, P=.162). Hypertension was the most prevalent contraindication (5.6% of clinic users and 9.8% of OTC users). After multivariable adjustment, OTC users had higher odds of having contraindications compared with clinic users (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.11-2.29). Women aged 35 years or older (OR 5.30, 95% CI 3.59-7.81) and those with body mass index 30.0 or more (OR 2.24, 95% CI 1.40-3.56) also had higher odds of having contraindications.CONCLUSION: Relative combined oral contraceptive contraindications are more common among OTC users in this setting. Progestin-only pills might be a better candidate for the first OTC product given their fewer contraindications. (Obstet Gynecol 2011;117:558-65) DOI:10.1097/AOG.0b013e31820b0244