Re: DEPO-PROVERA - during pregnancy - effects on fetus

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"The children exposed in utero to Depo-Provera had higher neonatal and infant mortality rates (44.3 and 62.9 per 1,000 live births, respectively) than did the controls (19.8 and 29.1 per 1,000 live births)...... low birth weight may act as an intermediate determinant of Depo-Provera-associated mortality.......However, among accidental pregnancies with Depo-Provera, the risk of low birth weight was significantly increased when conception was estimated to have occurred within 4 weeks of injection. The odds ratios were 1.9 (95% Cl 1.4-3.2) for injection-to-conception intervals of less than or equal to 4 weeks........... There was a significantly increased association of polysyndactyly among infants of DMPA users relative to the other groups, which was most pronounced in offspring of women under age 30 years, and persisted after exclusion of subjects with a family history or infants with multiple abnormalities. However, in five out of the ten polysyndactyly cases, the last injection of DMPA occurred more than 9 months before conception, and only three cases had definite gestational exposure. The association of chromosomal anomalies was also significantly increased in infants of mothers who used DMPA. The unrelated nature of these defects, the lack of confirmation from other studies, the distant preconceptional exposure to DMPA in many cases, and chance effects due to multiple statistical comparisons make a causal association unlikely. Other birth defects that had been previously reported in some publications to be associated with progestational steroid exposure, such as neural tube defects, heart malformations, and limb reduction defects, were not found in this study..............the modest demasculinization effects of prenatal hormone exposure observed in females."

--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York

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