Abstract

Background:

Injectable contraceptive use is common, with 74 million users worldwide. Use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) is associated with bone mineral density loss. We hypothesize that increased bone resorption with DMPA use allows for mobilization of the toxic metal lead stored in bone to blood, presenting users with increased systemic exposure to lead.

Objective:

The objective of our study was to investigate the association between current DMPA use and blood lead concentrations.

Methods:

We conducted a cross-sectional analysis using enrollment data from the Study of Environment, Lifestyle & Fibroids (SELF), a cohort of 1,693 African-American women who were 23–35 years of age. Data on DMPA use were collected by computer-assisted telephone interview. Blood lead concentrations were measured in whole blood samples among 1,548 participants (91% of cohort). We estimated the adjusted percent difference in blood lead concentrations and 95% confidence intervals (CI) between current DMPA users and nonusers using multivariable linear regression.

Results:

Geometric mean blood lead concentration was $0.69\mathrm{\mu }\mathrm{g}/\text{dL}$ (95% CI: 0.67, 0.71). After adjustment, current DMPA users (7% of cohort) had blood lead concentrations that were 18% higher than those of nonusers (95% CI: 8%, 29%). Similar associations were observed with additional analyses to assess for potential bias from smoking, DMPA-induced amenorrhea, use of estrogen-containing contraceptives, having given birth in the prior year, and history of medical conditions or current medication use associated with bone loss.

Discussion:

Our results indicate that current DMPA use is associated with increased blood lead concentrations. Further research, particularly in populations highly exposed to lead, is warranted to consider tradeoffs between the adverse effects of lead on human health and the importance of DMPA as a contraceptive option to prevent unintended pregnancy. https://doi.org/10.1289/EHP7017

中文翻译：

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一组年轻女性中长效醋酸甲羟孕酮的使用和血铅水平

 抽象的

 背景：

注射避孕药的使用很普遍，全世界有 7400 万使用者。使用注射避孕药长效醋酸甲羟孕酮 (DMPA) 会导致骨矿物质密度下降。我们假设使用 DMPA 会增加骨吸收，从而将骨骼中储存的有毒金属铅转移到血液中，从而使使用者的全身铅暴露量增加。

 客观的：

我们研究的目的是调查当前 DMPA 使用与血铅浓度之间的关联。

 方法：

我们使用环境、生活方式和肌瘤研究 (SELF) 的入组数据进行了一项横断面分析，该研究由 1,693 名 23-35 岁的非裔美国女性组成。 DMPA 使用数据通过计算机辅助电话采访收集。对 1,548 名参与者（占队列的 91%）的全血样本中的血铅浓度进行了测量。我们使用多元线性回归估计了当前 DMPA 用户和非用户之间血铅浓度的调整百分比差异和 95% 置信区间 (CI)。

 结果：

几何平均血铅浓度为$\mathrm{<span\; data-immersive-translate-walked="087ef351-12c1-4f18-80ee-078b9ba542f0">0.69</span>}\mathrm{<span\; data-immersive-translate-walked="087ef351-12c1-4f18-80ee-078b9ba542f0">\mu </span>}\mathrm{<span\; data-immersive-translate-walked="087ef351-12c1-4f18-80ee-078b9ba542f0">克</span>}<span\; data-immersive-translate-walked="087ef351-12c1-4f18-80ee-078b9ba542f0">/</span>\text{<span data-immersive-translate-walked="087ef351-12c1-4f18-80ee-078b9ba542f0">dL</span>}$ （95% CI：0.67，0.71）。调整后，当前 DMPA 用户（队列中的 7%）的血铅浓度比非用户高 18%（95% CI：8%、29%）。通过额外的分析观察到类似的关联，以评估吸烟、DMPA 引起的闭经、使用含雌激素的避孕药、前一年生育过、以及与骨质流失相关的医疗状况或当前药物使用的潜在偏差。

 讨论：

我们的结果表明，目前 DMPA 的使用与血铅浓度升高有关。进一步的研究，特别是在铅高度暴露的人群中，有必要考虑铅对人类健康的不利影响与 DMPA 作为预防意外怀孕的避孕选择的重要性之间的权衡。 https://doi.org/10.1289/EHP7017