醋酸甲羟孕酮储存剂的使用与年轻女性血铅水平的队列研究。
Depot Medroxyprogesterone Acetate Use and Blood Lead Levels in a Cohort of Young Women.
机构信息
Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA.
出版信息
Environ Health Perspect. 2020 Nov;128(11):117004. doi: 10.1289/EHP7017. Epub 2020 Nov 18.
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 (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.
背景
全球有 7400 万名女性使用可注射避孕药，其中包括注射用醋酸甲羟孕酮（DMPA）。使用 DMPA 与骨密度降低有关。我们假设 DMPA 的使用会增加骨吸收，从而使储存在骨骼中的有毒金属铅释放到血液中，使使用者面临更高的铅系统暴露风险。
目的
本研究旨在探讨当前使用 DMPA 与血铅浓度之间的关系。
方法
我们对“环境、生活方式和纤维瘤研究（SELF）”的入组数据进行了横断面分析，该队列由 1693 名年龄在 23-35 岁的非裔美国女性组成。通过计算机辅助电话访谈收集 DMPA 使用数据。在 1548 名参与者（队列的 91%）中测量全血样本中的血铅浓度。我们使用多变量线性回归估计当前 DMPA 用户与非用户之间血铅浓度的调整后百分比差异及其 95%置信区间（CI）。
结果
几何平均血铅浓度为 （95%CI：0.67，0.71）。调整后，当前 DMPA 用户（占队列的 7%）的血铅浓度比非用户高 18%（95%CI：8%，29%）。在评估吸烟、DMPA 诱导的闭经、使用含雌激素的避孕药、前一年分娩、以及与骨丢失相关的医疗状况或当前用药史等潜在偏倚的额外分析中，也观察到了类似的关联。
讨论
我们的结果表明，当前 DMPA 的使用与血铅浓度升高有关。需要进一步研究，特别是在铅暴露程度较高的人群中，以权衡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。https://doi.org/10.1289/EHP7017.
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