Akademik Veri Yönetim Sistemi
5th Regional TIAFT Meeting in TURKIYE, Diyarbakır, Türkiye, 9 - 11 Ekim 2024
Introduction
Medroxyprogesterone
acetate (MPA) is one of the first-generation progestins and 20-50 times more
potent than progesterone. In our country, it is widely used orally (2.5-10
mg/day) or intramuscularly (150 mg) for the evaluation of secondary amenorrhea,
to prevent miscarriage, and as a contraceptive by inhibiting the secretion of
gonadotropic hormones and ovulation through its central effect.
Past animal
studies have linked exposure to MPA during pregnancy to cleft palate, external
genital anomalies, and muscular ventricular septal defect (VSD). Previous
studies have associated maternal MPA exposure with congenital heart anomalies,
neural tube defects, and external genital anomalies. Yovich et al. (2020) found
that pregnant women using oral MPA in the first trimester due to miscarriage
threat had a higher risk of fetal anomalies compared to non-users, but this
risk was not above the background pregnancy risk. Additionally, Reprotox
reports that the use of MPA during early pregnancy was not associated with an
increase in non-genital malformations. Insufficient
and conflicting data exist on the effects of MPA exposure on the fetus in
pregnancy
Aim
The aim of
this study is to evaluate the fetal outcomes of our pregnant women who used
medroxyprogesterone acetate.
Method
Our study
examined 146 pregnant women who used MPA during pregnancy and presented to the
Trabzon Teratogenicity Information Service (Trabzon-TIS) between 2000 and 2022. Data
collected included maternal age, smoking and alcohol consumption,
consanguinity, Rh incompatibility, previous pregnancy outcomes, X-ray exposure,
medication details, and gestational age. Risk assessments were conducted based
on these data, clinical properties, and relevant literature. Physicians and
patients were informed of about the assessed risks. Pregnancy courses and outcomes were
recorded, and postnatal physical and mental development were followed up for
one year.
Findings
Of
146 pregnant women who visited our clinic, 37 were excluded due to loss of
contact post-delivery. The ages of the 109 included women ranged from 17 to
43, with an average age of 30.32
years. In addition to MPA, the women used between 1 and 14 other active
substances (average 3.12).
A total of 106 women were exposed to MPA only in the first trimester, and three
were exposed during both the first and second trimesters. Four women used MPA
intramuscularly (single dose Depoprovera® 150 mg/ml), while 105 used it orally
(5-10 (five to ten) mg/day).
One women exposed combined preparation containing conjugated estrogen and MPA.
Of the 109
pregnancies with postnatal outcomes, 87 resulted in healthy births. Adverse
outcomes included four spontaneous abortions, 12 therapeutic abortions, two
intrauterine deaths, and four babies with cardiac defects.
Conclusion
Our study
noted cardiac defects in four babies (two with atrial septal defect(ASD), one
with minimal ASD+VSD, one with ASD+ Vesicoureteral
Reflux) and two intrauterine losses (one due to unknown causes, one due to
maternal thrombophilia) compared to 87 healthy babies. None of the newborns in
our study had neural tube defects or external genital anomalies. Further
studies are needed due to the small number of cases and lack of a control
group.
Keyword:
Medroxyprogesterone acetate, cardiac defects, teratogenicity