Advertisement

Hormonal Contraceptive Use Among Adolescent Girls in Germany in Relation to Health Behavior and Biological Cardiovascular Risk Factors

      Abstract

      Purpose

      To determine the association between hormonal contraceptive (HC) use, and behavior-related and biological cardiovascular risk factors among teenage girls in Germany.

      Methods

      HC use was assessed among 2,285 girls aged 13–17 years who participated in the health survey for children and adolescents (German Health Interview and Examination Survey for Children and Adolescents, KiGGS), between years 2003 and 2006. Prevalence of HC use was determined according to sociodemographic variables, behavior-related health risks, and overweight status. We compared HC users and nonusers with respect to biological cardiovascular risk factors, including systolic and diastolic blood pressure, and serum concentrations of lipids, lipoproteins, high sensitivity C-reactive protein (hs-CRP), and homocysteine.

      Results

      HC users were more likely than nonusers to combine several behavior-related health risks, independent of sociodemographic factors. In particular, HC use was strongly associated with current smoking (odds ratio: 3.4, 95% confidence interval: 2.7–4.3). HC use and behavioral factors showed an additive effect on biological cardiovascular risk factors, explaining between 6% and 30% of the population variance. Relative contributions of HC use ranged from <1% for systolic and diastolic blood pressure to 12% for hs-CRP.

      Conclusions

      HC use among 13–17-year-old girls in Germany is significantly correlated with a more unfavorable cardiovascular risk profile, which is partly explained by a clustering of behavioral risk factors among HC users. When prescribing HC to teenagers, physicians should systematically assess avoidable behavioral cardiovascular risk factors and provide counseling tailored to the risk profile of the individual patient.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rabe T.
        • Brucker C.
        Gemeinsame Stellungnahme der Deutschen Gesellschaft für Gynäkologische Endokrinologie und Fortpflanzungsmedizin e.V. (DGGEF e.V.) in Zusammenarbeit mit dem Berufsverband der Frauenärzte e.V.: Empfängnisverhütung–Familienplanung in Deutschland.
        J Reproduktionsmed Endokrinol. 2004; 1: 202-221
        • Haider Z.
        • D'Souza R.
        Non-contraceptive benefits and risks of contraception.
        Best Pract Res Clin Obstet Gynaecol. 2009; 23: 249-262
        • World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
        Venous thromboembolic disease and combined oral contraceptives: Results of international multicentre case-control study.
        Lancet. 1995; 346: 1575-1582
        • World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
        Ischaemic stroke and combined oral contraceptives: Results of international multicentre case-control study.
        Lancet. 1996; 348: 498-505
        • World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
        Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: Results of international multicentre case-control study.
        Lancet. 1996; 348: 505-510
        • World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
        Acute myocardial infarction and combined oral contraceptives: Results of international multicentre case-control study.
        Lancet. 1997; 349: 1202-1209
        • Gillum L.A.
        • Mamidipudi S.K.
        • Johnston S.C.
        Ischemic stroke risk with oral contraceptives: A meta-analysis.
        JAMA. 2000; 284: 72-78
        • Kemmeren J.M.
        • Algra A.
        • Grobbee D.E.
        Third generation oral contraceptives and risk of venous thrombosis: Meta-analysis.
        BMJ. 2001; 323: 131-134
        • van Hylckama-Vlieg A.
        • Helmerhorst F.M.
        • Vandenbroucke J.P.
        • et al.
        The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: Results of the MEGA case-control study.
        BMJ. 2009; 339: b2921
        • Lidegaard O.
        • Lokkegaard E.
        • Svendsen A.L.
        • et al.
        Hormonal contraception and risk of venous thromboembolism: National follow-up study.
        BMJ. 2009; 339: b2890
        • Paulus D.
        • Saint-Remy A.
        • Jeanjean M.
        Oral contraception and cardiovascular risk factors during adolescence.
        Contraception. 2000; 62: 113-116
        • Kosunen E.A.
        • Rimpela A.H.
        • Kaprio J.A.
        • et al.
        Oral contraception and smoking: Time trends for a risk behaviour in Finland.
        Eur J Public Health. 1997; 7: 29-33
        • Raitakari O.T.
        • Porkka K.V.
        • Rasanen L.
        • et al.
        Relations of life-style with lipids, blood pressure and insulin in adolescents and young adults.
        Atherosclerosis. 1994; 111: 237-246
        • Webber L.S.
        • Hunter S.M.
        • Johnson C.C.
        • et al.
        Smoking, alcohol, and oral contraceptives.
        Ann N Y Acad Sci. 1991; 623: 135-154
        • Nawrot T.S.
        • Den Hond E.
        • Fagard R.H.
        • et al.
        Blood pressure, serum total cholesterol and contraceptive pill use in 17-year-old girls.
        Eur J Cardiovasc Prev Rehabil. 2003; 10: 438-442
        • Webber L.S.
        • Hunter S.M.
        • Baugh J.G.
        • et al.
        The interaction of cigarette smoking, oral contraceptive use, and cardiovascular risk factor variables in children: The Bogalusa Heart Study.
        Am J Public Health. 1982; 72: 266-274
        • Kurth B.M.
        • Kamtsiuris P.
        • Holling H.
        • et al.
        The challenge of comprehensively mapping children's health in a nation-wide health survey: Design of the German KiGGS-Study.
        BMC Public Health. 2008; 8: 196
        • Kromeyer-Hauschild K.
        • Wabitsch M.
        • Kunze D.
        • et al.
        Perzentile für den Body-mass Index für das Kindes-und Jugendalter unter Heranziehung verschiedener Deutscher Stichproben.
        Monatsschr Kinderheilkd. 2001; 149: 807-818
        • Kahl H.
        • Schaffrath-Rosario A.
        • Schlaud M.
        Sexual maturation of children and adolescents in Germany.
        Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007; 50 ([in German]): 677-685
        • Thierfelder W.
        • Dortschy R.
        • Hintzpeter B.
        • et al.
        Biochemical measures in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS).
        Lab Med. 2008; 32: 1-14
        • Winkler J.
        • Stolzenberg H.
        Social class index in the Federal Health Survey.
        Gesundheitswesen. 1999; 61 ([in German]): S178-S183
        • Schmid-Tannwald I.
        • Kluge N.
        Sexualität und Kontrazeption aus der Sicht der Jugendlichen und ihrer Eltern.
        Bundeszentrale für gesundheitliche Aufklärung, Köln, Germany2003
        • Krishnamoorthy N.
        • Simpson C.D.
        • Townend J.
        • et al.
        Adolescent females and hormonal contraception: A retrospective study in primary care.
        J Adolesc Health. 2008; 42: 97-101
        • van Hooff M.H.
        • Hirasing R.A.
        • Kaptein M.B.
        • et al.
        The use of oral contraceptives by adolescents for contraception, menstrual cycle problems or acne.
        Acta Obstet Gynecol Scand. 1998; 77: 898-904
        • Hassani K.F.
        • Kosunen E.
        • Rimpela A.
        The use of oral contraceptives among Finnish teenagers from 1981 to 2003.
        J Adolesc Health. 2006; 39: 649-655
        • Du Y.
        • Melchert H.U.
        • Schafer-Korting M.
        Use of oral contraceptives in Germany: Prevalence, determinants and use-associated health correlates.
        Eur J Obstet Gynecol Reprod Biol. 2007; 134: 57-66
        • Lundberg V.
        • Tolonen H.
        • Stegmayr B.
        • et al.
        Use of oral contraceptives and hormone replacement therapy in the WHO MONICA project.
        Maturitas. 2004; 48: 39-49
        • Robert Koch-Institut
        20 Jahre nach dem Fall der Mauer: Wie hat sich die Gesundheit in Deutschland entwickelt?.
        RKI, Berlin, Germany2009
        • Paulus D.
        • Saint-Remy A.
        • Jeanjean M.
        Smoking during adolescence: Association with other cardiovascular risk factors in Belgian adolescents.
        Eur J Public Health. 2000; 10: 39-44
        • Orchard T.J.
        • Rodgers M.
        • Hedley A.J.
        • et al.
        Changes in blood lipids and blood pressure during adolescence.
        BMJ. 1980; 280: 1563-1567
        • Cauci S.
        • Di Santolo M.
        • Culhane J.F.
        • et al.
        Effects of third-generation oral contraceptives on high-sensitivity C-reactive protein and homocysteine in young women.
        Obstet Gynecol. 2008; 111: 857-864
        • Raitakari M.
        • Mansikkaniemi K.
        • Marniemi J.
        • et al.
        Distribution and determinants of serum high-sensitive C-reactive protein in a population of young adults: The cardiovascular Risk in Young Finns Study.
        J Intern Med. 2005; 258: 428-434
        • van Rooijen M.
        • Hansson L.O.
        • Frostegard J.
        • et al.
        Treatment with combined oral contraceptives induces a rise in serum C-reactive protein in the absence of a general inflammatory response.
        J Thromb Haemost. 2006; 4: 77-82
        • Buchbinder S.
        • Kratzsch J.
        • Fiedler G.M.
        • et al.
        Body weight and oral contraceptives are the most important modulators of serum CRP levels.
        Scand J Clin Lab Invest. 2008; 68: 140-144
        • Croft P.
        • Hannaford P.C.
        Risk factors for acute myocardial infarction in women: Evidence from the Royal College of General Practitioners' oral contraception study.
        BMJ. 1989; 298: 165-168
        • Pomp E.R.
        • Rosendaal F.R.
        • Doggen C.J.
        Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use.
        Am J Hematol. 2008; 83: 97-102
        • Dietrich J.E.
        • Hertweck S.P.
        Thrombophilias in adolescents: The past, present and future.
        Curr Opin Obstet Gynecol. 2008; 20: 470-474
        • de Ferranti S.D.
        • Rifai N.
        C-reactive protein: A nontraditional serum marker of cardiovascular risk.
        Cardiovasc Pathol. 2007; 16: 14-21
        • Genest J.
        C-reactive protein: Risk factor, biomarker and/or therapeutic target?.
        Can J Cardiol. 2010; 26: 41A-44A