Ashley Morgan Hammer, MD and Lamar Ekbladh, MD
Department of Obstetrics and Gynecology, Drexel University College of Medicine
Introduction
More than one-third (34.9% or 78.9 million) of U.S
adults are now obese.1 Obesity related conditions,
including heart disease, stroke, type 2 diabetes, and
certain forms of cancer, are leading preventable
causes of death.
Approximately half of all pregnancies in the U.S.
are unplanned. In unmarried women in their twenties,
seven out of ten pregnancies are unplanned. The
reason for this is multifaceted, with cost and access
barriers contributing to the high numbers. However,
lack of knowledge about contraception, as well as
beliefs in myths and misinformation, add to the
alarming rate of unplanned pregnancy
Obesity is known to affect the health of both
present and future generations. There are higher rates
of maternal and fetal morbidity and mortality in obese
women when compared to women of normal weight.3
Therefore, any association between obesity and the
ability to prevent pregnancy constitutes a major health
concern. Most of the available literature on obesity
and contraception focuses on effectiveness,
pharmacokinetics, and medical complications.
Results Continued
Results
61 women completed the survey. After exclusion of women who were under the age of 18, 58 surveys were analyzed. Of the
respondents, 35 women were of normal BMI and 23 women (39.6%) were obese. There were no statistically significant differences
between the groups in age, race, or parity. The average age of participants was 24 and 26 in the normal BMI group and the obese
group, respectively (p=0.052). The survey results are displayed below.
Prior Contraceptive Use
Method
Planned Postpartum Contraception
Normal BMI
Obese
p Value
Condoms
63.6
45.5
0.22
OCPs
54.5
40.9
0.36
Depo
Ring
60.6
31.8
9.1
9.1
0.046
0.64
Method
Normal BMI
Obese
p Value
Condoms
6.1
9.1
0.93
OCPs
15.1
27.3
0.44
Depo
36.4
9.1
0.026
Ring
6.1
4.5
0.71
Patch
6.1
0
0.67
Withdrawal
0
9.1
0.30
Nothing
0
4.5
0.83
Patch
3.0
9.1
0.71
Withdrawal
6.1
9.1
0.93
Nothing
12.1
22.7
0.49
IUD
12.1
22.7
0.49
IUD
6.1
18.2
0.32
Implant
6.1
4.5
0.92
Implant
3.0
0
0.83
BTL
15.1
9.1
0.82
Contraceptive Beliefs
Materials and Methods
The goal of this study was to determine differences
in contraceptive choice between obese and normal
BMI women in an inner-city clinic and to discern
potential reasoning behind those choices. To do this, a
questionnaire was distributed to pregnant women at
the Drexel University Women’s Care Center, a resident
run clinic in downtown Philadelphia.
The survey included questions that assessed
women’s beliefs about contraception, their
contraceptive influences, as well as their prior
contraceptive use and future plans for contraception.
A traditional BMI of 30 was used as the cutoff for
obesity. The survey was distributed to pregnant
women between 32 and 40 weeks gestation. Women
were excluded if they were less than 18 years of age
at the time of survey distribution or if they were nonEnglish speaking.
After delivery, the actual chosen contraceptive
methods were compared. This was determined using
documentation at the postpartum visit as well as
discharge summaries from hospitalization.
Contraceptive Influences
Belief
Influence
Previous Experience
Normal
Obese
Less Likely
More Likely
Friends’ Experience
31.2
68.8
73.9
26.1
Less Likely
More Likely
Partner Preference
Less Likely
More Likely
Provider Counseling
77.1
22.9
Less Likely
More Likely
Resources (internet,
pamplets, etc)
42.9
57.1
Less Likely
More Likely
p Value
0.001
0.884
61.6
38.4
0.884
77.1
22.9
87
13
0.002
76.5
23.5
0.242
60
40
78.2
22.8
Pills cause weight gain
Less likely
More Likely
Depo causes weight gain
Less likely
More Likely
IUD causes weight gain
Less likely
More Likely
Weight can affect the method that’s
right for me
Less likely
More Likely
Birth control can be bad for health
Normal
Obese
p Value
0.761
48.5
51.5
82.2
17.8
0.752
39.4
60.6
36.4
63.6
0.477
63.7
36.3
81.8
18.2
0.03
69.6
30.4
40.8
59.2
0.925
Less likely
More Likely
Pregnancy can be bad for health
82.8
17.2
Less likely
More Likely
Birth control is more dangerous
than pregnancy
Less likely
More Likely
88.6
11.4
78.2
21.8
0.644
95.6
4.4
0.620
94.3
5.7
86.9
13.1
After pregnancy, the chosen contraceptive
methods were then compared. Depo provera was the
most commonly used form of contraception in both
groups, with 38 percent of women in the normal BMI
group and 21 percent of women in the obese group
using this method (p=0.14). There were no statistically
significant differences between the groups when the
postpartum method was analyzed. There were a
significant number of women who were lost to follow
up prior to the postpartum visit so that the actual
chosen method could not be determined.
Conclusions
This study found a statistically significant
difference between obese women and normal BMI
women’s recorded Depo provera usage. This
difference was found in both the reported historical use
and planned future use. The questionnaire suggests
that obese women are more likely to believe that
weight influences contraceptive choice and women of
normal BMI are more likely to report influence by prior
experience and provider counseling.
The observed difference in Depo provera use
between obese and normal BMI women was no longer
observed when patient charts were reviewed
postpartum. One of the possible reasons for this is
that Depo provera is the only method offered at our
hospital prior to discharge. Also, the large number of
women lost to follow-up between hospital discharge
and the postpartum visit makes the number of women
available for analysis very small.
A strength of this study is that the population was
not using contraception when they completed the
survey, allowing evaluation of past use and future
plans for contraception. The largest limitation of this
study is the small sample size. Although there were
statistically significant differences observed in answers
between obese and normal BMI women, these
differences could not be carried through to the
postpartum time frame.
Larger studies are needed in this area to
determine the true differences between obese and
normal BMI women when it comes to contraceptive
ideas and use patterns. These findings demonstrate a
need for continued education about different types of
contraception and side effect profiles.