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Do contraceptive methods pose fetal risks?


 The author reviews the fetal risks of various contraceptive methods and concludes that contraceptive methods do not pose substantive fetal risks. Oral contraceptives have been implicated as both teratogens and mutagens. Many prospective studies show no link between progestins and cardiac anomalies. A table presents studies, sample size, control size, anomalies, and comments. Problems with the retrospective studies include 1) recall biases, 2) no account taken of prior pregnancy outcome, 3) no account taken of reasons for wishing to continue the pregnancy, 4) the fact that hormones could have been administered in pregnancies already showing problems such as bleeding, and 5) analysis not being restricted to the period of embryogenesis when exposure could produce cardiac defects. Studies have also failed to show an association between progestins and hypospadias, limb reduction deformities, neural tube defects, and other anomalies. A further consensus exists that progestins do not predispose to chromosomally abnormal abortuses. Pregnancies of women with IUDs are known to be associated with increased frequencies of ectopic pregnancy and spontaneous abortion but do not show a greater frequency of anomalies. Vaginal spermicides are also not associated with increased malformations in the offspring of women using spermicides either during or prior to pregnancy. Pregnancies resulting from contraceptive failures--oral contraceptives, IUDs, spermicides, and barrier methods--do not appear to be at risk for congenital anomalies; the same conclusion applies to pregnancies that occur after a method is discountinued.
