Effect of Depo Medroxyprogesterone Acetate (Dmpa) Injectable Contraceptive On Cardiometabolic Risk Profile Among Women of Reproductive Age in Kigali, Rwanda

Abstract

Background Depo medroxyprogesterone acetate (DMPA) injectable contraceptive is a reversible and effective hormonal contraceptive method many women in East Africa use. However, various studies suggest it might increase cardiometabolic disease risk due to its influence on cardiometabolic risk factors and call for a thorough evaluation of its effects on cardiometabolic risk profile to design proper prevention strategies. There is a need for further research to fully characterize the effects and make an informed decision on establishing measures for regular follow-up with users. This study responds to that need and explores the impact of DMPA use on lipid profile, waist circumference, blood pressure, glycated haemoglobin, and inflammatory markers among women of reproductive age in Rwanda. Three main objectives guided the study: (i) to explore the prevalence of central obesity and its association with other cardiometabolic risk factors in women of reproductive age in Kigali, Rwanda; (ii) to evaluate the effects of DMPA on lipid profile, waist circumference, blood pressure, glycated haemoglobin, and inflammatory markers among women of reproductive age in Kigali, Rwanda; and (iii) to analyse changes in cardiometabolic risk markers among abdominally obese women of reproductive age in Kigali, Rwanda during the use of DMPA.

Methods The study used a cross-sectional design to explore the prevalence of central obesity and its correlates (objective 1). It also used a prospective cohort design to evaluate the effects of DMPA on cardiometabolic risk profile among the users (objective 2) and a pre-post design to analyse the changes in cardiometabolic risk markers among abdominally obese women. The target population was women of reproductive age in Kigali city. To explore the prevalence of central obesity and its correlates, we conveniently selected 138 participants and analysed data by chi-square and logistic regression analyses. To evaluate the effects of DMPA on cardiometabolic risk profile, we randomly selected 45 DMPA users and 45 non-hormonal methods users and analysed data by the Manny Whitney test. To assess the changes in cardiometabolic risk markers among abdominally obese women during DMPA use, we selected a sample of 65 participants and analysed data using Wilcoxon signed-rank test.

Results The thesis report is presented as a compilation of three complementary manuscripts, each responding to one of the objectives earlier described. Study 1: The first study explored the prevalence of central obesity and its correlates using a cross-sectional design. Results indicate that the prevalence of central obesity was 48.5% and was significantly associated with age (OR=3.25, 95% CI: 1.11-9.47), alcohol use (OR=5.57, 95% CI: 1.91-16.20), meat consumption (OR=4.33, 95% CI: 1.49-12.59), hypertriglyceridemia (OR= 4.12, 1.01-14.76), and elevated diastolic blood pressure (OR=4.87, 95% CI: 1.47-16.13).

Study 2: The second study evaluates the effects of DMPA on cardiometabolic risk profiles among the users using a prospective design. Results indicate that DMPA users experienced a significant increase in waist circumference, TG, LDL, TC, hs-CRP, and glycated haemoglobin at twelve months of follow-up. In contrast, they experienced a significantly lower HDL than controls (p= <0.05). However, the study did not indicate a significant difference in blood pressure changes between DMPA users and the control group (p> 0.05).

Study 3: The third study analysed the changes in cardiometabolic risk markers among abdominally obese women during the use of DMPA. Results indicate that after twelve months, all cardiometabolic risk markers showed significant changes; there was a gradual decrease in HDL and an increase in TG, LDL, TC, hs-CRP, waist circumference, SBP, DBP, and glycated haemoglobin (p= <0.05).

Conclusions The prevalence of central obesity was relatively high among women of reproductive age, and it was associated with older age, elevated diastolic blood pressure, high triglycerides levels, and meat and alcohol consumption. The study recommends an intensive awareness of health risks associated with central obesity and its associated factors to address the rising risk of cardiovascular diseases in this population. DMPA induces alteration in the cardiometabolic risk profile, where this alteration worsens when the user is abdominally obese. Considering the cardiometabolic health of individual users before initiating the method and providing a follow up to the users of increased risk sounds essential