Center of the Storm

 

Birth control, even today, inhabits the center of the storm on some issues. In the ongoing microcephaly epidemic that may be linked to Zika virus epidemic, call for better access to reproductive health services such as birth control are under heavy debate. And a recent guidance issued by the Centers for Disease Control and Prevention on using birth control as part of  a strategy to reduce a woman’s risk for fetal-alcohol syndrome sparked angry media responses. Controversy is not new to reproductive health providers, but buried in this particular set of controversies is an important message: contraceptives can help reduce the risk for birth defects.

The northeast regions of Brazil experienced an outbreak mosquito-borne Zika virus infection in early 2015, By September 2015, reports of microcephaly in the affected areas of Brazil roused concern, and investigations suggested a link to Zika virus infection during pregnancy. As Zika virus affected more Latin American nations, officials in Colombia, Ecuador, El Salvador, and Jamaica cautioned women to delay getting pregnant.[1] Similar advice could apply to other affected areas. Contraceptive use to delay pregnancies potentially at risk could be an important part of the strategy to reduce the risk of microcephaly. Controversy has erupted because women many Latin American nations have limited access to contraception, sometimes due in part to religious proscription.

Here in the United States on February 2, the CDC issued the statement that “Sexually active women who stop using birth control should stop drinking alcohol…”[2] Of course, public health advisories could lose effect if issued with fine print containing all the relevant caveats and exceptions. In this case, however, the unfootnoted pronouncement stirred up the proverbial hornet’s nest as media and women complained that the paternalistic tone was outrageous.[3]^,[4] Despite what may have been an awkward presentation of its message, CDC’s advice tells us what we know to be true: heavy drinking increases women’s risk of poor reproductive health outcomes such as STD and unintended pregnancy, as well as the birth defects and other disorders of fetal alcohol syndrome.[5]

Beyond Zika virus or alcohol, many other exogenous factors can cause birth defects. And contraception could play a valuable role in buying time for women to avoid the risk from these exposures or to get treated for certain conditions:

1. Maternal infections such as:

Cytomegalovirus

Herpes simplex

HIV

Rubella

Toxoplasmosis

Varicella zoster virus

2. Teratogenic agents such as:

Alcohol

Angiotensins

Antibiotics (some)

Anti-convulsant medications (some)

Cocaine

Isotretinoin

Lead

Mercury

Radiation

3. Maternal health conditions such as:

Diabetes

Hypothyroidism

Severe obesity

The good news is that and a recent study again confirms that oral contraceptives do not cause birth defects. This Danish observational study of 22,013 infants born with major birth defects showed that women who took birth control pills just before or during the beginning of their pregnancies showed no increased risk of birth defects.[6]

—Deborah Kowal, MA, PA, Executive editor of Contraceptive Technology