title: Early adolescent Depo-Provera exposure increases stillbirths in adult sooty mangabeys.
abstract: The 3-month injectable contraceptive medroxyprogesterone acetate (MPA; Depo-Provera) is a synthetic progestin that protects against pregnancy by suppressing ovulation. Studies have focused on the resumption of ovulation after MPA-treatment cessation but neglected potential long-term effects of MPA exposure on future successful reproduction. MPA is frequently administered to adolescent girls; however, long-term fertility effects of adolescent MPA exposure have not been explored. We investigated fertility after extended MPA exposure in a species of old world primate, the sooty mangabey (Cercocebus atys). Female sooty mangabeys (n=31) received chronic MPA-treatment for 4-8 years. At MPA-treatment onset, subjects were either parous adults (n=14) or nulliparous adolescents (n=17), with adolescent-treated subjects being further divided into those who had reached first ovulation (n=10) and those who had not (n=7). After MPA-treatment cessation, adolescent-treated females had a significantly higher incidence of stillbirth than did age-matched and parity-matched controls, whereas adult-treated females did not differ from their matched controls. Females placed on MPA-treatment prior to first ovulation had a significantly higher incidence of stillbirth post-treatment than did females placed on MPA-treatment after first ovulation. Diabetic females had an increased incidence of stillbirth as compared to nondiabetic females; however, when controlling for diabetes, MPA exposure prior to first ovulation was still a significant positive predictor of stillbirth. These findings suggest that the post-treatment fertility effects of chronic MPA exposure vary with the developmental timing of treatment onset and raise concern about the use of MPA as a contraceptive for adolescent girls.
authors.forename: Maurand
authors.initials: M
authors.lastname: Cappelletti
authors.affiliation: Department of PsychologyEmory University, 36 Eagle Row, Atlanta, Georgia 30322, USAYerkes National Primate Research CenterAtlanta, Georgia 30322, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Ethun
authors.affiliation: Department of PsychologyEmory University, 36 Eagle Row, Atlanta, Georgia 30322, USAYerkes National Primate Research CenterAtlanta, Georgia 30322, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Meeker
authors.affiliation: Department of PsychologyEmory University, 36 Eagle Row, Atlanta, Georgia 30322, USAYerkes National Primate Research CenterAtlanta, Georgia 30322, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Von Scherr
authors.forename: Kim
authors.initials: K
authors.lastname: Wallen
mesh_terms: D000367:Age Factors; D000818:Animals; D016665:Cercocebus atys; D003271:Contraceptive Agents, Female / Q000633:toxicity*; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D005298:Fertility / Q000187:drug effects*; D017258:Medroxyprogesterone Acetate / Q000633:toxicity*; D023421:Models, Animal; D010060:Ovulation / Q000187:drug effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012741:Sexual Maturation; D050497:Stillbirth; D013997:Time Factors
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate