World Health Organization : Technical Report Series, No. 657: The Effect of Female Sex Hormones on Felal Development and Infant Health

By E. Alberman

Book Id: WPLBN0000170388
Format Type: PDF eBook:
File Size: 2.97 MB
Reproduction Date: 2005

Title:	World Health Organization : Technical Report Series, No. 657: The Effect of Female Sex Hormones on Felal Development and Infant Health
Author:	E. Alberman
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago Alberman, B. E. (n.d.). World Health Organization : Technical Report Series, No. 657. Retrieved from http://gutenberg.cc/

Description
Medical Reference Publication

Excerpt
1. INTRODUCTION Female sex hormones1 have now been used for nearly forty years for a variety of purposes. including the treatment of threatened abortion, habitual abortion, premature labour, infertility, and dysmenorrhoea. They have also been used as abortifacients, as agents in pregnancy tests, and, most widely, as contraceptives. Well over 30 naturally occurring and synthetically derived sex hormone formulations have been used, and with the exception of their use in contraception and in the treatment of dysmenorrhoea and infertility, their application is often based on little or no sound scientific evidence of their efficacy. The widespread use of these preparations around the time of pregnancy, whether just before, during, or just after, has for many years raised questions about their effects on fetal development and infant health. While there is no evidence of any frequently occurring adverse effect on the fetus, a number of rare adverse effects have been reported. These effects, however, cannot be ascribed to the general category of sex hormones but can only be attributed to specific hormones used in the treatment of particular conditions. Furthermore, the risk-benefit ratio for steroidal contraceptives may differ considerably from that of the use of sex hormones in pregnancy tests and in the treatment of

Table of Contents
CONTENTS Page 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2 . Classification of exposure and female sex hormones used . . . . . . . . . . . . . . . . . . 8 2.1 Treatment of infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Oralcontraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.3 Other hormonal contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.4 Hormonal pregnancy tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.5 Obstetric support therap! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.6 Suppression of lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 3 . Methods of study of adverse developmental outcomes . . . . . . . . . . . . . . . . . . . . . 3.1 Developmental stages at risk of sex hormone exposure . . . . . . . . . . . . . . . . . 3.2 Cytogenetic research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 Microscopic and macroscopic examination . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 Observations on births and later life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 Animal teratology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 Epidemiological studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7 Problems specific to research on sex hormones and fetal outcomes . . . . . . 3.8 Biases in the ascertainment of hormone exposure or outcomes of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 Confounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . Assessment of existing data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.1 Treatment of infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.2 Hormonal contracepthes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.3 Hormonal pregnancl- tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.4 Supportive hormone therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4.5 Maternal use of steroidal contracepti\-es during lactation ............... 52 4.6 Effect of hormonal contraceptives on the x-olume and duration of lactation 53 5 . Conclusions and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.1 Public health impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.2 Indications for use of sex hormones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 5.3 Recommendations for further research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Annex 1. Chemical structures of female sex hormones . . . . . . . . . . . . . . . . . . . . . . . . 73