Depot medroxyprogesterone results in increased weight gain compared to oral contraceptives

strongest conclusions of this study are that rapid influenzatesting adds very little to clinical decision-making, and thatinfluenza-vaccinated children had lower costs and betterhealth outcomes than non-vaccinated children, regardless oftreatment strategy chosen. The latter result was curiouslydownplayed in this report; in my view, it is perhaps the mostimportant one!

Geoffrey A. Weinberg, MDUniversity of Rochester School of Medicine & Dentistry

Rochester, NY 14642

REFERENCES1. Poehling KA, Walker F, Copeland J, Edwards KM, Szilagyi P, Hall C,et al. Epidemiology of outpatient visits for influenza infections in youngchildren. Pediatr Res 2004;55(4 part 2):241A.2. Poehling KA, Griffin MR, Dittus RS, Tang YW, Holland K, Li H, etal. Bedside diagnosis of influenzavirus infections in hospitalized children.Pediatrics 2002;110:83-8.3. Griffin MR, Walker FJ, Iwane MK, Weinberg GA, Staat MA, ErdmanDD, et al. Epidemiology of respiratory infections in young children: insightsfrom the new vaccine surveillance network. Pediatr Infect Dis J2004:S188-92.4. Centers for Disease Control and Prevention. High levels of adamantaneresistance among influenza A (H3N2) viruses and interim guidelines for useof antiviral agents–United States, 2005-06 influenza season. MMWR MorbMortal Wkly Rep 2006;55:44-6.5. Ison MG, Gubareva LV, Atmar RL, Treanor J, Hayden FG. Recoveryof drug-resistant influenza virus from immunocompromised patients: a caseseries. J Infect Dis. 2006;193:760-4.6. Monto AS. The threat of an avian influenza pandemic. N Engl J Med2005;352:323-5.

Depot medroxyprogesterone results inincreased weight gain compared to oralcontraceptivesBonny AE, Ziegler J, Harvey R, Debanne SM, Secic M,Cromer BA. Weight gain in obese and nonobese adolescentgirls initiating depot medroxyprogesterone, oral contraceptivepills, or no hormonal contraceptive method. Arch PediatrAdolesc Med 2006;160:40-5.

Question Does the initiation of depot medroxyprogesteroneacetate (DMPA) result in significant weight gain in obese andnonobese adolescent girls, when compared with an oral con-traceptive (OC), or no hormonal contraceptive method (con-trol)?

Design Non-randomized, prospective study.

Setting Four urban health clinics.

Participants 450 adolescent girls, aged 12 to 18 years.

Intervention The adolescents were treated with DMPA,OC, or control, based on their preferences.

Outcomes Weight was assessed at 6, 12, and 18 monthsand also as a mean change over 18 months.

Results Adolescent girls who were obese at initiation ofDMPA gained significantly more weight than did obese girlsstarting OC or control (P�.001 for both). At 18 months,

mean weight gain was 9.4, 0.2, and 3.1 kg for obese girlsreceiving DMPA, receiving OC, and control, respectively.Weight gain in obese girls receiving DMPA was also greaterthan weight gain in all nonobese categories (4.0 kg, DMPA;2.8 kg, OC; 3.5 kg, control; P�.001). A significant interac-tion (P�.006) between length of time receiving DMPA andweight gain was evident for obese subjects.

Conclusions Over 18 months, DMPA use was associatedwith increasing rates of weight gain in obese subjects. Thepotential contribution to severe obesity in this population isconcerning.

Comment This is another interesting study that shows anincrease in weight gain in adolescents using hormonal con-traception. The investigators used data that had been col-lected from a 2-year prospective cohort study evaluating hor-monal contraception and bone mineral density changes inadolescents. The participants were followed for 18 months,which is longer than most studies in the field. Unfortunately,the baseline characteristics of the cohorts have significantdifferences. The control group had a younger age, lowerbaseline weight, and decreased rate of sexual activity whencompared to both treatment groups. The DMPA cohort hada higher rate of prior pregnancy than the OC group (5.1% vs2.9%). The attrition rate was high for all groups; consistentwith other studies evaluating contraception in adolescents,however it was particularly high for the OC group (46.3%OC, 37.4% DMPA, 25% controls). This is a well-designedstudy, but the baseline differences do raise some caution. Forexample, the effect of prior pregnancy on the decision tocontinue DMPA despite weight gain is unknown. Also, thehigher dropout rate in the OC group may have been second-ary to perceived weight gain. Ultimately, it is unclear whatimpact the baseline differences have had on final data inter-pretation. The excess weight gain seen in these obese adoles-cents using DMPA is concerning. However, this concernmust be balanced with the social and medical complications ofunplanned teen pregnancy. Further study with well-matchedcohorts will be of great benefit.

Pamela Davis, MDUniversity of MichiganAnn Arbor, MI 48109

Placement of ear ventilation tubes does notimprove long-term hearing threshholds andincreases scarringStenstrom R, Pless IB, Bernard P. Hearing thresholds andtympanic membrane sequelae in children managed medicallyor surgically for otitis media with effusion. Arch PediatrAdolesc Med 2005;159:1151-6.

Question Does the use of ventilation tube insertion inchildren with otitis media with effusion have an effect onhearing thresholds and tympanic membrane pathologic ab-normalities?

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