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Women with a
BMI of 40 or more have 3.06 times higher odds of expulsion of levonorgestrel
IUD as compared with women who are overweight, obese or have a BMI less than 35
according to a study presented at the at the ACOG 2017.
Lynne
Saito-Tom, MD and her colleague from University of Hawaii at Manoa, Honolulu, conducted
this retrospective cohort study at Kaiser Permanente-Hawaii between January
2009 and December 2010.
The study
was also published in May issue of Journal of Obstetrics and Gynecology.
The
researchers recruited 1,071 eligible patients, of whom nearly one third were
obese with nearly 8% had a BMI more than 35. The main independent variable was BMI
at the time of insertion and the dependent variables include successful IUD
insertion, difficult IUD insertion, 12-month continuation, and complications
related to the LNG-IUD.
No differences
were observed across different BMI groups for insertion (P = .59) or acceptance
of IUD for 1 year (P = .69)
Patients
with BMI 40 and more faced higher rates of complications (24%) as compared to obese (13%) ,
overweight or class 1 obesity counterparts (10%).
The study
did not have sufficient women enrolled to explore the reasons of higher
expulsion but the researchers did think that it may be related to difficult
insertion in very obese women and also menorrhagia experienced by these women.
This is the
first known study to evaluate LNG-IUD use by BMI in diverse Hawaiian population
of Asian and Pacific Islander women.
Larger
studies are needed to stratify the expulsion and complications according to
class of obesity.
Meanwhile,
the researchers advocate that the study findings should not discourage
physician from educating women about the benefits of IUDs.
“While the
expulsion rate was higher than seen generally, it is still an effective method
for most obese women. That’s much more beneficial than discouraging patients,” said
the lead researcher Dr. Saito-Tom.
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