More complications when pregnant within three months of discontinuing oral contraceptives 'Consider temporary use of another method of birth control'

Among women who become pregnant within three months of discontinuing oral contraceptives, preeclampsia and preterm birth are more common. The occurrence of these complications also depends on the type of contraceptive pill used, demonstrates a study conducted by the Radboud university medical center including over 7,000 pregnancies. 

Oral contraceptives are one of the most frequently used medications in the Netherlands. “The pill” contains hormones that prevent pregnancy. When you intend to get pregnant, you stop taking the pill. But that does not mean that the body's hormonal balance immediately returns to normal. Researchers at the Radboud university medical center investigated whether there is an association between getting pregnant quickly after discontinuing the pill and pregnancy complications.

Preeclampsia and preterm birth 

The researchers used data from more than 7,000 pregnancies. In fifteen percent of those, the pill was used within three months before pregnancy. Among these women, preeclampsia and preterm birth were more than one and a half times more common than among women who did not use the pill during this period.

The study also shows that the risk of complications differ depending on the hormonal composition of the pill. Among women who used the pill from the first and second generations, preeclampsia was more common, while preterm birth was more common when the third generation was used. Too few women used fourth-generation pills to draw reliable conclusions.

Lead researcher Marleen van Gelder of the Department for Health Evidence explains: 'The different generations contain different types of progestin. This could play a role in the development of complications. The amount of estrogen also varies between different types of the pill. That may also be important, but further research is required to elucidate these aspects.'

Another method of contraception

The researchers stress that the complications remained relatively rare, also among women who became pregnant shortly after stopping the pill. Among those women, preeclampsia occurred in about three percent of pregnancies, and preterm birth in approximately six percent. So what should women who stop taking the pill because they want to get pregnant do?

Gynecologist Marc Spaanderman, co-author of the study, says: ‘Although we cannot yet conclude with certainty that the pill causes pregnancy complications based on this observational study, women may consider another method of contraception for three months after stopping the pill. But this also has disadvantages, such as unintended earlier pregnancy and more severe menstrual symptoms. In the end, it remains a personal decision. In any case, be aware of the possible disadvantages and discuss it with your partner and, if necessary, with a health care provider.’

About the publication

This study was published in the International Journal of Epidemiology: Associations of periconceptional oral contraceptive use with pregnancy complications and adverse birth outcomes. A. Schreuder, I. Mokadem, N.J.L. Smeets, M.E.A. Spaanderman, N. Roeleveld, A. Lupattelli, M.M.H.J. van Gelder. DOI: 10.1093/ije/dyad045.

Data for this study were collected in the PRIDE Study, the largest birth cohort study among pregnant women and their offspring in the Netherlands.

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