Assessment of Glucose and Lipid Profile of Women on Contraceptives in Maiduguri North Eastern Nigeria

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R.M. Gali, F. Dalhatu, Y.P. Mamza, F. Zakari
Department of Medical Laboratory Science, College of Medical Sciences, University of Maiduguri, Borno State Nigeria.
S. Kwari
Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Maiduguri, Borno State.
R.Y. Genesis
Department of Chemical Pathology, University of Maiduguri Teaching Hospital Borno State Nigeria.

All correspondents to: Dr (Mrs) R M Gali, Department of Medical Laboratory Science, College of Medical Sciences,
University of Maiduguri. E-Mail rmgali@yahoo.com

ABSTRACT
Objectives: This study assessed the effect of contraceptives on glucose and lipid profile of women on contraceptives (oral and injectable) in family planning unit of State Specialist Hospital, Maiduguri, Borno State Nigeria.
Methods: Ninety women made up of Fifty(50) women) on oral and injectable contraceptives and forty (40) mothers who are not on any contraceptive had their Glucose determined by glucose oxidase method, total cholesterol, triglyceride and high density lipoprotein determined by enzymatic reaction while Freidwald’s formular was used for low density lipoprotein estimation.
Results: Fasting glucose level was significantly higher in contraceptive women than in non-contraceptive women (5.54±3.35mmol/L and 4.15±0.70mmol/L respectively; p=0.018). Total cholesterol was significantly higher in contraceptive women than in non-contraceptive women (5.33±1.31mmol/l and 4.60±1.12mmol/l; p=0.007). In addition, low-density lipoprotein were significantly higher in contraceptive women than in non-contraceptive women (3.43±1.22mmol/l and 2.65±1.14mmol/l; p=0.007). Whereas triglyceride and high-density lipoprotein in both group were statistically not significant (p>0.05). The comparison of oral and injectable contraceptives showed no significant differences in all the parameters studied except high density lipoprotein which is higher in oral contraceptive women than in women using injectable contraceptives (1.70±0.73mmol/l and 1.37±0.37mmol/l; p=0.043). There was no significant differences in Glucose concentration of women on oral contraceptives and those on injectable contraceptives (P>0.05),
Conclusion: In conclusion, glucose, total cholesterol and low-density lipoprotein are elevated in this study. Therefore, regular tests for lipid profile and glucose is necessary for women on contraceptives to avoid risk of developing diabetes mellitus and cardiac vascular disorders.

KEYWORDS: Glucose, lipid profile, contraceptives.

INTRODUCTION

Birth control in developing countries has decreased the number of maternal deaths by 40% and could be prevented by 70% if fully demands for birth controls were met1,2. Birth control methods include barrier methods, hormonal birth controls, sterilization, and behavioral methods. Hormonal contraceptives are referred to as birth control methods that act on the endocrine gland. Hormonal contraceptives work by inhibiting ovulation and fertilization3. Hormonal contraceptives are available in a number of different forms. The oral and injectable methods are by far the most popular methods. Altogether, 18% of the world`s contraceptive users rely on hormonal method4. The use of injectable hormonal contraceptives has risen rapidly
in many countries5. The estimated number of injectable users doubled from 1995 to 2005; by 2015, about 40 million women are expected to use this method5. Some studies indicated that intake of oral contraceptives could cause metabolic changes in carbohydrate, protein, and lipid macromolecules6,7. Progestin exerts an adverse influence on lipid metabolism, they have ability to counteract the estrogen-induced changes in low density lipoprotein and high density lipoprotein levels8. Women are prone to develop dyslipidemia due to long-term use of hormonal contraceptives9. Hormonal contraceptives induce the body to produce more of the stress hormone cortisol (glucocorticoid), which has effects on lipid and glucose metabolism. Therefore, this study aims at assessing the effect of contraceptives on glucose and lipid in women in this environment.

MATERIALS AND METHODS
This study was carried out in State specialist hospital (family planning unit) Maiduguri Borno State Nigeria. A total of 90 women were recruited for this study. Fifty women who were randomly selected at the family planning unit and forty women who were not on any contraceptives were regarded as control group. The subjects were apparently healthy and were within the reproductive age. Eleven (11) of them were on combined oral contraceptives, whereas 39 were on injectable contraceptive (Medroxyprogesterone). Ethical clearance was obtained from the research and ethical committee of State Specialist Hospital Maiduguri. Oral consent of the mothers was sought after explaining the purpose of the research. Questionnaire was administered to every woman that was eligible for the research.
A fasting blood sample of 5ml volume was withdrawn from each patient; 2ml of blood was collected into fluoride oxalate vacutainer bottle and 3ml into plain container. The plasma was used for the estimation of fasting glucose using oxidase-peroxidase enzymatic colorimetric method as described by Trinder10 and the serum was used for the estimation of triglyceride (TG) by enzymatic method as described by Fossati11, total cholesterol by enzymatic method as described by Meiattini12 and HDL by enzymatic method as described by Warnick13. All the test kits are manufactured by Randox laboratories limited, Ardmore, Diamond road, Crumin.co. Antrim UK. Low-density
lipoprotein (LDL) was calculated using Freidwald’s formular as described by Freidwald14. Statistical analysis of data was done with SPSS version 18 to determine mean, standard deviation, Anova and student t- test. The level of confidence was set at p<0.05.

RESULTS
There were significant differences between means of fasting plasma glucose, total cholesterol, and low-density lipoprotein of contraceptive women with that of the control group. Fasting plasma glucose level was significantly higher in contraceptive women than non-contraceptive women (5.54±3.35mmol.l and 4.15±0.70mmol/l; p=0.018).There is significant high level of total cholesterol in women on contraceptives than non contraceptive (5.33±1.31mmol/l and 4.60±1.12mmol/l; p=0.007). Also low-density lipoprotein is significantly higher in women on contraceptive than the women that are not on contraceptive (3.43±1.22mmol/l and 2.65±1.14mmol/l; p=0.007). On the other hand, there was no significant differences in the levels of triglyceride and high-density lipoprotein in both women on contraceptive and the control group. The comparison between women on oral contraceptive and those on injectable contraceptives showed no significant difference in all the parameters study except high-density lipoprotein, which is significantly higher in women on oral contraceptives than those on injectable contraceptives. No significant change was seen in all the parameters on duration of the use of contraceptives.

were slightly higher in oral contraceptive users than in injectable contraceptive women but are statistically non significant. However, high-density lipoprotein cholesterol was significantly increased in oral contraceptive women as compared to those injectable contraceptive women (Table 2), and this may be due to the effect of estrogen in combined oral contraceptive pills. This study is in accord with the findings of Sitruk-ware19 and Hogan et al20 whose studies revealed high levels of high-density lipoprotein cholesterol in oral contraceptive women.
This study grouped the subjects for the duration of the use of contraceptives into two; less than five years using contraceptive (45 subjects) and five to ten years of using contraceptives (5 subjects). Our findings revealed no significant changes in all the parameters used on duration of contraceptives use (Table 3), this study contradicts the findings of Berenson et al18 who stated that over 3 years of using injectable contraceptives, there was increased in levels of glucose and insulin. In addition, our results contradict with other studies who stated that the levels of triglyceride, LDL-cholesterol and VLDL-cholesterol increased with duration of oral contraceptives intake 16-18. Although this study revealed increased in low-density cholesterol due to duration, the increase is not statistically significant. On the other hand, there is decreased in high density cholesterol in 5-10 years of contraceptives use (Table 3) but not statistically significant. This study was not able to prove the claim by Santos et al9 who state that Women are prone to develop dyslipidemia due to long-term use of hormonal contraceptives.
In conclusion, contraceptives are good for birth control that help families to plan their lives, this should be used with caution, and regular check up is necessary to avoid risk of diseases such as diabetes mellitus and cardiovascular diseases that may be detrimental to human health.

ACKNOWLEGDMENTS
We wish to thank all staff of Family planning unit of State Specialist Hospital Borno State and Department of Chemical Pathology University of Maiduguri Teaching Hospital Borno State Nigeria for their support and
DISCUSSION
The major health risks of oral and injectable contraceptives are glucose impairment and cardiovascular diseases particularly coronary artery disease, stroke and venous thrombolism. Hypercholesterolemia is associated with endothelial cell dysfunction, elevated oxidant stress, and creation of a strongly pro-inflammatory conditions15.
In this study, the total cholesterol and low-density lipoprotein cholesterol levels in women on contraceptive are higher than non-contraceptive women and are statistically significant (Table1). This study agrees with the findings of Yesmin and Asare16,17 who reported increase total cholesterol, and low density lipoprotein. The increase in serum total cholesterol in women taking contraceptives may be due to impaired lipoprotein metabolism and higher levels of low-density lipoprotein may be due to increase lipoprotein synthesis rather than impaired lipolytic catabolism in association with accumulation of cholesterol16. In this study, there is no significant difference in triglyceride level in women on contraceptive and non contraceptive women (Table1), which is in line with findings of Asare17 and contradicts the findings of Yesmin16, who stated that there is elevated triglyceride in women on contraceptive than non contraceptive women. He attributed that increased serum triglyceride might be due to increase production and transportation of very low-density lipoproteins that endogenously synthesize triglyceride in the blood; although our finding did not indicate that.
There was no difference in high-density lipoprotein, which is in accordance with findings of Asare17. In this study, fasting plasma glucose was significantly high in contraceptive women than non contraceptive women, this finding is similar to those of Berenson et al18 who reported high glucose level in women on contraceptives. They attributed this high glucose level to compensation for increased insulin resistance and glucocorticoid-like activity of progestogen.
Glucose level in oral contraceptive women was slightly higher than in injectable contraceptive women but is statistically non-significant. Also the total cholesterol, triglyceride, and Low Density Lipoprotein cholesterol

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