The effect of increased access to emergency contraception among young adolescents.

OBJECTIVES: The United States Food and Drug Administration cited an absence of data on young adolescents as the reason the emergency contraceptive, Plan B, could not be moved over-the-counter. This study analyzed data on young adolescents with increased access to emergency contraception. METHODS: We conducted an age-stratified analysis with previously published data from a randomized, controlled trial of Plan B with a sample size of 2,117, including 964 adolescents, 90 of whom were aged younger than 16 years. Participants were randomly assigned to nonprescription pharmacy access, advance provision of 3 packs, or clinic access (control). We measured contraceptive and sexual risk behaviors at baseline and 6-month follow-up and tested for pregnancy and sexually transmitted infections. We used contingency table and logistic regression analysis to measure the effect of the intervention on risk behaviors in young adolescents (< 16 years), compared with middle adolescents (16-17 years), older adolescents (18-19 years), and adults (20-24 years). RESULTS: Adolescents aged younger than 16 years behaved no differently in response to increased access to emergency contraception (EC) from the other age groups. As with adults, EC use was greater among adolescents in advance provision than in clinic access (44% compared with 29%; P < or = .001), and other behaviors were unchanged by study arm, including unprotected intercourse, condom use, sexually transmitted infection acquisition, or pregnancy. Additionally, adolescents with increased access to EC did not become more vulnerable to unwanted sexual activity. CONCLUSION: Young adolescents with improved access to EC used the method more frequently when needed, but did not compromise their use of routine contraception nor increase their sexual risk behavior. LEVEL OF EVIDENCE: I.

Peroxisome proliferator-activated receptor-gamma and retinoid X receptor signaling regulate fatty acid uptake by primary human placental trophoblasts.

CONTEXT: Transplacental transfer of fatty acids from the maternal to the fetal circulation is essential for fetal development. The nuclear receptor peroxisome proliferator-activated receptor-gamma (PPARgamma) regulates fatty acid transport and storage in adipocytes and other cell types. OBJECTIVE: This study tested the hypothesis that PPARgamma and its heterodimeric nuclear receptor partner, retinoid X receptor (RXR), regulate fatty acid uptake by human trophoblasts. DESIGN: Prospective basic laboratory in vitro research was conducted using primary term human trophoblasts. SETTING: The study was performed in the perinatal biology laboratory of an academic medical center. PATIENTS OR OTHER PARTICIPANTS: Study materials were obtained from healthy pregnant women at a gestational age of 37-41 wk. INTERVENTIONS: There were no interventions. MAIN OUTCOME MEASURES: Fat uptake and accumulation in human placental trophoblasts were measured. RESULTS: We initially demonstrated that activation of PPARgamma and/or RXR with selective agonists increased the accumulation of neutral lipids in trophoblasts as well as uptake of free fatty acids. Furthermore, activation of PPARgamma and RXR enhanced the expression of the fat droplet-associated protein adipophilin along with fatty acid transport protein (FATP)4, whereas expression of FATP2 was decreased by activation of RXR. Finally, we found that inhibition of p38 MAPK, which diminishes the activity of PPARgamma in trophoblasts, inhibited fatty acid uptake and blocked the PPARgamma- and RXR-dependent increases in adipophilin and FATP4 expression, yet stimulated the expression of FATP1, FATP2, and FATP3. CONCLUSIONS: These data support a role for PPARgamma and RXR in regulation of fatty acid transport and storage in human placental trophoblasts.