7\. Oral-Contraceptive Use Before or During Early Pregnancy  Extensive epidemiological studies have revealed no increased risk of birth defects in infants born to women who have used oral-contraceptives prior to pregnancy. Studies also do not suggest a teratogenic effect, particularly insofar as cardiac anomalies and limb-reduction defects are concerned, when taken inadvertently during early pregnancy(see CONTRAINDICATIONS). 

The administration of oral-contraceptives to induce withdrawal bleeding should not be used as a test for pregnancy. Oral-contraceptives should not be used during pregnancy to treat threatened or habitual abortion.

It is recommended that for any patient who has missed two consecutive periods, pregnancy should be ruled out. If the patient has not adhered to the prescribed schedule, the possibility of pregnancy should be considered at the time of the first missed period. Oral-contraceptive use should be discontinued if pregnancy is confirmed.

8\. Gallbladder Disease   
Combination oral-contraceptives may worsen existing gallbladder disease and may accelerate the development of this disease in previously asymptomatic women. Earlier studies have reported an increased lifetime relative risk of gallbladder surgery in users of oral-contraceptives and estrogens. More recent studies, however, have shown that the relative risk of developing gallbladder disease among oral-contraceptive users may be minimal. The recent findings of minimal risk may be related to the use of oral-contraceptive formulations containing lower hormonal doses of estrogens and progestogens. 

9\. Carbohydrate and Lipid Metabolic Effects    
Oral-contraceptives have been shown to cause glucose intolerance in a significant percentage of users. Oral-contraceptives containing greater than 75 mcg of estrogens cause hyperinsulinism, while lower doses of estrogen cause less glucose intolerance. Progestogens increase insulin secretion and create insulin resistance, this effect varying with different progestational agents. However, in the nondiabetic woman, oral-contraceptives appear to have no effect on fasting blood glucose. Because of these demonstrated effects, prediabetic and diabetic women should be carefully observed while taking oral-contraceptives. 

A small proportion of women will have persistent hypertriglyceridemia while on the pill. As discussed earlier (see WARNINGS, 1a. and 1d.; PRECAUTIONS, 3. ), changes in serum triglycerides and lipoprotein levels have been reported in oral-contraceptive users. 

10\. Elevated Blood Pressure    
An increase in blood pressure has been reported in women taking oral-contraceptives and this increase is more likely in older oral-contraceptive users and with continued use. Data from the Royal College of General Practitioners and subsequent randomized trials have shown that the incidence of hypertension increases with increasing quantities of progestogens. 

Women with a history of hypertension or hypertension-related diseases, or renal disease should be encouraged to use another method of contraception. If women with hypertension elect to use oral-contraceptives, they should be monitored closely and if significant elevation of blood pressure occurs, oral-contraceptives should be discontinued (See CONTRAINDICATIONS section). For most women, elevated blood pressure will return to normal after stopping oral-contraceptives, and there is no difference in the occurrence of hypertension among ever- and never-users.