Espey 2000.

Methods	Design: retrospective chart review Location: 3 Indian Health Service facilities in southwestern USA Time frame: first injection of DMPA from December 1992 to June 1995 Sample size estimation and outcome of focus: no information
Participants	Female members of Navajo tribe Inclusion criteria: 18 to 40 years old; completed at least 5 consecutive injections of DMPA at 10‐ to 14‐week intervals; had weights recorded at 1‐ or 2‐year intervals Exclusion criteria: history of diabetes or thyroid disease; women in postpartum group who had pre‐eclampsia or multiple gestations within index pregnancy
Interventions	DMPA initiation 1) Interval (N = 115): first injection ≥ 20 weeks past pregnancy of ≥ 20 weeks gestation 2) Postpartum (N = 57): first injection at 5 to 8 weeks after delivery of singleton pregnancy of ≥ 20 weeks gestation
Outcomes	Mean weight gain (lb) for DMPA by initiation group Time frame: 1 and 2 years
Notes	For another group, not included in this review, investigators reportedly extracted method of contraception from charts but did not provide specifics. Discussion noted that group "more frequently used" IUC or tubal ligation and included COC users.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	DMPA users by choice
NOS selection (NRS)	Low risk	Exposed: clinic population of Navajo women Non‐exposed: same population as exposed Exposure: clinic records of DMPA injections
NOS comparability (NRS)	Low risk	Analysis: adjusted for age, parity, and initial weight
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not feasible due to differences in insertion times
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	No information; objective outcome measure
Incomplete outcome data (attrition bias) All outcomes	High risk	Loss to follow‐up: for 1 year, only complete records included in retrospective review; does not account for discontinuation and loss; at 2 years, no weight data for 70% of interval group and 49% of postpartum group