31. Contraception Consistency in Postpartum Adolescents versus Adults and Associated Impact on Short Interval Pregnancy Rate

Abstract

<h3>Background</h3> An unintended pregnancy for an adolescent may cause complex, lasting challenges for the patient and their community. Once in the peripartum period, there are numerous opportunities to empower a patient to make reproductive choices compatible with their family planning goals regardless of age. In spite of improved counseling, prior studies have revealed that adolescents are less likely to opt for long acting reversible contraception (LARC) than non-adolescents. The objective of this study is to evaluate contraceptive choices between postpartum adolescents and adults, consistency in contraception plans across various peripartum time points, and associated rate of short interval pregnancy (SIP). <h3>Methods</h3> This retrospective, observational study was performed at an urban, tertiary hospital in Chicago, Illinois. The participants were defined as adolescent patients (< 22 years old at the time of delivery) or adults seen on labor and delivery between Jan. 1, 2017 and Dec. 31, 2017. Medical records were reviewed through 18 months postpartum to evaluate for consistency in contraception utilization and occurrence of SIP. Comparison of contraception choice was performed between adolescents and adults. The primary outcome of postpartum contraception consistency and incidence of SIP was compared within the adolescent group. Secondary analysis evaluated patient participation in postpartum visits, use of LARC vs. non-LARC, and the associated risk of SIP. Statistical analysis consisted of Chi Square test of association and logistic regression analysis. This study was approved by the on-site Institutional Review Board. <h3>Results</h3> A total of 207 adolescents and 1077 adults with complete data were included in the study. Prior to delivery, adolescents were significantly more likely to choose LARCs as their contraceptive plan as compared to adults (P=<0.00001). No such difference existed when either reporting no postpartum contraception plan or choosing non-LARCs (P=0.07 and 0.24, respectively). An inconsistent contraceptive plan was found to be an independent and significant predictor of SIP (Odds Ratio [OR] 3.4, 95% CI 1.2-9.4, P = 0.02) even when controlling for lack of a postpartum visit or whether a patient chose a LARC vs. non-LARC as their final contraceptive choice. <h3>Conclusions</h3> Inconsistency of contraception plan was found to confer a greater risk of SIP in the adolescent group than even lack of participation in a postpartum visit or the choice of utilizing a LARC vs. non-LARC as the final form of contraception. Therefore, continuous counseling of adolescents about their choice of contraception and developing a consistent plan in the peripartum period is crucial to reducing the incidence of unintended and short interval pregnancy.