Early Contraception Initiation in First Time Adolescent Mothers: Does it Decrease Rapid Repeat Pregnancy?

Abstract

Background: Adolescent pregnancy has declined in the United States in recent years, but is still higher than most industrialized nations. Rapid repeat pregnancy is also very common with up to 50% of adolescent mothers becoming pregnant againwithin two years. Adolescents who give birth to a second child are less likely to return to school or become economically self sufficient. Early initiation of contraception and specifically long acting reversible contraception (LARC) methods may result in fewer rapid repeat pregnancies in this population. Methods: A retrospective chart review was conducted to identify adolescents (age 19) who received prenatal care and delivered their first child at an urban teaching hospital from January 1, 2008 through December 31, 2008. Charts were reviewed for demographics, prenatal care, delivery information, evidence of social work involvement, contraception counseling, contraception initiation, and evidence of repeat pregnancy within 2 years. Patients lost to follow up during this time period were excluded in the analysis of predictors of repeat pregnancy. Descriptive statistics, fisher's exact test, chi-square, and logistic regression were used for analysis. IRB approval was obtained for this protocol. Results: A total of 210 first time adolescent mothers were identified. The average age was 17.5 ( 1.33) years old, 93.8% were African American, 91.42% had public insurance, and 49.05% were enrolled in a specialized teen pregnancy program. Contraception, in the form of Depo Provera, was administered prior to discharge from the postpartumward in 18.57% of the cases. At the 6 weeks postpartum visit, 22.86% of the patients were using Depo Provera. Within the first 8 weeks postpartum, 16.19% initiated LARC and an additional 5.24% were documented as intending to initiate LARC. Repeat pregnancy within two years of first delivery was documented in 35.41% (n1⁄474) of the patients with an average time from delivery to conception of 423.7 ( 191) days. A total of 27.27% (n1⁄457) were lost to follow up. Follow up within 8 weeks postpartum was associated with lower chance of repeat pregnancy (OR1⁄40.246, 95% CI 0.096-0.633). Initiation of a LARCmethod was also associated with decreased chance of rapid repeat pregnancy (OR1⁄40.135, 95% CI 0.037-0.492). Social work involvement, enrollment in the specialized teen pregnancy program, mode of delivery, Depo Provera administration in the hospital prior to discharge, and plan for type of contraception at discharge were not statistically significant predictors of rapid repeat pregnancy in this cohort. Conclusions: In this cohort of nulliparous adolescents who received prenatal care and delivered at an urban teaching hospital, compliance with follow up and initiation of LARC were associated with prevention of rapid repeat pregnancy. Evaluating the effect of providing LARC immediately postpartum for adolescents is an important future research question.