Impact of Immediate Postpartum Long Acting Reversible Contraception on Short Interval Pregnancy Rates [A27

Abstract

INTRODUCTION: To evaluate the impact of immediate postpartum long acting reversible contraception (LARC) at our institution, we compared short interval pregnancy (SIP) rates between women who received immediate postpartum LARC with those who did not. METHODS: Institutional review board (IRB) approval was obtained for a single center retrospective cohort study of women >/= 18 years old with government insurance who delivered between 7/1/2019-3/31/2020. SIP was defined as <12 months from live birth to conception of a subsequent pregnancy. Women who underwent cesarean hysterectomy or postpartum sterilization were excluded from analysis. RESULTS: A total of 1,220 women were identified. Of these, 150 (12.3%) received LARC prior to discharge: 56 received a levonorgestrel intrauterine device (IUD) (37.3%), 20 received a copper IUD (13.3%), 74 received an etonogestrel implant (49.3%). A higher proportion of women who received a LARC were ages 18-21 (26.7%), compared with the non-LARC group (14.1%, P<.001). SIP rate in the LARC group was 4.0% (n=6) vs. 14.5% (n=155) in the non-LARC group (P<.001). Excluding women who declined or deferred contraception until the postpartum visit, women choosing contraceptive methods other than immediate postpartum LARC also had a higher rate of SIP (12.6%) when compared with the LARC group (4.0%, P=0.003). After adjustment for potential confounders including nulliparity, young maternal age, and married status, SIP was lower with immediate postpartum LARC [AOR 0.27 (95% CI 0.18, 0.64), P=.003] and higher by married status [AOR 1.89 (95% CI 1.26, 2.84), P=.002]. CONCLUSION: Implementation of an immediate postpartum LARC program decreased SIP rates. Improved counseling about the impact of immediate LARC placement for family planning is encouraged.