Abstract
INTRODUCTION: Intrauterine device insertion may be more challenging as a patient’s body mass index (BMI) increases leading to a higher incidence of complications. However, few studies have evaluated this, particularly in a diverse population. This study aims to describe levonorgestrel intrauterine device (LNG-IUD) complications in obese women. METHODS: We evaluated BMI in relation to difficulty with IUD insertion (utilization of additional instruments or anesthesia beyond standard practice), 12-month IUD continuation, and IUD complications (expulsion, infection, perforation, pregnancy, and malposition) in a retrospective cohort study of women with a LNG-IUD inserted at Kaiser Permanente-Hawaii between January 2009 and December 2010. RESULTS: Of the 1,071 eligible patients, 36% were obese (18% Class I obesity; 10% Class II obesity; 8% Class III obesity). The most common races were Native Hawaiian/Pacific Islander (36%) and Asian (31%). No differences in difficulty with insertion (P=.59) and 12-month continuation (P=.69) were noted between BMI groups. Class III obese women had a higher proportion of any complication [Class III obesity 24% (20/82); Class II obesity 13% (14/107); Class I obesity 10% (19/199); P=.001]. In multivariable logistic regression, Class III obese patients had a 3.06 times higher odds (OR 3.06 95% CI 1.69-5.57) of LNG-IUD expulsion compared to the control group (normal weight, overweight, and Class I obesity) when adjusting for age, insurance, race and breastfeeding. CONCLUSION: Class III obesity was associated with higher rates of LNG-IUD complications, particularly expulsions. Further studies that include a larger number of obese women are needed to better understand these findings.
Published Version
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