Abstract
OBJECTIVE: Half of pregnancies in the United States are unintended. We hypothesized a high-risk pregnancy might represent a teachable moment regarding contraceptive options. METHODS: This was a retrospective study of women delivering at a university hospital during 2009-2010 who received prenatal care in the faculty or resident clinics. High-risk status was defined by Society of Maternal-Fetal Medicine guidelines; subject categorizations were agreed on by all authors. Documentation of contraceptive plan was abstracted from clinic and hospital records. Subsequent pregnancies through 2012 were abstracted. chi tests assessed correlations between risk status and both contraceptive choice and subsequent pregnancy. Binary logistic regression was performed for the outcomes of Tier 1 contraceptive choice at last contact and for subsequent pregnancy during the follow-up period. RESULTS: A total of 3063 women were included 2048 low risk and 1015 high risk. The index pregnancy was slightly more likely to be unintended among low-risk than high-risk women (48% compared with 43% P=.02). When contraceptive methods were categorized according to World Health Organization tiers intention to use tier 1 (most effective) contraceptives was high for both groups antepartum (54% low risk compared with 58% high risk) slightly decreased at hospital discharge (42% compared with 51% P<.001) and significantly decreased postpartum (27% compared with 32% P=.004). During follow-up 656 women (21.4%) had a second pregnancy lasting more than 20 weeks. These were unintended among 36.6% of low-risk and 32.4% of high-risk women which was not statistically different. CONCLUSION: Women experiencing high-risk pregnancy were no more likely to have planned their index pregnancy. Although their uptake of highly effective contraception was higher immediately postpartum they were as likely to have an unplanned pregnancy during follow-up. New strategies are needed to counsel all women about pregnancy planning and contraception.
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