Post-Partum LARC Utilization Among Group Prenatal Care Participants in Atlanta, Georgia [4E

Abstract

INTRODUCTION: CenteringPregnancy (CP) is a model of group prenatal care (PNC) that reduces preterm birth and increases patient satisfaction. Less is known about post-partum outcomes. This study was conducted to determine whether CP participants have increased utilization of long-acting reversible contraception (LARC) post-partum in comparison to those in traditional PNC. METHODS: We conducted a retrospective cohort study of 422 women who received PNC and delivered at Grady Memorial Hospital in Atlanta, Georgia between 2011 and 2015. Participants were eligible if enrolled in Medicaid and received at least three PNC visits with a Certified Nurse Midwife in either CP (n=248) or traditional PNC (n=174). Demographic and clinical data were abstracted from the electronic medical record. Unadjusted relative risk (RR) and adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CI) were generated to compare CP with traditional PNC. RESULTS: One quarter of women (26%) chose LARC for post-partum contraception. CP participants were more likely to use LARC by 12 weeks post-partum in comparison to those who received traditional PNC (aIRR 1.89; p=0.01), adjusting for age, mode of delivery, number of prenatal visits and primiparity. Short inter-pregnancy interval was similar between the CP and traditional PNC groups (RR 0.95, p=0.57). CONCLUSION: Women in CP groups may be more likely to choose LARC post-partum contraception but were no less likely to have a short inter-pregnancy interval.