Postpartum Long-Acting Reversible Contraception Is Associated With a Decrease in Recurrent Preterm Birth [3R

Abstract

INTRODUCTION: A history of preterm birth is a major risk factor for subsequent preterm birth. The purpose of this study was to compare the rate of recurrent preterm birth in women who received postpartum long-acting reversible contraception (LARC) to those who did not receive postpartum LARC. METHODS: This is a retrospective cohort study of women with singleton gestations who delivered prior to 37 weeks between January 2011 and January 2015. The study was approved by the local IRB, and protected health information was de-identified. The rate of recurrent preterm birth was compared between women who received a LARC method within 12 weeks postpartum and those who did not receive LARC. Chi square analysis and multivariate logistic regression were performed controlling for maternal age, BMI, education, employment, race, ethnicity and insurance type. Interpregnancy interval was investigated as a secondary outcome. RESULTS: Of 355 subjects with preterm birth, 110 (31%) received postpartum LARC. The rate of recurrent preterm birth was 10.6% in the LARC group vs 23.4% in the non-LARC group (P=.006). After adjusting for potential confounders, subjects with postpartum LARC were 58% less likely to have a recurrent preterm birth as compared to subjects without postpartum LARC (adjusted 95% CI 0.20 - 0.86). The mean interpregnancy interval was 11.2 months longer in the LARC group as compared to the non-LARC group (P=.003). CONCLUSION: LARC placement within 12 weeks following a preterm birth is associated with a decreased risk of recurrent preterm birth. Contraceptive counseling in women with preterm birth should address this risk-reducing intervention.