Postpartum contraceptive use among women with a recent preterm birth

Abstract

Objective: The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth.

Study design: Population-based data from the Pregnancy Risk Assessment Monitoring System in 9 states were used to estimate the postpartum use of highly or moderately effective contraception (sterilization, intrauterine device, implants, shots, pills, patch, and ring) and user-independent contraception (sterilization, implants, and intrauterine device) among women with recent live births (2009-2011). We assessed the differences in contraception by gestational age (≤27, 28-33, or 34-36 weeks vs term [≥37 weeks]) and modeled the associations using multivariable logistic regression with weighted data.

Results: A higher percentage of women with recent extreme preterm birth (≤27 weeks) reported using no postpartum method (31%) compared with all other women (15-16%). Women delivering extreme preterm infants had a decreased odds of using highly or moderately effective methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.6) and user-independent methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.7) compared with women having term births. Wanting to get pregnant was more frequently reported as a reason for contraceptive nonuse by women with an extreme preterm birth overall (45%) compared with all other women (15-18%, P < .0001). Infant death occurred in 41% of extreme preterm births and more than half of these mothers (54%) reported wanting to become pregnant as the reason for contraceptive nonuse.

Conclusion: During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant.

Keywords: Medicaid; contraception effectiveness; insurance; postpartum; preterm birth.

Figure 1. Percentage of Postpartum Contraceptive Method Type

This figure depicts the prevalence of postpartum contraception use (permanent, long-acting reversible contraceptives [LARCs], highly- and moderately-effective user-dependent methods, less effective methods, none) stratified by most recent birth outcome (term or preterm: 34–36 weeks, 28–33 weeks, ≤27 weeks) p<.0001 Pregnancy Risk Assessment Monitoring System, 9 U.S. states and New York City, 2009–2011. * Includes tubal ligation and vasectomy. † Includes intrauterine devices, and implants. ‡ Includes shots, pill, patch, and ring. § Includes male and female condoms, diaphragm, cervical cap, sponge, emergency contraception, rhythm, withdrawal, and other. ¶ Includes abstinence.