Contraceptive Preference, Continuation Rates, and Unintended Pregnancies in Patients with Comorbidities: A Prospective Cohort Study

Abstract

Background: Patients with comorbidities are more susceptible to adverse pregnancy outcomes, morbidity, and mortality than healthy patients. The goal of this study was to evaluate how comorbidities influence contraceptive choice, continuation rates, and the unintended pregnancy rate in reproductive-age participants. Methods: We analyzed data from the Contraceptive CHOICE Project. Baseline data included demographic, reproductive, and medical history, including self-reported hypertension (HTN), venous thromboembolism (VTE), migraines, cerebrovascular accidents (CVA), transient ischemic attack (TIA), or stroke. Participants were provided contraceptive counseling and their method of choice at no cost. Results: Among 9253 participants included in our analysis, 659 participants reported a history of HTN (7%), 20 participants reported a history of CVA/TIA/stroke (<1%), 1803 participants reported a history of migraine (19%), and 85 reported a history of VTE (<1%). Compared to baseline, use of long-acting reversible contraceptive methods (long-acting reversible contraception [LARC]: intrauterine devices and implants) increased for participants with all comorbidities: HTN 2.3%-84.2%; CVA/TIA/stroke 0%-85%; migraines 1.7%-77%, and VTE 1.2%-88.2%. Participants with HTN, VTE, and migraines were more likely to choose LARC than those without those conditions: HTN: relative risk (RR) = 1.14, 95% confidence interval (CI) 1.10-1.18; migraines RR = 1.04, 95% CI 1.01-1.07; and VTE RR = 1.18, 95% CI 1.09-1.28. Twelve-month continuation and unintended pregnancy rates did not differ significantly based on comorbidity status. Conclusions: Participants with serious comorbidities were more likely to choose LARC than healthy participants. Contraceptive counseling should always be individualized to the patient. Clinical Trials.gov Identifier: NCT01986439.

Keywords: comorbidity; contraception; long-acting reversible contraception; unplanned pregnancy.

FIG. 1.

Continuation rates by contraceptive method (LARC vs. non-LARC) and by presence of absence of thromboembolic disorder. LARC, long-acting reversible contraception.