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Shaw JG, Goldthwaite LM, Marić I, Shaw KA, Stevenson DK, Shaw GM. Postpartum long-acting reversible contraception among privately insured: U.S. National analysis 2007-2016, by term and preterm birth. Contraception 2023; 125:110065. [PMID: 37210023 DOI: 10.1016/j.contraception.2023.110065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To investigate postpartum long-acting reversible contraception (LARC) use among privately insured women, with specific consideration of use after preterm delivery. STUDY DESIGN We used the national IBM MarketScan Commercial Database to identify singleton deliveries from 2007 to 2016, spontaneous preterm birth, and follow-up ≤12 weeks postpartum. We assessed ≤12-week postpartum LARC placement overall and after spontaneous preterm deliveries, across study years. We examined timing of placement, rates of postpartum follow-up, and state-level variation in postpartum LARC. RESULTS Among 3,132,107 singleton deliveries, 6.6% were spontaneous preterm. Over the time period, total postpartum LARC use increased 4.8% to 11.7% for intrauterine devices (IUDs), 0.2% to 2.4% for implants. In 2016, those who experienced a spontaneous preterm birth were less likely to initiate postpartum IUDs compared to their peers (10.2% vs 11.8%, p < 0.001), minimally more likely to initiate implants (2.7% vs 2.4%, p = 0.04) and more likely to present for postpartum care (61.7% vs 55.9%, p < 0.001). LARC placement prior to hospital discharge was rare (preterm: 8 per 10,000 deliveries vs all others: 6.3 per 10,000 deliveries, p = 0.002). State-level analysis showed wide variation in postpartum LARC (range 6%-32%). CONCLUSIONS While postpartum LARC use increased among the privately insured 2007-2016, few received LARC prior to hospital discharge. Those experiencing preterm birth were no more likely to receive inpatient LARC. Postpartum follow-up remained low and regional variation of LARC was high, highlighting the need for efforts to remove barriers to inpatient postpartum LARC for all who desire it-public and privately insured alike. IMPLICATIONS Among the half of U.S. births that are privately insured, postpartum LARC is increasing after both term and preterm births, yet exceedingly few (<0.1%) received LARC prior to hospital discharge.
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Affiliation(s)
- Jonathan G Shaw
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | | | - Ivana Marić
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kate A Shaw
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Sun J, Yang R, Xian H, Zhang B, Lin H, Xaverius P, Yang S, Dong GH, Howard SW, LeBaige M, Peng A, Liu E, Zheng T, Zhou A, Qian Z. Association between maternal family history of hypertension and preterm birth: modification by noise exposure and multivitamin intake. J Matern Fetal Neonatal Med 2022; 35:10458-10465. [PMID: 36191924 DOI: 10.1080/14767058.2022.2128665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To measure the effect of maternal family history of hypertension on preterm birth (PTB) and to identify factors that modified this association. METHODS A case-control study was nested in a prospective cohort of the entire pregnant population in Wuhan, China, from 2011 to 2013. Home-visit interviews were scheduled for all PTBs and their controls, to collect extensive information on maternal exposures to behavioral, environmental, and intergenerational risk factors of PTB. The effects of maternal family history of hypertension on PTB were measured by logistic regression analyses, controlling for potential confounders. Potential effect modifiers were examined using stratified analyses. RESULTS There were 2393 PTBs and 4263 full-term births out of all eligible births. A positive association was observed between maternal family history of hypertension and PTB, after adjusted for potential confounders (adjusted odds ratio: 1.17 [1.03, 1.33]). A higher effect was observed when mothers were exposed to certain noise during pregnancy (adjusted odds ratio: 1.37 [1.14, 1.65]) and/or when they did not take multivitamins during pregnancy (adjusted odds ratio: 1.46 [1.20, 1.78]), whereas, this association was weaker and no longer significant when mothers took multivitamins during pregnancy (adjusted odds ratio: 1.00 [0.84, 1.19]) and/or when they were not exposed to certain noise during pregnancy (adjusted odds ratio: 1.01 [0.85, 1.12]). The modification effect from maternal multivitamin intake was significant on both spontaneous and medically indicated PTBs, and the modification effect from maternal exposure to certain noise was only significant on spontaneous PTB. CONCLUSIONS Increased PTB risk was observed for pregnant women with a family history of hypertension in Wuhan, China. This effect was stronger when pregnant women did not take multivitamin and/or exposed to certain noise during pregnancy, than those who took multivitamin and/or unexposed to certain noise.
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Affiliation(s)
- Jia Sun
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Rong Yang
- Department of Maternal Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Hong Xian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Bin Zhang
- Department of Maternal Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Pam Xaverius
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Shaoping Yang
- Child Health Care Department of Community, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Guang-Hui Dong
- Department of Environmental and Occupational Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Steven W Howard
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Morgan LeBaige
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Anna Peng
- Child Health Care Department of Community, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Echu Liu
- Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Tongzhang Zheng
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Aifen Zhou
- Department of Maternal Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
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Tessema GA, Håberg SE, Pereira G, Magnus MC. The role of intervening pregnancy loss in the association between interpregnancy interval and adverse pregnancy outcomes. BJOG 2022; 129:1853-1861. [PMID: 35596254 PMCID: PMC9541236 DOI: 10.1111/1471-0528.17223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/26/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether intervening miscarriages and induced abortions impact the associations between interpregnancy interval after a live birth and adverse pregnancy outcomes. DESIGN Population-based cohort study. SETTING Norway. PARTICIPANTS A total of 165 617 births to 143 916 women between 2008 and 2016. MAIN OUTCOME MEASURES We estimated adjusted relative risks for adverse pregnancy outcomes using log-binomial regression, first ignoring miscarriages and induced abortions in the interpregnancy interval estimation (conventional interpregnancy interval estimates) and subsequently accounting for intervening miscarriages or induced abortions (correct interpregnancy interval estimates). We then calculated the ratio of the two relative risks (ratio of ratios, RoR) as a measure of the difference. RESULTS The proportion of short interpregnancy interval (<6 months) was 4.0% in the conventional interpregnancy interval estimate and slightly increased to 4.6% in the correct interpregnancy interval estimate. For interpregnancy interval <6 months, compared with 18-23 months, the RoR was 0.97 for preterm birth (PTB) (95% confidence interval [CI] 0.83-1.13), 0.97 for spontaneous PTB ( 95% CI 0.80-1.19), 1.00 for small-for-gestational age ( 95% CI 0.86-1.14), 1.00 for large-for-gestational age (95% CI 0.90-1.10) and 0.99 for pre-eclampsia (95% CI 0.71-1.37). Similarly, conventional and correct interpregnancy intervals yielded associations of similar magnitude between long interpregnancy interval (≥60 months) and the pregnancy outcomes evaluated. CONCLUSION Not considering intervening pregnancy loss due to miscarriages or induced abortions, results in negligible difference in the associations between short and long interpregnancy intervals and adverse pregnancy outcomes.
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Affiliation(s)
- Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Tessema GA, Marinovich ML, Håberg SE, Gissler M, Mayo JA, Nassar N, Ball S, Betrán AP, Gebremedhin AT, de Klerk N, Magnus MC, Marston C, Regan AK, Shaw GM, Padula AM, Pereira G. Interpregnancy intervals and adverse birth outcomes in high-income countries: An international cohort study. PLoS One 2021; 16:e0255000. [PMID: 34280228 PMCID: PMC8289039 DOI: 10.1371/journal.pone.0255000] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women can address this issue. METHODS We conducted an international longitudinal cohort study of 5,521,211 births to 3,849,193 women from Australia (1980-2016), Finland (1987-2017), Norway (1980-2016) and the United States (California) (1991-2012). IPI was calculated based on the time difference between two dates-the date of birth of the first pregnancy and the date of conception of the next (index) pregnancy. We estimated associations between IPI and preterm birth (PTB), spontaneous PTB, and small-for-gestational age births (SGA) using logistic regression (between-women analyses). We also used conditional logistic regression comparing IPIs and birth outcomes in the same women (within-women analyses). Random effects meta-analysis was used to calculate pooled adjusted odds ratios (aOR). RESULTS Compared to an IPI of 18-23 months, there was insufficient evidence for an association between IPI <6 months and overall PTB (aOR 1.08, 95% CI 0.99-1.18) and SGA (aOR 0.99, 95% CI 0.81-1.19), but increased odds of spontaneous PTB (aOR 1.38, 95% CI 1.21-1.57) in the within-women analysis. We observed elevated odds of all birth outcomes associated with IPI ≥60 months. In comparison, between-women analyses showed elevated odds of adverse birth outcomes for <12 month and >24 month IPIs. CONCLUSIONS We found consistently elevated odds of adverse birth outcomes following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of other adverse birth outcomes. Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries.
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Affiliation(s)
- Gizachew A. Tessema
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - M. Luke Marinovich
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Siri E. Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jonathan A. Mayo
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, United States of America
| | - Natasha Nassar
- Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Stephen Ball
- Curtin School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Amanuel T. Gebremedhin
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Maria C. Magnus
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Cicely Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Annette K. Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health,Texas A&M University, College Station, Texas, United States of America
| | - Gary M. Shaw
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, United States of America
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States of America
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
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Changes in Rates of Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the USA, 2012-2016. Matern Child Health J 2021; 25:1562-1573. [PMID: 33970416 DOI: 10.1007/s10995-021-03152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine recent rates of long-acting and permanent methods (LAPM) of contraception use during delivery hospitalization and correlates of their use. METHODS A retrospective cohort study utilizing the 2012-2016 National Inpatient Sample of hospitalizations in the United States of America. The International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes were used to identify deliveries, inpatient long-acting reversible contraception (IPP LARC), and postpartum tubal ligation (PPTL). We conducted univariable and multivariable logistic regression to examine associations between demographic, clinical, hospital and geographical characteristics with likelihood of LAPM including IPP LARC and PPTL. RESULTS Our sample included 3,642,328 unweighted deliveries. The rate of IPP LARC increased from 34.6 to 54.9 per 10,000 deliveries (58.7%), while the rate of PPTL utilization decreased from 719.5 to 671.8 per 10,000 deliveries (6.6%) over the study period. In multivariable analysis of LAPM utilization versus neither, cesarean delivery (aOR 7.25, 95% CI 7.08-7.43) was associated with greater utilization. Native American (aOR 4.01, 95% CI 2.91-5.53) race was associated with increased use of IPP LARC compared to a non-long-acting method of contraception. Age between 18 and 29 years (aOR 6.21, 95% CI 5.42-7.11) was associated with greater use of IPP LARC versus PPTL. Delivering in a rural hospital ((aOR 0.09, 95% CI 0.06-0.12) and cesarean delivery (aOR 0.09, 95% CI 0.06-0.12) were associated with greater use PPTL versus IPP LARC. CONCLUSIONS The IPP LARC rate remains at less than 10% the PPTL rates in our study timeframe. The demonstrated variation in uptake of highly effective methods of contraception inpatient after delivery offer possible opportunities for better understanding and improvement in access.
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Sujan AC, Class QA, Rickert ME, Van Hulle C, D'Onofrio BM. Risk factors and child outcomes associated with short and long interpregnancy intervals. EARLY CHILD DEVELOPMENT AND CARE 2019; 191:2281-2292. [PMID: 34924676 PMCID: PMC8673594 DOI: 10.1080/03004430.2019.1703111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/07/2019] [Indexed: 06/14/2023]
Abstract
Previous research assessing consequences of interpregnancy intervals (IPIs) on child development is mixed. Utilizing a population-based US sample (n=5,339), we first estimated the associations between background characteristics (e.g., sociodemographic and maternal characteristics) and short (≤ 1 year) and long (> 3 years) IPI. Then, we estimated associations between IPI and birth outcomes, infant temperament, cognitive ability, and externalizing symptoms. Several background characteristics, such as maternal age at childbearing and previous pregnancy loss, were associated with IPI, indicating research on the putative effects of IPI must account for background characteristics. After covariate adjustment, short IPI was associated with poorer fetal growth and long IPI was associated with lower infant activity level; however, associations between short and long IPI and the other outcomes were neither large nor statistically significant. These findings indicate that rather than intervening to modify IPI, at-risk families may benefit from interventions aimed at other modifiable risk factors.
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Affiliation(s)
- Ayesha C Sujan
- Department of Psychological & Brain Sciences, Indiana University, Bloomington, IN, USA
- All correspondence should be sent to: Ayesha C. Sujan, Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St., Bloomington, IN 47405, , Telephone: 812-856-2588
| | - Quetzal A Class
- Department of Obstetrics & Gynecology, University of Illinois, Chicago, IL, USA
| | - Martin E Rickert
- Department of Psychological & Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Carol Van Hulle
- Alzheimer's Disease Research Center, University of Wisconsin-Madison, WI, USA
| | - Brian M D'Onofrio
- Department of Psychological & Brain Sciences, Indiana University, Bloomington, IN, USA
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
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