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Bullard KA, Ramanadhan S, Caughey AB, Rodriguez MI. Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis. Obstet Gynecol 2024; 144:294-303. [PMID: 39053007 DOI: 10.1097/aog.0000000000005679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/06/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To estimate the cost effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce future short interpregnancy interval (IPI), severe maternal morbidity (SMM), and preterm birth. METHODS We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI , defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities. RESULTS Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of -11,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796. CONCLUSION Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth.
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Affiliation(s)
- Kimberley A Bullard
- Department of Obstetrics and Gynecology, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee; and the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Das L, Shekhar C, Sengupta S, Mishra A. Adoption of contraception following a pregnancy loss in India. Int J Gynaecol Obstet 2024; 165:1091-1103. [PMID: 38189178 DOI: 10.1002/ijgo.15341] [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: 03/21/2023] [Revised: 08/21/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The present study was carried out to describe contraceptive adoption following pregnancy terminations that resulted in outcomes other than live birth. METHOD Retrospective calendar data on 31486 women who had experienced a pregnancy loss within the last 60 months prior to the survey date were drawn from a nationally representative dataset. Logistic regression was employed to model the associated factors with contraceptive uptake. RESULTS Overall, 57.8% reported not adopting any method following the end of the recent pregnancy. There was a significant association between the choice of contraceptive method and timing of adoption. Women with living children were significantly more likely to adopt contraception as compared to women without any child. CONCLUSION Contraceptive uptake following a non-live birth is considerably low in India. Interventions in reproductive health should focus on provision of different contraceptive methods and counseling emphasizing on effectiveness and correct use of the methods at the end of any pregnancy.
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Affiliation(s)
- Labhita Das
- Department of Biostatistics and Demography, International Institute for Population Sciences, Mumbai, India
| | - Chander Shekhar
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Shoummo Sengupta
- Koita Center for Digital Health, Indian Institute of Technology Bombay, Mumbai, India
| | - Akshay Mishra
- Department of Decision Sciences, Indian Institute of Management, Lucknow, India
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Bullard KA, Hersh A, Caughey AB, Rodriguez MI. Expanding comprehensive pregnancy care for Emergency Medicaid recipients: a cost-effectiveness analysis. Am J Obstet Gynecol MFM 2024; 6:101364. [PMID: 38574857 PMCID: PMC11102284 DOI: 10.1016/j.ajogmf.2024.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Emergency Medicaid is a restricted benefits program for individuals who have low-income status and who are immigrants. OBJECTIVE This study aimed to compare the cost-effectiveness of 2 strategies of pregnancy coverage for Emergency Medicaid recipients: the federal minimum of covering the delivery only vs extended coverage to 60 days after delivery. STUDY DESIGN A decision analytical Markov model was developed to evaluate the outcomes and costs of these policies, and the results in a theoretical cohort of 100,000 postpartum Emergency Medicaid recipients were considered. The payor perspective was adopted. Health outcomes and cost-effectiveness over a 1- and 3-year time horizon were investigated. All probabilities, utilities, and costs were obtained from the literature. Our primary outcome was the incremental cost-effectiveness ratio of the competing strategies. RESULTS Extending Emergency Medicaid to 60 days after delivery was determined to be a cost-saving strategy. Providing postpartum and contraceptive care resulted in 33,900 additional people receiving effective contraception in the first year and prevented 7290 additional unintended pregnancies. Over 1 year, it resulted in a gain of 1566 quality-adjusted life year at a cost of $10,903 per quality-adjusted life year. By 3 years of policy change, greater improvements were observed in all outcomes, and the expansion of Emergency Medicaid became cost saving and the dominant strategy. CONCLUSION The inclusion of postpartum care and contraception for immigrant women who have low-income status resulted in lower costs and improved health outcomes.
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Affiliation(s)
- Kimberley A Bullard
- Department of Obstetrics and Gynecology, Center for Reproductive Health Equity, Oregon Health & Science University, Portland, OR (Drs Bullard, Hersh, Caughey, and Rodriguez); Department of Obstetrics and Gynecology, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN (Dr Bullard)
| | - Alyssa Hersh
- Department of Obstetrics and Gynecology, Center for Reproductive Health Equity, Oregon Health & Science University, Portland, OR (Drs Bullard, Hersh, Caughey, and Rodriguez)
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Center for Reproductive Health Equity, Oregon Health & Science University, Portland, OR (Drs Bullard, Hersh, Caughey, and Rodriguez)
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Center for Reproductive Health Equity, Oregon Health & Science University, Portland, OR (Drs Bullard, Hersh, Caughey, and Rodriguez).
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Sakai-Bizmark R, Jackson NJ, Wu F, Marr EH, Kumamaru H, Estevez D, Gemmill A, Moreno JC, Henwood BF. Short Interpregnancy Intervals Among Women Experiencing Homelessness in Colorado. JAMA Netw Open 2024; 7:e2350242. [PMID: 38175646 PMCID: PMC10767616 DOI: 10.1001/jamanetworkopen.2023.50242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Importance Short interpregnancy intervals (SIPIs) are associated with increased risk of adverse maternal and neonatal outcomes. Disparities exist across socioeconomic status, but there is little information on SIPIs among women experiencing homelessness. Objective To investigate (1) differences in rates and characteristics of SIPIs between women experiencing homelessness and domiciled women, (2) whether the association of homelessness with SIPIs differs across races and ethnicities, and (3) whether the association between SIPIs of less than 6 months (very short interpregnancy interval [VSIPIs]) and maternal and neonatal outcomes differs between participant groups. Design, Setting, and Participants This cohort study used a Colorado statewide database linking the Colorado All Payer Claims Database, Homeless Management Information System, death records, and infant birth records. Participants included all women who gave birth between January 1, 2016, and December 31, 2021. Data were analyzed from September 1, 2022, to May 10, 2023. Exposures Homelessness and race and ethnicity. Main Outcomes and Measures The primary outcome consisted of SIPI, a binary variable indicating whether the interval between delivery and conception of the subsequent pregnancy was shorter than 18 months. The association of VSIPI with maternal and neonatal outcomes was also tested. Results A total of 77 494 women (mean [SD] age, 30.7 [5.3] years) were included in the analyses, of whom 636 (0.8%) were women experiencing homelessness. The mean (SD) age was 29.5 (5.4) years for women experiencing homelessness and 30.7 (5.3) years for domiciled women. In terms of race and ethnicity, 39.3% were Hispanic, 7.3% were non-Hispanic Black, and 48.4% were non-Hispanic White. Associations between homelessness and higher odds of SIPI (adjusted odds ratio [AOR], 1.23 [95% CI, 1.04-1.46]) were found. Smaller associations between homelessness and SIPI were found among non-Hispanic Black (AOR, 0.59 [95% CI, 0.37-0.96]) and non-Hispanic White (AOR, 0.57 [95% CI, 0.39-0.84]) women compared with Hispanic women. A greater association of VSIPI with emergency department visits and low birth weight was found among women experiencing homelessness compared with domiciled women, although no significant differences were detected. Conclusions and Relevance In this cohort study of women who gave birth from 2016 to 2021, an association between homelessness and higher odds of SIPIs was found. These findings highlight the importance of conception management among women experiencing homelessness. Racial and ethnic disparities should be considered when designing interventions.
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Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance
- Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Torrance
| | - Nicholas J. Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles
| | - Frank Wu
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance
| | - Emily H. Marr
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica C. Moreno
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance
| | - Benjamin F. Henwood
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
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Malhotra T, Sheyn D, Arora K. Association of Opioid Use Disorder and Provision of Highly Effective Inpatient Postpartum Contraception. Open Access J Contracept 2023; 14:95-102. [PMID: 37362953 PMCID: PMC10290468 DOI: 10.2147/oajc.s411092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
We sought to examine the rates of the inpatient provision of postpartum long-acting and permanent methods (IPP LAPM) of contraception in patients with opioid use disorder (OUD). This is a retrospective cross-sectional regression analysis of the National Inpatient Sample between 2012 and 2016. Patients with a diagnosis of OUD that delivered and received postpartum permanent contraception or long acting reversible contraception placement during the same hospitalization were identified. Regression analyses were performed to identify the demographic and clinical factors associated with long acting and permanent contraception method utilization. Of the 22,294 patients with OUD who delivered during the study period, 2291 (10.3%) received IPP LAPM. The majority of patients (1989) (86.6%) with OUD who chose inpatient provision of long acting or permanent methods after delivery received permanent contraception. After adjusting for covariates, patients with OUD had an overall decreased probability of receiving IPP LAPM (aOR=0.89, 95% CI: 0.85-0.95), decreased probability of receiving permanent contraception (aOR: 0.82, 95% CI: 0.78-0.88), but an increased probability of receiving long-acting reversible contraception (aOR: 1.29, 95% CI: 1.04-1.60) compared to patients without OUD. This study highlights the continued need to ensure appropriate measures (such as antepartum contraceptive counseling, availability of access to inpatient LAPM, and removal of Medicaid policy barriers to permanent contraception) are in place so that the contraceptive needs of patients with OUD are fulfilled.
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Affiliation(s)
- Tani Malhotra
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Sheyn
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kavita Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA
- Department of Obstetrics and Gynecology, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA
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Sothornwit J, Kaewrudee S, Lumbiganon P, Pattanittum P, Averbach SH. Immediate versus delayed postpartum insertion of contraceptive implant and IUD for contraception. Cochrane Database Syst Rev 2022; 10:CD011913. [PMID: 36302159 PMCID: PMC9612833 DOI: 10.1002/14651858.cd011913.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants, are highly effective, reversible methods of contraception. Providing LARC methods during the postpartum period is important to support contraceptive choice, and to prevent unintended pregnancy and short interpregnancy intervals. Delaying offering contraception to postpartum people until the first comprehensive postpartum visit, traditionally at around six weeks postpartum, may put some postpartum people at risk of unintended pregnancy, either due to loss to follow-up or because of initiation of sexual intercourse prior to receiving contraception. Therefore, immediate provision of highly effective contraception, prior to discharge from hospital, has the potential to improve contraceptive use and prevent unintended pregnancies and short interpregnancy intervals. OBJECTIVES To compare the initiation rate, utilization rates (at six months and 12 months after delivery), effectiveness, and adverse effects of immediate versus delayed postpartum insertion of implants and IUDs for contraception. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and POPLINE for eligible studies up to December 2020. We examined review articles and contacted investigators. We checked registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies. SELECTION CRITERIA We sought randomized controlled trials (RCTs) that compared immediate postpartum versus delayed insertion of contraceptive implant and IUDs for contraception. DATA COLLECTION AND ANALYSIS Two review authors (JS, SK) independently screened titles and abstracts of the search results, and assessed the full-text articles of potentially relevant studies for inclusion. They extracted data from the included studies, assessed risk of bias, compared results, and resolved disagreements by consulting a third review author (PL, SA or PP). We contacted investigators for additional data, where possible. We computed the Mantel-Haenszel or inverse variance risk ratio (RR) with 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous variables. MAIN RESULTS In this updated review, 16 studies met the inclusion criteria; five were studies of contraceptive implants (715 participants) and 11 were studies of IUDs (1894 participants). We identified 12 ongoing studies. We applied GRADE judgements to our results; the overall certainty of the evidence for each outcome ranged from moderate to very low, with the main limitations being risk of bias, inconsistency, and imprecision. Contraceptive implants Immediate insertion probably improves the initiation rate for contraceptive implants compared with delayed insertion (RR 1.48, 95% CI 1.11 to 1.98; 5 studies, 715 participants; I2 = 95%; moderate-certainty evidence). We are uncertain if there was a difference between the two groups for the utilization rate of contraceptive implants at six months after delivery (RR 1.16, 95% CI 0.90 to 1.50; 3 studies, 330 participants; I2 = 89%; very low-certainty evidence) or at 12 months after insertion (RR 0.98, 95% CI 0.93 to 1.04; 2 studies, 164 participants; I2 = 0%; very low-certainty evidence). People who received an immediate postpartum contraceptive implant insertion may have had a higher mean number of days of prolonged vaginal bleeding within six weeks postpartum (mean difference (MD) 2.98 days, 95% CI -2.71 to 8.66; 2 studies, 420 participants; I2 = 91%; low-certainty evidence) and a higher rate of other adverse effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; 1 study, 215 participants; low-certainty evidence) than those who received a delayed postpartum insertion. We are uncertain if there was a difference between the two groups for prolonged bleeding at six months after delivery (RR 1.19, 95% CI 0.29 to 4.94; 2 studies, 252 participants; I2 = 0%; very low-certainty evidence). There may be little or no difference between the two groups for rates of unintended pregnancy at six months (RR 0.20, 95% CI 0.01 to 4.08; one study, 205 participants; low-certainty evidence). We are uncertain whether there was a difference in rates of unintended pregnancy at 12 months postpartum (RR 1.82, 95% CI 0.38 to 8.71; 1 study, 64 participants; very low-certainty evidence). There may be little or no difference between the two groups for any breastfeeding rates at six months (RR 0.97, 95% CI 0.92 to 1.01; 2 studies, 225 participants; I2 = 48%; low-certainty evidence). IUDs Immediate insertion of IUDs probably improves the initiation rate compared with delayed insertion, regardless of type of IUD (RR 1.27, 95% CI 1.07 to 1.51; 10 studies, 1894 participants; I2 = 98%; moderate-certainty evidence). However, people who received an immediate postpartum IUD insertion may have had a higher expulsion rate at six months after delivery (RR 4.55, 95% CI 2.52 to 8.19; 8 studies, 1206 participants; I2 = 31%; low-certainty evidence) than those who received a delayed postpartum insertion. We are uncertain if there was a difference between the two groups in the utilization of IUDs at six months after insertion (RR 1.02, 95% CI 0.65 to 1.62; 6 studies, 971 participants; I2 = 96%; very low-certainty evidence) or at 12 months after insertion (RR 0.86, 95% CI 0.5 to 1.47; 3 studies, 796 participants; I2 = 92%; very low-certainty evidence). Immediate IUDs insertion may reduce unintended pregnancy at 12 months (RR 0.26, 95% CI 0.17 to 0.41; 1 study, 1000 participants; low-certainty evidence). We are uncertain whether there was difference in any breastfeeding rates at six months in people receiving progestin-releasing IUDs (RR 0.90, 95% CI 0.63 to 1.30; 5 studies, 435 participants; I2 = 54%; very low-certainty evidence). AUTHORS' CONCLUSIONS Evidence from this updated review indicates that immediate postpartum insertion improves the initiation rate of both contraceptive implants and IUDs by the first postpartum visit compared to delayed insertion. However, it is not clear whether that there are differences in utilization rates at six and 12 months postpartum. We are uncertain whether there is any difference in the unintended pregnancy rate at 12 months. Provision of progestin-releasing implants and IUDs immediately postpartum may have little or no negative impact on breastfeeding. However, the expulsion rate of IUDs and prolonged vaginal bleeding associated with immediate implants appears to be higher.
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Affiliation(s)
- Jen Sothornwit
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Srinaree Kaewrudee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Porjai Pattanittum
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Sarah H Averbach
- OB/GYN and Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA
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Rodriguez MI, Skye M, Samandari G, Darney BG. Timing of postpartum long acting, reversible contraception was not associated with 12-month removal rates in a large Medicaid sample. Contraception 2022; 113:49-56. [DOI: 10.1016/j.contraception.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/02/2022] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
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Attanasio LB, Ranchoff BL, Cooper MI, Geissler KH. Postpartum Visit Attendance in the United States: A Systematic Review. Womens Health Issues 2022; 32:369-375. [PMID: 35304034 DOI: 10.1016/j.whi.2022.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Adequate postpartum care, including the comprehensive postpartum visit, is critical for long-term maternal health and the reduction of maternal mortality, particularly for people who may lose insurance coverage postpartum. However, variation in previous estimates of postpartum visit attendance in the United States makes it difficult to assess rates of attendance and associated characteristics. METHODS We conducted a systematic review of estimates of postpartum visit attendance. We searched PubMed, CINAHL, PsycInfo, and Web of Science for articles published in English from 1995 to 2020 using search terms to capture postpartum visit attendance and use in the United States. RESULTS Eighty-eight studies were included in this analysis. Postpartum visit attendance rates varied substantially, from 24.9% to 96.5%, with a mean of 72.1%. Postpartum visit attendance rates were higher in studies using patient self-report than those using administrative data. The number of articles including an estimate of postpartum visit attendance increased considerably over the study period; the majority were published in 2015 or later. CONCLUSIONS Our findings suggest that increased systematic data collection efforts aligned with postpartum care guidelines and attention to postpartum visit attendance rates may help to target policies to improve maternal wellbeing. Most estimates indicate that a substantial proportion of women do not attend at least one postpartum visit, potentially contributing to maternal morbidity as well as preventing a smooth transition to future well-woman care. Estimates of current postpartum visit attendance are important for informing efforts that seek to increase postpartum visit attendance rates and to improve the quality of care.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts.
| | - Brittany L Ranchoff
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Michael I Cooper
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Kimberley H Geissler
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts
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Wilson CH, Lazorwitz A, Hyer J, Guiahi M. Concordance of Desired and Administered Postpartum Contraceptives among Emergency and Full Scope Medicaid Patients. Womens Health Issues 2022; 32:343-351. [PMID: 35272884 DOI: 10.1016/j.whi.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 12/29/2021] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if concordance of contraceptive preference and uptake differ between postpartum recipients of emergency versus full scope Medicaid. STUDY DESIGN We performed a historical cohort study of patients who delivered at a safety-net hospital in Denver, Colorado in 2016. In our public system, all patients had access to immediate postpartum tubal ligation and all forms of reversible contraception in outpatient clinics. We used data from electronic health records to compare contraceptive preferences and uptake between patients with full scope and emergency Medicaid at hospital discharge and by 12 weeks postpartum. We then compared contraceptive concordance (use of the same method as desired during delivery admission) between the groups at time of postpartum discharge and by 12 weeks postpartum. RESULTS We examined 693 women; 349 (50.1%) had emergency Medicaid and 344 (49.9%) had full scope Medicaid. The mean age at delivery was 27.9 years, and most patients were Hispanic (74%). Women with emergency Medicaid were less likely to receive their desired method of postpartum contraception before hospital discharge (53.6% vs. 66.9%; p < .01). One-half of the patients with emergency Medicaid who did not receive their desired method of immediate postpartum contraception were unable to obtain it based on insurance ineligibility. By 12 weeks postpartum, the rates of concordance did not differ by insurance status: 52.4% of patients with emergency Medicaid and 55.2% of patients with full scope Medicaid received their desired method of contraception (p = .46). CONCLUSIONS Emergency Medicaid recipients, largely recent and/or unauthorized immigrants, have high demand for highly effective postpartum contraceptives. Although emergency Medicaid recipients initially had lower rates of receipt of their desired contraceptive during the hospital stay compared with those with full scope Medicaid, they ultimately had similar concordance rates by 12 weeks postpartum. We suspect this finding was in part due to free access to all methods of contraception in our outpatient clinics during the postpartum course. Systemic barriers should be reduced to ensure better access to postpartum contraceptives for all patients, regardless of insurance coverage, to improve reproductive equity.
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Affiliation(s)
- Carrie H Wilson
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Aaron Lazorwitz
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer Hyer
- Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, Colorado
| | - Maryam Guiahi
- Planned Parenthood California Central Coast, Santa Barbara, California
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Rodriguez MI, McConnell KJ, Skye M, Kaufman M, Caughey AB, Lopez-Defede A, Darney BG. Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits. AJOG GLOBAL REPORTS 2022; 2:100030. [PMID: 36274968 PMCID: PMC9563385 DOI: 10.1016/j.xagr.2021.100030] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina. OBJECTIVE We assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 states with similar-sized immigrant populations. STUDY DESIGN We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data of live births covered by Medicaid (Traditional and Emergency) between January 1, 2010 and September 30, 2017, in Oregon and South Carolina. Our analysis was at the individual level. Primary outcomes were postpartum visit attendance and receipt of postpartum contraception within 2 months. We examined differences in demographic and delivery characteristics by Medicaid type. If women received postpartum contraception, we compared the timing of receipt (immediate postpartum, ≤1 month, 1–2 months, and 2–6 months after delivery) by the type of Medicaid. Among women using contraception, we described the type of contraceptive received at each time point, stratified by Medicaid type. Associations between Medicaid type (Traditional vs Emergency) and postpartum visit attendance and contraception use were assessed using adjusted absolute predicted probabilities from logistic regression models. We ran models for the entire cohort and conducted a subanalysis restricted to only Latina women. RESULTS Our study included 375,544 live births to 288,234 women, with 12.7% of births among Emergency Medicaid recipients. Women enrolled in Emergency Medicaid tended to be older (age >35 years; 18.1% vs 7.2%; P<.001) and were more likely to be multiparous (76.8% vs 60.8%; P<.001) and Latina (80.3% vs 9.5%; P<.001) than their Traditional Medicaid peers. Among women enrolled in Emergency Medicaid, the probability of having a postpartum visit was 6.1% (95% confidence interval, 5.9–6.4) compared with 58.8% (95% confidence interval, 58.6–58.9) for women covered by Traditional Medicaid. After 6 months following delivery, 97.6% of Emergency Medicaid recipients had no evidence of contraceptive use compared with 55.6% of Traditional Medicaid enrollees (P<.001). In our adjusted model, Emergency Medicaid recipients were also significantly less likely to receive postpartum contraception than Traditional Medicaid enrollees (1.9% vs 35.5%; 95% confidence interval, [1.8–2.1] vs [35.4–35.7]). We examined the role that race may play in postpartum contraceptive use by conducting a subanalysis restricted to Latina women only. Latinas with births covered by Emergency Medicaid had a 1.9% (95% confidence interval, 1.8–2.0) adjusted probability of postpartum contraception use within 2 months compared with 39.8% (95% confidence interval, 38.7–39.9) among Latinas enrolled in Traditional Medicaid. CONCLUSION Women enrolled in Emergency Medicaid experience large disparities in postpartum care and contraceptive use. Policies that restrict Medicaid coverage following delivery exacerbate inequities in postpartum care, potentially leading to worse health outcomes for low-income immigrants and their children.
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Patel KS, Bakk J, Pensak M, DeFranco E. Influence of Medicaid expansion on short interpregnancy interval rates in the United States. Am J Obstet Gynecol MFM 2021; 3:100484. [PMID: 34517145 DOI: 10.1016/j.ajogmf.2021.100484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Short interpregnancy intervals have been associated with poor maternal and infant outcomes. Contraception access could affect the short interpregnancy interval rates. OBJECTIVE To assess the influence of Medicaid on short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy intervals. STUDY DESIGN Using the United States birth certificate data, we performed a population-based retrospective cohort study including multiparous women who had live births in 2012 and 2016, which is before and after Medicaid expansion had been implemented in 2014. Multivariate logistic regression estimated the influence of Medicaid expansion on short interpregnancy intervals (<12 months). The rate differences of short interpregnancy intervals in 2012 and 2016 were compared between Medicaid expansion vs non-Medicaid expansion states. RESULTS There were a total of 7,916,908 live births in 2012 and 2016 in the United States, of which 3,362,904 (42.5%) were in multiparous women with data on interpregnancy intervals (n=1,961,683 [58.3%]) in Medicaid expansion states and in non-Medicaid expansion states (n=1,401,221 [41.7%]). The rate of short interpregnancy intervals in the United States was slightly lower in 2016 (17.3%) than in 2012 (17.4%), P=.0006; rate difference 0.13% (95% confidence interval, 0.05-0.20). Short interpregnancy intervals occurred more frequently in non-Medicaid expansion states than in Medicaid expansion states in both 2012 (18.1% vs 16.6%, respectively; P<.001) and 2016 (18.1% vs 16.4%, respectively; P<.001). The rate of short interpregnancy intervals decreased by 0.11% (95% confidence interval, 0.01-0.22) in Medicaid expansion states and increased by 0.04% (95% confidence interval, 0.09-0.17) in non-Medicaid expansion states. In 2016, living in a Medicaid expansion state was associated with a modestly decreased risk of short interpregnancy intervals (adjusted relative risk, 0.97; 95% confidence interval, 0.97-0.98), even after adjustment for coexisting risks. CONCLUSION The risk of short interpregnancy intervals decreased in the Medicaid expansion states even after adjusting for risk factors. Moreover, the short interpregnancy interval rates increased in nonexpansion states but decreased in Medicaid expansion states. If non-Medicaid expansion states had experienced the same rate of decrease in short interpregnancy intervals as Medicaid expansion states, 1122 fewer women would have had a short interpregnancy interval in 2016. Considering the known association between short interpregnancy intervals and adverse maternal and infant outcomes, these findings indicate that Medicaid expansion could improve perinatal outcomes.
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Affiliation(s)
- Kriya S Patel
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Juliana Bakk
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Meredith Pensak
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Emily DeFranco
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH.
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Rodriguez MI, Kaufman M, Lindner S, Caughey AB, DeFede AL, McConnell KJ. Association of Expanded Prenatal Care Coverage for Immigrant Women With Postpartum Contraception and Short Interpregnancy Interval Births. JAMA Netw Open 2021; 4:e2118912. [PMID: 34338791 PMCID: PMC8329738 DOI: 10.1001/jamanetworkopen.2021.18912] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Access to prenatal and postpartum care is restricted among women with low income who are recent or undocumented immigrants enrolled in Emergency Medicaid. OBJECTIVE To examine the association of extending prenatal care coverage to Emergency Medicaid enrollees with postpartum contraception and short interpregnancy interval births. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a difference-in-differences design to compare the staggered rollout of prenatal care in Oregon with South Carolina, a state that does not cover prenatal or postpartum care. Linked Medicaid claims and birth certificate data from 2010 to 2016 were examined for an association between prenatal care coverage for women whose births were covered by Emergency Medicaid and subsequent short IPI births. Additional maternal and infant health outcomes were also examined, including postpartum contraceptive use, preterm birth, and neonatal intensive care unit admission. The association between the policy change and measures of policy implementation (number of prenatal visits) and quality of care (receipt of 8 guideline-based screenings) was also analyzed. Statistical analysis was performed from August 2020 to March 2021. EXPOSURES Medicaid coverage of prenatal care. MAIN OUTCOMES AND MEASURES Postpartum contraceptive use, defined as receipt of any contraceptive method within 60 days of delivery; short IPI births, defined as occurring within 18 months of a previous pregnancy. RESULTS The study population consisted of 26 586 births to women enrolled in Emergency Medicaid in Oregon and South Carolina. Among these women, 14 749 (55.5%) were aged 25 to 35 years, 25 894 (97.4%) were Black, Hispanic, Native American, Alaskan, Pacific Islander, or Asian women or women with unknown race/ethnicity, and 17 905 (67.3%) lived in areas with urban zip codes. Coverage of prenatal care for women in Emergency Medicaid was associated with significant increases in mean (SD) prenatal visits (increase of 10.3 [0.9] prenatal visits) and prenatal quality. Prenatal care screenings (eg, anemia screening: increase of 65.7 percentage points [95% CI, 54.2 to 77.1 percentage points]) and vaccinations (eg, influenza vaccination: increase of 31.9 percentage points [95% CI, 27.4 to 36.3 percentage points]) increased significantly following the policy change. Although postpartum contraceptive use increased following prenatal care expansion (increase of 1.5 percentage points [95% CI, 0.4 to 2.6 percentage points]), the policy change was not associated with a reduction in short IPI births (-4.5 percentage points [95% CI, -9.5 to 0.5 percentage points), preterm births (-0.6 percentage points [95% CI, -3.2 to 2.0 percentage points]), or neonatal intensive care unit admissions (increase of 0.8 percentage points [95% CI, -2.0 to 3.6 percentage points]). CONCLUSIONS AND RELEVANCE This study found that expanding Emergency Medicaid benefits to include prenatal care significantly improved receipt of guideline-concordant prenatal care. Prenatal care coverage alone was not associated with a meaningful increase in postpartum contraception or a reduction in subsequent short IPI births.
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Affiliation(s)
- Maria I. Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Menolly Kaufman
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Stephan Lindner
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Ana Lopez DeFede
- Institute for Families in Society, University of South Carolina, Columbia
| | - K. John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
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Caskey RN, Olender SE, Zocchi A, Bergo CJ, Uesugi KH, Haider S, Handler AS. Addressing Women's Health Care Needs During Pediatric Care. WOMEN'S HEALTH REPORTS 2021; 2:227-234. [PMID: 34318292 PMCID: PMC8310745 DOI: 10.1089/whr.2021.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
Objective: To determine if the use of a simple self-administered Postpartum Questionnaire for Mothers (PQM) at the well-baby visit (WBV) increased the proportion of women who received health care and contraception by 6 months postpartum (PP). Methods: This was a single-site, system-level, intervention. Women were recruited from the pediatric clinic when presenting with their infants for a 2-month WBV. During phase 1 of the study, a control group was enrolled, followed by an 8-week washout period; then enrollment of the intervention group (phase 2). During phase 2, the PQM was administered and reviewed by the pediatrician during the infant's visit; the tool prompted the pediatrician to make a referral for the mother's primary or contraceptive care as needed. Data were collected at baseline and at 6 months PP, and additional data were extracted from the electronic medical record. Results: We found that PP women exposed to the PQM during their infant's WBV were more likely to have had a health care visit for themselves between 2 and 6 months PP, compared with the control group (relative risk [RR] 1.66, [confidence interval (CI) 0.91–3.03]). In addition, at 6 months PP, women in the intervention group were more likely to identify a primary care provider (RR 1.84, [CI 0.98–3.46]), and more likely to report use of long-acting reversible contraception (LARC) (RR 1.24, [CI 0.99–1.58]), compared with women in the control group. Conclusion: A simple self-administered PQM resulted in an increase in women's receipt of health care and use of LARC by 6 months PP. Clinical Trial Registration: Use of a reproductive life planning tool at the pediatric well-baby visit with postpartum women, NCT03448289.
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Affiliation(s)
- Rachel N Caskey
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sarah E Olender
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alejandra Zocchi
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cara J Bergo
- Center of Excellence in Maternal and Child Health, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Keriann H Uesugi
- Center of Excellence in Maternal and Child Health, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Arden S Handler
- Center of Excellence in Maternal and Child Health, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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14
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Tucker C, Berrien K, Menard MK, Herring AH, Rowley D, Halpern CT. Preterm Birth and Receipt of Postpartum Contraception Among Women with Medicaid in North Carolina. Matern Child Health J 2020; 24:640-650. [PMID: 32200477 DOI: 10.1007/s10995-020-02889-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare receipt of contraception and method effectiveness in the early postpartum period among women with and without a recent preterm birth (PTB). METHODS We used data from North Carolina birth certificates linked to Medicaid claims. We assessed contraceptive claims with dates of service within 90 days of delivery among a retrospective cohort of women who had a live birth covered by Medicaid between September 2011 and 2012 (n = 58,201). To estimate the odds of receipt of contraception by PTB status (24-36 weeks compared to 37-42 weeks [referent]), we used logistic regression and tested for interaction by parity. To estimate the relationship between PTB and method effectiveness based on the Center for Disease Control and Prevention Levels of Effectiveness of Family Planning Methods (most, moderate and least effective [referent]), we used multinomial logistic regression. RESULTS Less than half of all women with a live birth covered by Medicaid in North Carolina had a contraceptive claim within 90 days postpartum. Women with a recent PTB had a lower prevalence of contraceptive receipt compared to women with a term birth (45.7% vs. 49.6%). Women who experienced a PTB had a lower odds of receiving contraception. When we stratified by parity, women with a PTB had a lower odds of contraceptive receipt among women with more than two births (0.79, 95% CI 0.74-0.85), but not among women with two births or fewer. One-fourth of women received a most effective method. Women with a preterm birth had a lower odds of receiving a most effective method (0.83, 95% CI 0.77-0.88) compared to women with a term birth. CONCLUSIONS FOR PRACTICE Contraceptive receipt was low among women with a live birth covered by Medicaid in North Carolina. To optimize contraceptive use among women at risk for subsequent preterm birth, family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed. SIGNIFICANCE Access to free or affordable highly effective contraception is associated with reductions in preterm birth. Self-report data indicate that women with a very preterm birth (PTB) are less likely to use highly or moderately effective contraception postpartum compared to women delivering at later gestational ages. Using Medicaid claims data, we found that less than half of all women with a Medicaid covered delivery in North Carolina in 2011-2012 had a contraceptive claim within 90 days postpartum, and one fourth received a most effective method. Women with a PTB and more than two children were least likely to receive any method. Family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed so that women may access their contraceptive method of choice in the postpartum period.
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Affiliation(s)
- Christine Tucker
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB # 7445, Chapel Hill, 27599-7445, USA.
| | - Kate Berrien
- UNC Hospitals, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Kathryn Menard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Amy H Herring
- Department of Statistical Science and Global Health Institute, Duke University, Durham, USA
| | - Diane Rowley
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB # 7445, Chapel Hill, 27599-7445, USA
| | - Carolyn Tucker Halpern
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 401 Rosenau Hall, CB # 7445, Chapel Hill, 27599-7445, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
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15
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Associations between immediate postpartum long-acting reversible contraception and short interpregnancy intervals. Contraception 2020; 102:409-413. [PMID: 32918870 DOI: 10.1016/j.contraception.2020.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aimed to evaluate the rates of short interpregnancy interval pregnancies and deliveries among women who receive immediate postpartum LARC. STUDY DESIGN We conducted a retrospective cohort study of all women who delivered at Montefiore Medical Center between January 2015 and June 2016 (N = 9561). In this cohort, we identified all repeat deliveries and pregnancies within 18 months of the initial delivery. Using logistic regression models, we compared rates of short interpregnancy interval delivery and pregnancy among recipients of an immediate postpartum IUD, immediate postpartum implant, and no immediate postpartum LARC, adjusting for covariates including patient age, mode of delivery, socioeconomic status, and race. RESULTS In our cohort, 12.9% of patients received immediate postpartum LARC. The rates of short interpregnancy interval delivery were 3.3% (N = 259/7833) among patients who did not receive immediate postpartum LARC, 1% (N = 6/595) among immediate postpartum IUD recipients, and 0.4% (N = 2/562) among immediate postpartum implant recipients. The rates of short interpregnancy interval pregnancy were 13.8% (N = 1082/7833) among patients who did not receive immediate postpartum LARC, 7.4% (N = 44/595) among immediate postpartum IUD recipients, and 5.2% (N = 29/562) among immediate postpartum implant recipients. Both recipients of immediate postpartum IUDs and immediate postpartum implants had lower rates of short interpregnancy interval delivery and pregnancy compared to patients who did not receive immediate postpartum LARC. CONCLUSIONS This study confirms that women who received immediate postpartum IUDs and implants have lower rates of short interpregnancy interval pregnancies. IMPLICATIONS Making immediate postpartum LARC widely available is a promising public health approach to help women achieve a longer interpregnancy interval.
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16
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Yang JM, Cheney K, Taylor R, Black K. Interpregnancy intervals and women's knowledge of the ideal timing between birth and conception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200277. [PMID: 31511242 DOI: 10.1136/bmjsrh-2018-200277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 08/05/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Short interpregnancy intervals (IPIs) are associated with adverse obstetric outcomes. However, few studies have explored women's understanding of ideal IPIs or investigated knowledge of the consequences of short IPIs. METHODS We performed a prospective questionnaire-based study at two hospitals in Sydney, Australia. We recruited women attending antenatal clinics and collected demographic data, actual IPI, ideal IPI, contraceptive use, and education provided on birth-spacing and contraception following a previous live birth. We explored associations between an IPI <12 months and a selection of demographic and health variables. RESULTS Data were collected from 467 women, of whom 344 were pregnant following a live birth. Overall, 72 (20.9%) women had an IPI <12 months only 7.5% of whom believed this was ideal, and the remaining stating their ideal IPI was over 12 months (52.3%) or they had no ideal IPI (40.3%). IPI <12 months following a live birth was significantly associated with younger age (p=0.043) but not with ethnicity, relationship status, education, religion, parity nor previous mode of delivery. IPI <12 months was associated with non-use of long-acting reversible contraception (LARC) (p<0.001), breastfeeding <12 months (p=0.041) and shorter ideal IPI (p=0.03). Less than half of the women (43.3%, n=149) reported having received advice about IPI and less than half about postnatal contraception (44.2%, n=147). CONCLUSIONS Younger age and non-use of LARC are significantly associated with IPIs <12 months. A minority of women with a short IPI perceived it to be ideal. Prevention of short IPIs could be achieved with improved access to postnatal contraception.
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Affiliation(s)
- Jenny M Yang
- Women and Babies Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kate Cheney
- Women and Babies Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Rebecca Taylor
- Women and Babies Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kirsten Black
- University of Sydney, Sydney, New South Wales, Australia
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17
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Sijpkens MK, van den Hazel CZ, Delbaere I, Tydén T, Mogilevkina I, Steegers EAP, Shawe J, Rosman AN. Results of a Dutch national and subsequent international expert meeting on interconception care. J Matern Fetal Neonatal Med 2019; 33:2232-2240. [PMID: 30606078 DOI: 10.1080/14767058.2018.1547375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The potential value of preconception care and interconception care is increasingly acknowledged, but delivery is generally uncommon. Reaching women for interconception care is potentially easier than for preconception care, however the concept is still unfamiliar. Expert consensus could facilitate guidelines, policies and subsequent implementation. A national and subsequent international expert meeting were organized to discuss the term, definition, content, relevant target groups, and ways to reach target groups for interconception care.Methods: We performed a literature study to develop propositions for discussion in a national expert meeting in the Netherlands in October 2015. The outcomes of this meeting were discussed during an international congress on preconception care in Sweden in February 2016. Both meetings were recorded, transcribed and subsequently reviewed by participants.Results: The experts argued that the term, definition, and content for interconception care should be in line with preconception care. They discussed that the target group for interconception care should be "all women who have been pregnant and could be pregnant in the future and their (possible) partners". In addition, they opted that any healthcare provider having contact with the target group should reach out and make every encounter a potential opportunity to promote interconception care.Discussion: Expert discussions led to a description of the term, definition, content, and relevant target groups for interconception care. Opportunities to reach the target group were identified, but should be further developed and evaluated in policies and guidelines to determine the optimal way to deliver interconception care.
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Affiliation(s)
- Meertien K Sijpkens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Céline Z van den Hazel
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilse Delbaere
- Department of Health Care, VIVES University College, Kortrijk, Belgium
| | - Tanja Tydén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Iryna Mogilevkina
- Educational and Research Center of Continuous Medical Education, Bogomolets National Medical University, Kiev, Ukraine
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jill Shawe
- Institute of Health & Community, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ageeth N Rosman
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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18
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Coleman-Minahan K, Dillaway CH, Canfield C, Kuhn DM, Strandberg KS, Potter JE. Low-Income Texas Women's Experiences Accessing Their Desired Contraceptive Method at the First Postpartum Visit. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2018; 50:189-198. [PMID: 30506996 PMCID: PMC6314803 DOI: 10.1363/psrh.12083] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Early access to contraception may increase postpartum contraceptive use. However, little is known about women's experiences receiving their desired method at the first postpartum visit or how access is associated with use. METHODS In a 2014-2016 prospective cohort study of low-income Texas women, data were collected from 685 individuals who desired a reversible contraceptive and discussed contraception with a provider at their first postpartum visit, usually within six weeks of birth. Women's experiences were captured using open- and closed-ended survey questions. Thematic and multivariate logistic regression analyses were employed to examine contraceptive access and barriers, and method use at three months postpartum. RESULTS Twenty-three percent of women received their desired method at the first postpartum visit; 11% a prescription for their desired pill, patch or ring; 8% a method (or prescription) other than that desired; and 58% no method. Among women who did not receive their desired method, 44% reported clinic-level barriers (e.g., method unavailability or no same-day provision), 26% provider-level barriers (e.g., inaccurate contraceptive counseling) and 23% cost barriers. Women who used private practices were more likely than those who used public clinics to report availability and cost barriers (odds ratios, 6.4 and 2.7, respectively). Forty-one percent of women who did not receive their desired method, compared with 86% of those who did, were using that method at three months postpartum. CONCLUSION Eliminating the various barriers that postpartum women face may improve their access to contraceptives. Further research is needed to improve the understanding of clinic- and provider-level barriers.
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Affiliation(s)
- Kate Coleman-Minahan
- Assistant Professor, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora
| | - Chloe H Dillaway
- Graduate Student at Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Caitlin Canfield
- Evaluation Manager, Evaluation and Research, Louisiana Public Health Institute, New Orleans
| | - Daniela M Kuhn
- Research Associate, Population Research Center, University of Texas at Austin
| | | | - Joseph E Potter
- Professor, Population Research Center, University of Texas at Austin
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Unger J, Ronen K, Perrier T, DeRenzi B, Slyker J, Drake A, Mogaka D, Kinuthia J, John-Stewart G. Short message service communication improves exclusive breastfeeding and early postpartum contraception in a low- to middle-income country setting: a randomised trial. BJOG 2018; 125:1620-1629. [PMID: 29924912 PMCID: PMC6179930 DOI: 10.1111/1471-0528.15337] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of short message service (SMS) communication on facility delivery, exclusive breastfeeding (EBF), and contraceptive use. DESIGN Mobile WACh was a three-arm unblinded individually randomised controlled trial. SETTING A public sector maternal child health (MCH) clinic in Nairobi, Kenya. POPULATION Three hundred women attending antenatal care were randomised, 100 to each arm, and followed for 24 weeks postpartum. Pregnant women, at least 14 years old with access to a mobile phone and able to read SMS were eligible for participation. METHODS Women were randomised (1:1:1) to receive one-way SMS versus two-way SMS with a nurse versus control. Weekly SMS content was tailored for maternal characteristics and pregnancy or postpartum timing. MAIN OUTCOME MEASURES Facility delivery, EBF, and contraceptive use were compared separately between each intervention arm and the control arm by Kaplan-Meier analysis and chi-square tests using intent-to-treat analyses. RESULTS The overall facility delivery rate was high (98%) and did not differ by arm. Compared with controls, probability of EBF was higher in the one-way SMS arm at 10 and 16 weeks, and in the two-way SMS arm at 10, 16, and 24 weeks (P < 0.005 for all). Contraceptive use was significantly higher in both intervention arms by 16 weeks (one-way SMS: 72% and two-way SMS: 73%; P = 0.03 and P = 0.02 versus 57% control, respectively); however, this difference was not significant when correcting for multiple comparisons. CONCLUSION One-way and two-way SMS improved EBF practices and early contraceptive use. Two-way SMS had an added benefit on sustained EBF, providing evidence that SMS messaging influences uptake of interventions that improve maternal and neonatal health. SOURCE OF FUNDING Funding was provided by the National Institutes of Health (K12HD001264 to JAU, R01HD080460, K24HD054314 to GJS, and K01AI116298 to ALD), the National Science Foundation (Graduate Research Fellowship to TP and BD), as well as the University of Washington Global Center for Integrated Health of Women Adolescents and Children (Global WACh). TWEETABLE ABSTRACT The Mobile WACh RCT demonstrates that SMS improved practice of exclusive breastfeeding and early postpartum contraception.
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Affiliation(s)
- Jennifer Unger
- Department of Global Health, University of Washington, Seattle, WA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA
| | - Trevor Perrier
- Department of Computer Science and Engineering, University of Washington, Seattle, WA
| | - Brian DeRenzi
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
| | - Jennifer Slyker
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Alison Drake
- Department of Global Health, University of Washington, Seattle, WA
| | - Dyphna Mogaka
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- University of Nairobi, Obstetrics and Gynaecology, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
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20
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Adolescent Contraception Use after Pregnancy, an Opportunity for Improvement. J Pediatr Adolesc Gynecol 2018; 31:388-393. [PMID: 29551429 DOI: 10.1016/j.jpag.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/16/2018] [Accepted: 03/12/2018] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To describe contraceptive method use by adolescent women in the 6 months after any pregnancy. DESIGN We conducted a secondary analysis of the 2011-2013 and 2013-2015 cycles of the National Survey of Family Growth. SETTING This survey is a nationally-representative population-based survey of reproductive aged women in the United States. PARTICIPANTS The sample included respondents who had at least 1 pregnancy that ended within the contraceptive calendar period as well as before the month of the respondent's 20th birthday. Women were included even if they did not have a full 6 months' worth of data. INTERVENTIONS AND MAIN OUTCOME MEASURES We examined contraception method use at 1, 2, 4, and 6 months post pregnancy regardless of pregnancy outcome (live birth, induced abortion, or miscarriage). RESULTS Our sample consisted of 337 women with a mean age of 18.5 years. Almost half (N = 158, weighted percentage = 43.5%) of adolescents were using no method of contraception at 1 month post pregnancy. By 6 months post pregnancy, only 143 of 287 women with data through 6 months (weighted percentage = 49.7%) were using more effective methods of contraception (long-acting reversible contraception or hormonal methods), and 83 of these 287 were using no method (weighted percentage = 29.2%), including 61 of 261 women who reported that their last pregnancy was unwanted. Women from racial and ethnic minorities were less likely to use the most effective contraceptive methods. Rapid repeat pregnancy occurred among 44 of 209 women in the subsample with 18 months' follow-up data (weighted percentage = 16.9%). Only 56 of 337 adolescents (weighted percentage = 19.0%) used long-acting reversible contraceptive methods at any time post pregnancy regardless of pregnancy outcome. CONCLUSION Contraceptive use, especially of the most effective methods, remains low for adolescent women by 6 months post pregnancy.
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Dude A, Matulich M, Estevez S, Liu LY, Yee LM. Disparities in Postpartum Contraceptive Counseling and Provision Among Mothers of Preterm Infants. J Womens Health (Larchmt) 2018; 27:676-683. [PMID: 29359987 PMCID: PMC5962326 DOI: 10.1089/jwh.2017.6561] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Use of effective contraception could be one method to decrease recurrent preterm birth by increasing intervals between pregnancies. We assessed correlates of contraceptive counseling and uptake among women who delivered preterm. MATERIALS AND METHODS This is a retrospective cohort study of women who delivered live-born singletons or twins before 32 weeks' gestation. We assessed documented contraceptive counseling and method uptake by postpartum discharge, using inpatient medical records, and correlates of highly effective contraception uptake by the postpartum visit using outpatient records. RESULTS Of 594 eligible women, 44.6% (n = 265) had documented inpatient contraceptive counseling, but only 21.4% (n = 127) left the hospital using a World Health Organization (WHO) tier 1 or 2 method. Women who were younger, non-Hispanic black, multiparous, and delivered at earlier gestational ages were more likely to have inpatient counseling documented. Compared with women with private insurance, women with public insurance were more likely to have documented counseling (22.8% vs. 87.5%, p < 0.001; adjusted odds ratio [aOR] 9.55, 95% confidence interval [CI] 5.31-17.2) and to uptake a WHO tier 1 or 2 method as an inpatient (5.8% vs. 52.0%, p < 0.001; aOR 9.51, 95% CI 4.78-18.9). Of the 175 women with outpatient records available who attended a postpartum visit, only 54.9% (n = 96) adopted a WHO tier 1 or tier 2 method. CONCLUSION Although all women in this cohort were at risk of recurrent preterm birth, counseling about contraception after a preterm birth (<32 weeks) was not universal. Women with multiple risk factors for recurrent preterm birth, such as multiparity and public insurance, were more likely to have received documented contraceptive counseling and highly effective contraceptives.
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Affiliation(s)
- Annie Dude
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melissa Matulich
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Samantha Estevez
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lilly Y. Liu
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynn M. Yee
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Postpartum Contraception and Interpregnancy Intervals Among Adolescent Mothers Accessing Public Services in California. Matern Child Health J 2018; 21:752-759. [PMID: 27475821 DOI: 10.1007/s10995-016-2164-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective To determine the association of age at index birth with postpartum contraceptive use and optimal interpregnancy interval (IPI, defined as delivery to next pregnancy >18 months), controlling for provider type and client demographics among adolescent mothers who have repeat pregnancies. Methods California's 2008 birth records were linked to California's Medi-Cal and Family PACT claims data to identify 26,393 women with repeat births between 2002 and 2008, whose index birth occurred as an adolescent, and who received publicly-funded services within 18 months after the index birth. Multivariable regression analyses were conducted to examine the relationship between timing of contraception provision and interpregnancy intervals, adjusting for socio-demographic factors. Results Seventy-eight percent of adolescent women did not receive contraception at their first postpartum visit, and twenty-eight percent of adolescent women never received contraception from a Family PACT or Medi-Cal provider. Adolescents who were older at their index birth had lower rates of optimal IPIs. Native American, Asian-Pacific Islander and Latina women had lower rates of optimal IPIs compared to white women. Compared to those using only barrier methods, adolescent women receiving highly effective contraceptive methods had a 4.25 times higher odds of having an optimal IPI than those receiving hormonal methods (OR 2.10), or using no method (OR 0.70). Conclusion Effective postpartum contraceptive use and being a Family PACT provider were associated with optimal birth spacing among adolescent mothers, yet racial and ethnic disparities persisted. A missed opportunity was the provision of contraception at the first postpartum visit. Providers should aim to remove barriers to initiation of contraception at this visit.
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Vanya M, Devosa I, Barabás K, Bártfai G, Kozinszky Z. Choice of contraception at 6-8 weeks postpartum in south-eastern Hungary. EUR J CONTRACEP REPR 2018; 23:52-57. [PMID: 29393708 DOI: 10.1080/13625187.2017.1422238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aims of the study were to describe the sociodemographic determinants, breastfeeding- and sexual life-related predictive factors of contraceptive use at 6-8 weeks postpartum. METHODS A prospective, web-based questionnaire survey was carried out by distributing an access code to women immediately after delivery at the Department of Obstetrics and Gynaecology, the University of Szeged, Szeged, Hungary, between 1 September 2013 and 1 May 2015. RESULTS In total, 1875 women were invited to participate in the study, 632 of whom refused or were excluded and 644 were not sexually active. The remaining sexually active women (n = 599) completed the questionnaire. At 6-8 weeks postpartum, 22.5% were using an effective contraceptive method and 40.2% were relying on lactational amenorrhoea (LAM). We found a significant direct association between the educational level of a woman's partner and her use of an effective contraceptive method (p < .001) (adjusted odds ratio [AOR]: 1.9) or LAM (AOR: 1.49). Use of an effective contraceptive method before pregnancy increased the likelihood of using the same method after delivery (AOR: 3.16) and decreased the likelihood of LAM use at weeks 6-8 (AOR: 0.31). The AOR for effective contraceptive use was 2.23 times higher in women who had sexual intercourse once or more a week compared with those who had sexual intercourse less frequently. CONCLUSIONS Concerted efforts to promote the use of long-acting reversible contraception (LARC) are required, particularly among women who would like future childbearing. Further research is needed on the factors contributing to the low uptake of LARC in this population.
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Affiliation(s)
- Melinda Vanya
- a Health Research and Health Promotion Research Group, Teacher Training Faculty , Pallas Athena University , Kecskemét , Hungary.,b MEDITEAM Szeged Co. Ltd. , Szeged , Hungary.,c Department of Obstetrics and Gynaecology , Pándy Kálmán Hospital , Gyula , Hungary
| | - Iván Devosa
- a Health Research and Health Promotion Research Group, Teacher Training Faculty , Pallas Athena University , Kecskemét , Hungary.,d Hungarian Academy of Sciences , Academic Committee of Szeged, Education Committee on Theoretical Education , Szeged , Hungary
| | - Katalin Barabás
- e Department of Behavioural Sciences, Faculty of General Medicine , Albert Szent-Györgyi Health Centre, University of Szeged , Szeged , Hungary
| | - György Bártfai
- f Department of Obstetrics and Gynaecology, Faculty of General Medicine , Albert Szent-Györgyi Health Centre, University of Szeged , Szeged , Hungary
| | - Zoltan Kozinszky
- a Health Research and Health Promotion Research Group, Teacher Training Faculty , Pallas Athena University , Kecskemét , Hungary.,g Department of Obstetrics and Gynaecology , Blekinge Hospital , Karlskrona , Sweden
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Vela VX, Patton EW, Sanghavi D, Wood SF, Shin P, Rosenbaum S. Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception. Womens Health Issues 2018; 28:137-143. [PMID: 29329988 DOI: 10.1016/j.whi.2017.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. METHODS Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid. RESULTS All nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion. CONCLUSIONS Although Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain.
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Affiliation(s)
- Veronica X Vela
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Center for Health Policy Research, Washington, DC.
| | - Elizabeth W Patton
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Susan F Wood
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Center for Health Policy Research, Washington, DC; Jacobs Institute of Women's Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Peter Shin
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Center for Health Policy Research, Washington, DC; Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sara Rosenbaum
- Center for Health Policy Research, Milken Institute School of Public Health, George Washington University, Washington, DC
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Sundstrom B, Szabo C, Dempsey A. "My Body. My Choice": A Qualitative Study of the Influence of Trust and Locus of Control on Postpartum Contraceptive Choice. JOURNAL OF HEALTH COMMUNICATION 2018; 23:162-169. [PMID: 29297766 DOI: 10.1080/10810730.2017.1421728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Postpartum contraception helps reduce unintended pregnancy and space births to improve maternal and child health. This study explored women's perceptions of contraceptive choice during the postpartum period in the context of locus of control and trust in healthcare providers. Researchers conducted six focus groups with 47 women, ages 18-39, receiving postpartum care at an outpatient clinic. Techniques from grounded theory methodology provided an inductive approach to analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated a constant-comparative coding process to identify emergent themes. Participants expressed a preference for relationship-centered care, in which healthcare providers listened, individualized their approach to care through rapport-building, and engaged women in shared decision-making about contraceptive use through open communication, reciprocity, and mutual influence. Conflicting health messages served as barriers to uptake of effective contraception. While participants trusted their healthcare provider's advice, many women prioritized personal experience and autonomy in decisions about contraception. Providers can promote trust and relationship-centered care to optimize contraceptive uptake by listening, exploring patient beliefs and preferences about contraception and birth spacing, and tailoring their advice to individuals. Results suggest that antenatal contraceptive counseling should incorporate information about effectiveness, dispel misconceptions, and engage patients in shared decision-making.
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Affiliation(s)
- Beth Sundstrom
- a College of Charleston, Department of Communication , Charleston , SC , USA
| | - Caitlin Szabo
- b Emory University School of Medicine, Department of Gynecology and Obstetrics , Atlanta , GA , USA
| | - Angela Dempsey
- c Medical University of South Carolina, Department of Obstetrics and Gynecology , Charleston , SC , USA
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Millar A, Vogel RI, Bedell S, Ayers Looby M, Hubbs JL, Harlow BL, Ghebre R. Patterns of postpartum contraceptive use among Somali immigrant women living in Minnesota. Contracept Reprod Med 2017; 2:14. [PMID: 29201419 PMCID: PMC5683445 DOI: 10.1186/s40834-017-0041-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/16/2017] [Indexed: 11/16/2022] Open
Abstract
Background The postpartum period is a crucial time to provide family planning counseling and can decrease incidence of adverse reproductive outcomes. The purpose of this study was to characterize patterns of postpartum contraception and to investigate long acting reversible contraceptive (LARC) use among Somali women living in a metropolitan area of Minnesota in an effort to provide better family planning and reproductive health counseling in this growing immigrant population. Methods A retrospective chart review was conducted of Somali women who delivered between January 1, 2011 and December 31, 2014. Information was collected regarding family planning counseling provided and contraceptive methods chosen at the postpartum clinic visit. Results Of the 747 Somali women who delivered during this time period, 56.4% had no postpartum follow up visit. At the postpartum visit, 88.3% of women received family planning counseling and 80.8% chose a contraceptive method with the remainder declining. The intrauterine device (IUD) was the most popular contraceptive method, chosen by 39.7% of women. Other than parity, no statistically significant differences were observed between women who chose LARC versus other contraceptive methods. Of the women that chose a LARC, 39.4% had it placed at the time of their postpartum visit; immediate placement was statistically significantly more likely with more recent delivery, lower BMI and obstetrician as the provider type. Conclusions The IUD was the most popular method of postpartum contraception. There was a trend toward increase in LARC use with increasing parity. Same-day LARC placement was uncommon, but should be encouraged in this population given high loss to follow up rate.
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Affiliation(s)
- Amy Millar
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | - Rachel Isaksson Vogel
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | - Sabrina Bedell
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | - Maureen Ayers Looby
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | - Jessica L Hubbs
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA
| | | | - Rahel Ghebre
- University of Minnesota Department of Obstetrics, Gynecology and Women's Health, 420 Delaware St SE, MMC 395, Minneapolis, MN 55455 USA.,Human Resources for Health Program Rwanda and Yale School of Medicine, New Haven, CT USA
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Turok DK, Leeman L, Sanders JN, Thaxton L, Eggebroten JL, Yonke N, Bullock H, Singh R, Gawron LM, Espey E. Immediate postpartum levonorgestrel intrauterine device insertion and breast-feeding outcomes: a noninferiority randomized controlled trial. Am J Obstet Gynecol 2017; 217:665.e1-665.e8. [PMID: 28842126 PMCID: PMC6040814 DOI: 10.1016/j.ajog.2017.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. OBJECTIVE This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes. STUDY DESIGN We conducted this noninferiority randomized controlled trial at the University of Utah and the University of New Mexico Health Sciences Centers from February 2014 through March 2016. Eligible women were pregnant and planned to breast-feed, spoke English or Spanish, were aged 18-40 years, and desired a levonorgestrel intrauterine device. Enrolled women were randomized 1:1 to immediate postpartum insertion or delayed insertion at 4-12 weeks' postpartum. Prespecified exclusion criteria included delivery <37.0 weeks' gestational age, chorioamnionitis, postpartum hemorrhage, contraindications to levonorgestrel intrauterine device insertion, and medical complications of pregnancy that could affect breast-feeding. We conducted per-protocol analysis as the primary approach, as it is considered the standard for noninferiority studies; we also report the alternative intent-to-treat analysis. We powered the study for the primary outcome, breast-feeding continuation at 8 weeks, to detect a 15% noninferiority margin between groups, requiring 132 participants in each arm. The secondary study outcome, time to lactogenesis, used a validated measure, and was analyzed by survival analysis and log rank test. We followed up participants for ongoing data collection for 6 months. Only the data analysis team was blinded to the intervention. RESULTS We met the enrollment target with 319 participants, but lost 34 prior to randomization and excluded an additional 26 for medical complications prior to delivery. The final analytic sample included 132 in the immediate group and 127 in the delayed group. Report of any breast-feeding at 8 weeks in the immediate group (79%; 95% confidence interval, 70-86%) was noninferior to that of the delayed group (84%; 95% confidence interval, 76-91%). The 5% difference in breast-feeding continuation at 8 weeks between the groups fell within the noninferiority margin (95% confidence interval, -5.6 to 15%). Time to lactogenesis (mean ± SD) in the immediate group, 65.3 ± 25.7 hours, was noninferior to that of the delayed group, 63.6 ± 21.6 hours. The mean difference between groups was 1.7 hours (95% confidence interval, -4.8 to 8.2 hours), noninferior by log-rank test. A total of 24 intrauterine device expulsions occurred in the immediate group compared to 2 in the delayed group (19% vs 2%, P < .001), consistent with the known higher expulsion rate with immediate vs delayed postpartum intrauterine device insertion. No intrauterine device perforations occurred in either group. CONCLUSION Our results of noninferior breast-feeding outcomes between women with immediate and delayed postpartum levonorgestrel intrauterine device insertion suggest that immediate postpartum intrauterine device insertion is an acceptable option for women planning to breast-feed and use the levonorgestrel intrauterine device. Expulsion rates are higher with immediate postpartum levonorgestrel intrauterine device insertion compared to delayed insertion, but this disadvantage may be outweighed by the advantages of immediate initiation of contraception. Providers should offer immediate postpartum intrauterine device insertion to breast-feeding women planning to use the levonorgestrel intrauterine device.
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Affiliation(s)
- David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Lauren Thaxton
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Nicole Yonke
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Holly Bullock
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Rameet Singh
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Lori M Gawron
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
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Women's experiences with immediate postpartum intrauterine device insertion: a mixed-methods study. Contraception 2017; 97:219-226. [PMID: 29080696 DOI: 10.1016/j.contraception.2017.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/12/2017] [Accepted: 10/17/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe women's pain and experiences with immediate postpartum intrauterine device (IUD) insertion (IPPI) following vaginal delivery using a ring forceps insertion technique. STUDY DESIGN This observational mixed-methods study included women who underwent successful IPPI using ring forceps, with and without epidural analgesia. To describe women's pain during the procedure, we recruited women during antenatal care and at the time of admission for delivery until we collected at least 30 sets of pain scores at two time points (preprocedure and immediately postprocedure) in both groups using two instruments: 100-mm visual analogue scale (VAS) and a 4-point Likert verbal rating scale (VRS) (0=none, 1=mild, 2=moderate, 3=severe). After placing the IUD, physicians rated ease of IUD insertion. A subset of participants in both groups underwent semistructured interviews prior to hospital discharge. Our goal was to explore women's (a) decisional influences and prior contraception experience, (b) experience during IPPI and (c) decisional regret. We conducted iterative analysis of interview content until thematic saturation was reached in both groups. Interviewees provided recall pain scores and rated satisfaction with IPPI. RESULTS We collected 30 pain scores in the no-epidural group and 36 in the epidural group. At both time points, the VAS data exhibited very low pain scores in the epidural group and a uniform distribution in the no-epidural group; standard deviations were large. The majority of women in both groups reported "none-mild" pain on the VRS. Physicians reported minimal difficulty with IUD insertion in most cases. We conducted interviews with 12 women who had an epidural and 9 who did not. Both groups offered similar comments across all domains. Convenience was the primary motivation to undergo IPPI, and women recognized the barriers to obtaining effective contraception remote from delivery. The majority of interviewees, even those with high pain scores, characterized their procedural pain as less than expected, and IUD insertion pain was less than or similar to labor pain. Interviewees' recall pain scores were similar to those reported at the time of IUD insertion. An unanticipated theme that emerged was an ineffective informed consent process; women could not recall most procedural risks or how IPPI was accomplished. All interviewees endorsed IPPI, expressing a high degree of satisfaction; none regretted undergoing the procedure. CONCLUSION The distributions of our VAS scores did not reveal useful summary statistics in either group. The VRS scores were a more informative representation of women's pain during IPPI; most women reported little pain. Convenience of obtaining highly effective contraception immediately postpartum was the key motivator for undergoing IPPI. All women voiced favorable experiences, even those who had high pain scores. IMPLICATIONS Women in our study overwhelmingly described less pain than anticipated with IPPI and also reported a high degree of satisfaction. Our study offers valuable patient-centered guidance to inform antenatal contraceptive counseling with respect to IPPI and lays the groundwork for ongoing research towards optimizing women's experiences with the procedure.
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Schwarz EB, Braughton MY, Riedel JC, Cohen S, Logan J, Howell M, Thiel de Bocanegra H. Postpartum care and contraception provided to women with gestational and preconception diabetes in California's Medicaid program. Contraception 2017; 96:432-438. [PMID: 28844877 DOI: 10.1016/j.contraception.2017.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare rates of postpartum care and contraception provided to women with gestational or preconception diabetes mellitus to women with no known diabetes mellitus. METHODS A retrospective cohort study of 199,860 women aged 15-44 years who were continuously enrolled in California's Medicaid program, Medi-Cal, from 43 days prior to 99 days after delivering in 2012. Claims for postpartum clinic visits and contraceptive supplies were compared for 11,494 mothers with preconception diabetes, 17,970 mothers with gestational diabetes, and 170,396 mothers without diabetes. Multivariable logistic regression was used to control for maternal age, race/ethnicity, primary language, residence in a primary care shortage area, state-funded healthcare program and Cesarean delivery, when examining the effects of diabetes on postpartum care and contraception. RESULTS Although postpartum clinic visits were more common with diabetes (55% preconception, 55% gestational, 48% no diabetes, p=<.0001), almost half did not receive any postpartum care within 99 days of delivery. Women with pregnancies complicated by diabetes were more likely to receive permanent contraception than women without diabetes (preconception diabetes, aOR: 1.39, 95% CI: 1.31-1.47; gestational diabetes, aOR: 1.20, 95% CI: 1.14-1.27). However, among women without permanent contraception, less than half received any reversible contraception within 99 days of delivery (44% preconception, 43% gestational, 43% no diabetes) and less effective, barrier contraceptives were more commonly provided to women with preconception diabetes than women without diabetes (aOR: 1.24, 95% CI:1.16-1.33). CONCLUSIONS Low-income Californian women with pregnancies complicated by diabetes do not consistently receive postpartum care or contraception that may prevent complication of future pregnancies. IMPLICATIONS Efforts are needed to improve rates of provision of postpartum care and high quality contraceptive services to low income women in California, particularly following pregnancies complicated by diabetes.
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Affiliation(s)
| | - Monica Y Braughton
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA
| | - Julie Cross Riedel
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA
| | - Susannah Cohen
- California Department of Health Care Services, Information Management Division, Sacramento, CA, USA
| | - Julia Logan
- California Department of Health Care Services, Office of the Medical Director, Sacramento, CA, USA
| | - Mike Howell
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA
| | - Heike Thiel de Bocanegra
- University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA
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Delara RMM, Madden E, Bryant AS. Short interpregnancy intervals and associated risk of preterm birth in Asians and Pacific Islanders. J Matern Fetal Neonatal Med 2017; 31:1894-1899. [PMID: 28511627 DOI: 10.1080/14767058.2017.1331431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The prevalence of short interpregnancy intervals (IPIs) and associated rates of preterm birth has been understudied in Asian and Pacific Islander populations. We sought to estimate rates of short IPI among Asian subgroups and Pacific Islanders and associated risk of preterm birth. MATERIALS AND METHODS For this retrospective cohort study, we linked records of women in California with a first birth in 1999-2000 and a second birth before 2005 with hospital discharge data. We used multivariate modeling to determine whether specific Asian ethnicities and Pacific Islanders were at greater risk of short IPI (<6 months, 6-18 months) and if a short IPI increased risk for preterm birth in these groups. RESULTS Our sample included 189,931 women. In multivariable analyses, Asian subgroups and Pacific Islanders were more likely to have an IPI <6 months than were White women (Pacific Islanders: OR 3.31 (95%CI [2.7, 4.1]); Filipinas: OR 1.51 (95%CI [1.33, 1.71]); Southeast Asians: OR 1.93 (95%CI [1.73, 2.1]); East Asians: OR 1.65 (95%CI [1.48, 1.84]); other Asians: OR 2.04 (95%CI [1.70, 2.4])). CONCLUSIONS Asian and Pacific Islander women have higher rates of IPI <6 months, but this did not significantly increase their risk of preterm birth.
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Affiliation(s)
| | - Erin Madden
- b Northern California Institute for Research and Education , San Francisco , CA , USA
| | - Allison S Bryant
- c Department of Obstetrics and Gynecology , Massachusetts General Hospital , Boston , MA , USA
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Sothornwit J, Werawatakul Y, Kaewrudee S, Lumbiganon P, Laopaiboon M. Immediate versus delayed postpartum insertion of contraceptive implant for contraception. Cochrane Database Syst Rev 2017; 4:CD011913. [PMID: 28432791 PMCID: PMC6478153 DOI: 10.1002/14651858.cd011913.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The spacing of pregnancies has a positive impact on maternal and newborn health. The progestin contraceptive implant, which is a long-acting, reversible method of contraception, has a well-established low failure rate that is compatible with tubal sterilization. The standard provision of contraceptive methods on the first postpartum visit may put some women at risk of unintended pregnancy, either due to loss to follow-up or having sexual intercourse prior to receiving contraception. Therefore, the immediate administration of contraception prior to discharge from the hospital that has high efficacy may improve contraceptive prevalence and prevent unintended pregnancy. OBJECTIVES To compare the initiation rate, effectiveness, and side effects of immediate versus delayed postpartum insertion of implant for contraception. SEARCH METHODS We searched for eligible studies up to 28 October 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and POPLINE. We examined review articles and contacted investigators. We also checked registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies. SELECTION CRITERIA We sought randomised controlled trials (RCTs) that compared immediate postpartum versus delayed insertion of contraceptive implant for contraception. DATA COLLECTION AND ANALYSIS Two review authors (JS, YW) independently screened titles and abstracts of the search results, and assessed the full-text articles of potentially relevant studies for inclusion. They extracted data from the included studies, assessed risk of bias, compared results, and resolved disagreements by consulting a third review author (PL or SK). We contacted investigators for additional data, where possible. We computed the Mantel-Haenszel risk ratio (RR) with 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous variables. MAIN RESULTS Three studies that included 410 participants met the inclusion criteria of the review. We did not identify any ongoing trials. Two included studies were at low risk of selection, attrition, and reporting biases, but were at high risk of performance and detection biases due to the inability to blind participants to the intervention. One included study was at high risk of attrition bias. The overall quality of the evidence for each comparison ranged from very low to moderate; the main limitations were risk of bias and imprecision.Initiation rate of contraceptive implants at the first postpartum check-up visit was significantly higher in the immediate insertion group than in the delayed insertion group (RR 1.41, 95% CI 1.28 to 1.55; three studies, 410 participants; moderate quality evidence).There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant used at six months after insertion (RR 1.02, 95% CI 0.93 to 1.11; two studies, 125 participants; low quality evidence) or at 12 months after insertion (RR 1.04; 95% CI 0.81 to 1.34; one study, 64 participants;very low quality evidence)Women who received an immediate postpartum contraceptive implant insertion had a higher mean number of days of abnormal vaginal bleeding within six weeks postpartum (MD 5.80 days, 95% CI 3.79 to 7.81; one study, 215 participants; low quality evidence) and a higher rate of other side effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; one study, 215 participants; low quality evidence) than those who received a delayed postpartum insertion. There appeared to be little or no difference between the groups in heavy, irregular vaginal bleeding or associated severe cramping within 12 months (RR 1.01, 95% CI 0.72 to 1.44, one study, 64 participants;very low quality evidence).It was unclear whether there was any difference between the groups in scores for participant satisfaction on a 0-10 scale (MD -0.40, 95% CI -1.26 to 0.46, low quality evidence), or in rates of unintended pregnancy (RR 1.82, 95% CI 0.38 to 8.71, 1 RCT, 64 women, very low quality evidence) at 12 months, or in rate of breastfeeding rate at six months (RR 2.01, 95% CI 0.72 ro 5.63, 1 RCT, 64 women, very low quality evidence) rate did not differ significantly between the groups. AUTHORS' CONCLUSIONS Evidence from this review indicates that the rate of initiation of contraceptive implant at the first postpartum check-up visit was higher with immediate postpartum insertion than with delayed insertion. There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant use at 6 months. It was unclear whether there was any difference between the groups in continuation of contraceptive use at 12 months or in the unintended pregnancy rate at 12 months.
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Affiliation(s)
- Jen Sothornwit
- Faculty of Medicine, Khon Kaen UniversityDepartment of Obstetrics and GynaecologyKhon KaenThailand
| | - Yuthapong Werawatakul
- Faculty of Medicine, Khon Kaen UniversityDepartment of Obstetrics and GynaecologyKhon KaenThailand
| | - Srinaree Kaewrudee
- Faculty of Medicine, Khon Kaen UniversityDepartment of Obstetrics and GynaecologyKhon KaenThailand
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Epidemiology and Biostatistics, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Taub RL, Jensen JT. Advances in contraception: new options for postpartum women. Expert Opin Pharmacother 2017; 18:677-688. [DOI: 10.1080/14656566.2017.1316370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Sridhar A, Salcedo J. Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing. Matern Health Neonatol Perinatol 2017; 3:1. [PMID: 28101373 PMCID: PMC5237348 DOI: 10.1186/s40748-016-0040-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/18/2016] [Indexed: 12/11/2022] Open
Abstract
Postpartum contraception is important to prevent unintended pregnancies. Assisting women in achieving recommended inter-pregnancy intervals is a significant maternal-child health concern. Short inter-pregnancy intervals are associated with negative perinatal, neonatal, infant, and maternal health outcomes. More than 30% of women experience inter-pregnancy intervals of less than 18 months in the United States. Provision of any contraceptive method after giving birth is associated with improved inter-pregnancy intervals. However, concerns about the impact of hormonal contraceptives on breastfeeding and infant health have limited recommendations for such methods and have led to discrepant recommendations by organizations such as the World Health Organization and the U.S. Centers for Disease Control and Prevention. In this review, we discuss current recommendations for the use of hormonal contraception in the postpartum period. We also discuss details of the lactational amenorrhea method and effects of hormonal contraception on breastfeeding. Given the paucity of high quality evidence on the impact on hormonal contraception on breastfeeding outcomes, and the strong evidence for improved health outcomes with achievement of recommended birth spacing intervals, the real risk of unintended pregnancy and its consequences must not be neglected for fear of theoretical neonatal risks. Women should establish desired hormonal contraception before the risk of pregnancy resumes. With optimization of postpartum contraception provision, we will step closer toward a healthcare system with fewer unintended pregnancies and improved birth outcomes.
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Affiliation(s)
- Aparna Sridhar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, California, USA
| | - Jennifer Salcedo
- Department of Obstetrics, Gynecology & Women's Health, University of Hawaii John A. Burns School of Medicine, Hawaii, USA
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Zerden ML, Stuart GS, Charm S, Bryant A, Garrett J, Morse J. Two-week postpartum intrauterine contraception insertion: a study of feasibility, patient acceptability and short-term outcomes. Contraception 2017; 95:65-70. [DOI: 10.1016/j.contraception.2016.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
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Postpartum Visit Attendance Increases the Use of Modern Contraceptives. J Pregnancy 2016; 2016:2058127. [PMID: 28070422 PMCID: PMC5187481 DOI: 10.1155/2016/2058127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 11/25/2022] Open
Abstract
Background. Delays in postpartum contraceptive use may increase risk for unintended or rapid repeat pregnancies. The postpartum care visit (PPCV) is a good opportunity for women to discuss family planning options with their health care providers. This study examined the association between PPCV attendance and modern contraceptive use using data from a managed care organization. Methods. Claims and demographic and administrative data came from a nonprofit managed care organization in Virginia (2008–2012). Information on the most recent delivery for mothers with singleton births was analyzed (N = 24,619). Routine PPCV (yes, no) and modern contraceptive use were both dichotomized. Descriptive analyses provided percentages, frequencies, and means. Multiple logistic regression was conducted and ORs and 95% CIs were calculated. Results. More than half of the women did not attend their PPCV (50.8%) and 86.9% had no modern contraceptive use. After controlling for the effects of confounders, women with PPCV were 50% more likely to use modern contraceptive methods than women with no PPCV (OR = 1.50, 95% CI = 1.31, 1.72). Conclusions. These findings highlight the importance of PPCV in improving modern contraceptive use and guide health care policy in the effort of reducing unintended pregnancy rates.
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Abstract
OBJECTIVE To assess pregnancies that could have been averted through improved access to contraceptive methods in the 2 years after delivery. METHODS In this cohort study, we interviewed 403 postpartum women in a hospital in Austin, Texas, who wanted to delay childbearing for at least 2 years. Follow-up interviews were completed at 3, 6, 9, 12, 18, and 24 months after delivery; retention at 24 months was 83%. At each interview, participants reported their pregnancy status and contraceptive method. At the 3- and 6-month interviews, participants were also asked about their preferred contraceptive method 3 months in the future. We identified types of barriers among women unable to access their preferred method and used Cox models to analyze the risk of pregnancy from 6 to 24 months after delivery. RESULTS Among women interviewed 6 months postpartum (n=377), two thirds had experienced a barrier to accessing their preferred method of contraception. By 24 months postpartum, 89 women had reported a pregnancy; 71 were unintended. Between 6 and 24 months postpartum, 77 of 377 women became pregnant (20.4%), with 56 (14.9%) lost to follow-up. Women who encountered a barrier to obtaining their preferred method were more likely to become pregnant less than 24 months after delivery. They had a cumulative risk of pregnancy of 34% (95% confidence interval [CI] 0.25-0.43) as compared with 12% (95% CI 0.05-0.18) for women with no barrier. All but three of the women reporting an unintended pregnancy had earlier expressed interest in using long-acting reversible contraception or a permanent method. CONCLUSION In this study, most unintended pregnancies less than 24 months after delivery could have been prevented or postponed had women been able to access their desired long-acting and permanent methods.
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Krew MA. Publicly funded postpartum contraception use is associated with a reduction in the rate of subsequent preterm birth. EVIDENCE-BASED MEDICINE 2016; 21:175. [PMID: 27506444 DOI: 10.1136/ebmed-2016-110415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Tucker CM, Berrien K, Menard MK, Herring AH, Daniels J, Rowley DL, Halpern CT. Predicting Preterm Birth Among Women Screened by North Carolina's Pregnancy Medical Home Program. Matern Child Health J 2016; 19:2438-52. [PMID: 26112751 DOI: 10.1007/s10995-015-1763-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine which combination of risk factors from Community Care of North Carolina's (CCNC) Pregnancy Medical Home (PMH) risk screening form was most predictive of preterm birth (PTB) by parity and race/ethnicity. METHODS This retrospective cohort included pregnant Medicaid patients screened by the PMH program before 24 weeks gestation who delivered a live birth in North Carolina between September 2011-September 2012 (N = 15,428). Data came from CCNC's Case Management Information System, Medicaid claims, and birth certificates. Logistic regression with backward stepwise elimination was used to arrive at the final models. To internally validate the predictive model, we used bootstrapping techniques. RESULTS The prevalence of PTB was 11 %. Multifetal gestation, a previous PTB, cervical insufficiency, diabetes, renal disease, and hypertension were the strongest risk factors with odds ratios ranging from 2.34 to 10.78. Non-Hispanic black race, underweight, smoking during pregnancy, asthma, other chronic conditions, nulliparity, and a history of a low birth weight infant or fetal death/second trimester loss were additional predictors in the final predictive model. About half of the risk factors prioritized by the PMH program remained in our final model (ROC = 0.66). The odds of PTB associated with food insecurity and obesity differed by parity. The influence of unsafe or unstable housing and short interpregnancy interval on PTB differed by race/ethnicity. CONCLUSIONS Evaluation of the PMH risk screen provides insight to ensure women at highest risk are prioritized for care management. Using multiple data sources, salient risk factors for PTB were identified, allowing for better-targeted approaches for PTB prevention.
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Affiliation(s)
- Christine M Tucker
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box #8120, Chapel Hill, NC, 27599-8120, USA. .,Carolina Population Center, 206 W. Franklin St., Chapel Hill, NC, 27516, USA.
| | - Kate Berrien
- Community Care of North Carolina, 2300 Rexwoods Drive, Suite 100, Raleigh, NC, 27607, USA.
| | - M Kathryn Menard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Amy H Herring
- Carolina Population Center, 206 W. Franklin St., Chapel Hill, NC, 27516, USA. .,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box #7420, Chapel Hill, NC, 27599-7420, USA.
| | - Julie Daniels
- Department of Epidemiology and Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box #7435, Chapel Hill, NC, 27599-7435, USA.
| | - Diane L Rowley
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box #7445, Chapel Hill, NC, 27599-7445, USA.
| | - Carolyn Tucker Halpern
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box #8120, Chapel Hill, NC, 27599-8120, USA. .,Carolina Population Center, 206 W. Franklin St., Chapel Hill, NC, 27516, USA.
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Rutledge RI, Domino ME, Hillemeier MM, Wells R. The effect of maternity care coordination services on utilization of postpartum contraceptive services. Contraception 2016; 94:541-547. [PMID: 27350389 DOI: 10.1016/j.contraception.2016.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 06/03/2016] [Accepted: 06/14/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine whether maternity care coordination (MCC) services are associated with utilization of postpartum contraceptive services. METHODS Using a random sample of 7120 live births, we analyzed administrative data to assess whether MCC services affected utilization of contraceptive services within 3months of delivery. Treatment groups were constructed as MCC during the prenatal period only (n=531), MCC in both the prenatal and postpartum periods (n=1723) and a non-MCC control group (n=4866). Inverse probability of treatment weights (IPTWs) were calculated and applied to balance baseline risk factors across groups. We used the IPTW linear probability model to estimate postpartum contraceptive service utilization, controlling for demographic, social, reproductive and medical home enrollment characteristics. RESULTS At 3months postpartum, MCC participation was associated with a 19-percentage point higher level of utilization of postpartum contraceptive services among women who received both prenatal and postpartum care coordination services (p<.001), as compared with controls. Women who received only prenatal MCC services showed no difference in utilization of services at 3months postpartum from non-MCC controls. Sensitivity modeling showed the effect of MCC was independent of postpartum obstetrical care. Additionally, MCC had differential treatment effects across subpopulations based on maternal age, race, ethnicity and education; women who were white and did not have a medical home were more likely to benefit from MCC services in initiating postpartum contraceptives. CONCLUSIONS MCC programs may be instrumental in increasing timely utilization of postpartum contraceptive services, but continuation of the intervention into the postpartum period is critical. IMPLICATION MCC offered both prenatally and in the postpartum period appears to complement clinical care by increasing postpartum contraceptive service utilization. Providers should consider the potential added benefits of care coordination services in tandem with traditional obstetric care to increase postpartum contraceptive use and subsequently reduce short birth intervals.
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Affiliation(s)
- Regina I Rutledge
- Department of Health Policy and Management, The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599-7411, USA.
| | - Marisa Elena Domino
- Department of Health Policy and Management, The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599-7411, USA.
| | - Marianne M Hillemeier
- Department of Health Policy and Administration, The Pennsylvania State University, 604E Ford, University Park, PA 16802, USA.
| | - Rebecca Wells
- Department of Management, Policy, and Community Health, The University of Texas School of Public Health, 1200 Pressler E343; Houston, TX 77030, USA.
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Melnick AL, Rdesinski RE, Marino M, Jacob-Files E, Gipson T, Kuyl M, Dexter E, Olds D. Randomized Controlled Trial of Home-Based Hormonal Contraceptive Dispensing for Women At Risk of Unintended Pregnancy. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2016; 48:93-99. [PMID: 27196986 DOI: 10.1363/48e9816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 06/05/2023]
Abstract
CONTEXT Women frequently experience barriers to obtaining effective contraceptives from clinic-based providers. Allowing nurses to dispense hormonal methods during home visits may be a way to reduce barriers and improve -effective contraceptive use. METHODS Between 2009 and 2013, a sample of 337 low-income, pregnant clients of a nurse home-visit program in Washington State were randomly selected to receive either usual care or enhanced care in which nurses were permitted to provide hormonal contraceptives postpartum. Participants were surveyed at baseline and every three months postpartum for up to two years. Longitudinal Poisson mixed-effects regression analysis was used to examine group differences in gaps in effective contraceptive use, and survival analysis was used to examine time until a subsequent pregnancy. RESULTS Compared with usual care participants, enhanced care participants had an average of 9.6 fewer days not covered by effective contraceptive use during the 90 days following a first birth (52.6 vs. 62.2). By six months postpartum, 50% of usual care participants and 39% of enhanced care participants were using a long-acting reversible contraceptive (LARC). In analyses excluding LARC use, enhanced care participants had an average of 14.2 fewer days not covered by effective contraceptive use 0-3 months postpartum (65.0 vs. 79.2) and 15.7 fewer uncovered days 4-6 months postpartum (39.2 vs. 54.9). CONCLUSION Home dispensing of hormonal contraceptives may improve women's postpartum contraceptive use and should be explored as an intervention in communities where contraceptives are not easily accessible.
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Affiliation(s)
- Alan L Melnick
- Department of Family Medicine, Oregon Health & Science University, Portland
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland
| | | | - Teresa Gipson
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Marni Kuyl
- Department of Health and Human Services, Hillsboro, OR
| | - Eve Dexter
- Department of Family Medicine, Oregon Health & Science University, Portland
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Dunn K, Bayer LL, Mody SK. Postpartum contraception: An exploratory study of lactation consultants' knowledge and practices. Contraception 2016; 94:87-92. [PMID: 26996737 DOI: 10.1016/j.contraception.2016.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/09/2016] [Accepted: 03/13/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Lactation consultants interact with women during the postpartum period; however, they may not have comprehensive education on postpartum contraception and the impact on breastfeeding. The aims of this study were to assess lactation consultants' knowledge and practices about postpartum contraception and assess whether lactation consultants are interested in more education on postpartum contraception. STUDY DESIGN We distributed a 30-question survey to self-identified lactation consultants and recruited participants via email, social media and at the 2015 California Breastfeeding Summit. RESULTS We surveyed a total of 194 lactation consultants. Seventy-seven percent (137/177) stated they offer advice about postpartum contraception and its impact on breastfeeding. The majority of lactation consultants felt the theoretical or proven risks outweighed the benefits or there was an unacceptable health risk for the progestin-only pill 76.3% (100/131), progestin injection 90.1% (118/131) and progestin implant 93.1% (122/131) if used within 21days of delivery. Although 68.7% (92/134) reported prior education on postpartum contraception, 82.1% (110/134) reported wanting more education on this topic, specifically in the form of a webinar 61.9% (83/134). Only 29.9% (40/134) reported knowledge of the United States Centers for Disease Control and Prevention 2011 Medical Eligibility Criteria for Contraceptive Use (USMEC) guidance for postpartum contraception. CONCLUSION There is a disconnect between the USMEC guidance and lactation consultants' knowledge regarding the safety of immediate postpartum contraception. IMPLICATIONS This study explores lactation consultants' knowledge and practices about postpartum contraception, demonstrating that more evidence-based education is needed on this topic.
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Affiliation(s)
- Kathleen Dunn
- Section of Family Planning, Department of Reproductive Medicine, University of California San Diego, 200 W. Arbor Drive 8433, San Diego, CA, 92103, USA.
| | - Lisa L Bayer
- Section of Family Planning, Department of Reproductive Medicine, University of California San Diego, 200 W. Arbor Drive 8433, San Diego, CA, 92103, USA.
| | - Sheila K Mody
- Section of Family Planning, Department of Reproductive Medicine, University of California San Diego, 200 W. Arbor Drive 8433, San Diego, CA, 92103, USA.
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Leaverton A, Lopes V, Vohr B, Dailey T, Phipps MG, Allen RH. Postpartum contraception needs of women with preterm infants in the neonatal intensive care unit. J Perinatol 2016; 36:186-9. [PMID: 26658122 DOI: 10.1038/jp.2015.174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/05/2015] [Accepted: 10/15/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate postpartum contraception experiences of mothers with premature infants in the neonatal intensive care unit (NICU), their knowledge of risk factors for preterm delivery and their interest in a family planning clinic located near the NICU. STUDY DESIGN This is a cross-sectional survey of English or Spanish-speaking women 18 or older whose premature neonate had been in the NICU for 5 days or more in a current stable condition. RESULTS A total of 95 women were interviewed at a median of 2.7 weeks postpartum (range 0.6-12.9). Approximately 75% of women were currently using or planning to use contraception, with 33% using less effective methods. Half of women reported they would obtain contraception at a family planning clinic near the NICU. Only 32% identified a short interpregnancy interval as a risk factor for preterm delivery. CONCLUSION Lack of knowledge of short interpregnancy interval as a risk factor for a future preterm delivery highlights the need to address postpartum contraception education and provision in this high-risk population.
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Affiliation(s)
- A Leaverton
- The Departments of Obstetrics and Gynecology and the Department of Pediatrics, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
| | - V Lopes
- The Departments of Obstetrics and Gynecology and the Department of Pediatrics, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
| | - B Vohr
- The Departments of Obstetrics and Gynecology and the Department of Pediatrics, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
| | - T Dailey
- The Departments of Obstetrics and Gynecology and the Department of Pediatrics, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
| | - M G Phipps
- The Departments of Obstetrics and Gynecology and the Department of Pediatrics, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
| | - R H Allen
- The Departments of Obstetrics and Gynecology and the Department of Pediatrics, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
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Sok C, Sanders JN, Saltzman HM, Turok DK. Sexual Behavior, Satisfaction, and Contraceptive Use Among Postpartum Women. J Midwifery Womens Health 2016; 61:158-65. [DOI: 10.1111/jmwh.12409] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Rodriguez MI, Chang R, Thiel de Bocanegra H. The impact of postpartum contraception on reducing preterm birth: findings from California. Am J Obstet Gynecol 2015. [PMID: 26220110 DOI: 10.1016/j.ajog.2015.07.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Family planning is recommended as a strategy to prevent adverse birth outcomes. The potential contribution of postpartum contraceptive coverage to reducing rates of preterm birth is unknown. In this study, we examine the impact of contraceptive coverage and use within 18 months of a birth on preventing preterm birth in a Californian cohort. STUDY DESIGN We identified records for second or higher-order births among women from California's 2011 Birth Statistical Master File and their prior births from earlier Birth Statistical Master Files. To identify women who received contraceptive services from publicly funded programs, we applied a probabilistic linking methodology to match birth files with enrollment records for women with Medi-Cal or Family Planning, Access, Care, and Treatment Program (PACT) claims. The length of contraceptive coverage was determined through applying an algorithm based on the specified method and the quantity dispensed. Preterm birth was defined as a birth occurring <37 weeks' gestation, and calculated from the medical record. We further examined differences in preterm birth using subcategories defined by the World Health Organization: extremely preterm (<28 weeks); very preterm (28 to <32 weeks); and moderate to late preterm (32 to <37 weeks). We built a multivariable regression model to examine the effect of contraceptive coverage on the odds of a preterm birth and control for key covariates. RESULTS The cohort consisted of 111,948 women who were seen at least once by a Medi-Cal or Family PACT provider within 18 months of delivery. Of the cohort, 9.75% had a preterm birth. Contraceptive coverage was found to be protective against preterm birth. For every month of contraceptive coverage, odds of a preterm birth <37 weeks decrease by 1.1% (odds ratio, 0.989; 95% confidence interval, 0.986-0.993). CONCLUSION Improving postpartum contraceptive use has the potential to reduce preterm births.
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Affiliation(s)
- Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
| | - Richard Chang
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Heike Thiel de Bocanegra
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA
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Gilliam M. Saving lives with contraceptive coverage. Am J Obstet Gynecol 2015; 213:602-3. [PMID: 26525519 DOI: 10.1016/j.ajog.2015.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 11/17/2022]
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Robbins CL, Farr SL, Zapata LB, D'Angelo DV, Callaghan WM. Postpartum contraceptive use among women with a recent preterm birth. Am J Obstet Gynecol 2015; 213:508.e1-9. [PMID: 26003062 PMCID: PMC5379122 DOI: 10.1016/j.ajog.2015.05.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/20/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
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.
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Affiliation(s)
- Cheryl L Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Sherry L Farr
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Denise V D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - William M Callaghan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Contraception post severe maternal morbidity: a retrospective audit. Contraception 2015; 92:308-12. [DOI: 10.1016/j.contraception.2015.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/27/2015] [Accepted: 05/31/2015] [Indexed: 11/23/2022]
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Contraception after delivery and short interpregnancy intervals among women in the United States. Obstet Gynecol 2015; 125:1471-1477. [PMID: 26000519 DOI: 10.1097/aog.0000000000000841] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate women's patterns of contraceptive use after delivery and the association between method use and risk of pregnancy within 18 months. METHODS We used the 2006-2010 National Survey of Family Growth to examine women's contraceptive use after delivery and at 3, 6, 12, and 18 months after giving birth. The sample included 3,005 births that occurred within 3 years of the survey date and for which information on contraceptive use was available. We estimated multivariable-adjusted Cox regression models to assess the association between women's method use and risk of pregnancy within 18 months after delivery. We also examined the percentage of pregnancies occurring 18 months or less after the index birth that were unintended. RESULTS Between delivery and 3 months postpartum, contraceptive use increased from 21% to 72%. At 3 months, 13% of women used permanent contraception, 6% used long-acting reversible contraceptives, 28% used other hormonal methods, and 25% relied on less-effective methods; the distribution of method use was similar in subsequent months. Among women using hormonal methods, 12.6% became pregnant within 18 months of delivery or less compared with 0.5% using permanent and long-acting contraception (adjusted hazard ratio [HR] 21.2, 95% confidence interval [CI] 6.17-72.8). Additionally, 17.8% of women using less-effective methods (HR 34.8, 95% CI 9.26-131) and 23% using no method (HR 43.2, 95% CI 12.3-152) became pregnant 18 months or less. At least 70% of pregnancies within 1 year after delivery were unintended. CONCLUSION Few women use long-acting reversible contraceptives after delivery, and those using less-effective methods have an increased risk of unintended pregnancy. LEVEL OF EVIDENCE II.
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Zerden ML, Tang JH, Stuart GS, Norton DR, Verbiest SB, Brody S. Barriers to Receiving Long-acting Reversible Contraception in the Postpartum Period. Womens Health Issues 2015. [PMID: 26212318 DOI: 10.1016/j.whi.2015.06.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess why postpartum women who desired long-acting reversible contraception (LARC) did not receive it in the postpartum period and to assess which contraceptive methods they were using instead. STUDY DESIGN This was a subgroup analysis of 324 women enrolled in a randomized, controlled trial to receive or not receive an educational LARC script during their postpartum hospitalization. Participants in this subgroup analysis stated that they were either using LARC (n = 114) or interested in using LARC (n = 210) during a follow-up survey completed after their scheduled 6-week postpartum visit. Modified Poisson regression analysis was used to assess for characteristics associated with using LARC by the time of the follow-up survey. RESULTS Women who were interested in LARC but not using it were more likely to be multiparous (relative risk [RR], 1.59; 95% CI, 1.19-2.11) and to have missed their postpartum visit (RR, 25.88; 95% CI, 3.75-178.44) compared with those using LARC. Among the interested 210 who were not using LARC, the most common reasons provided for non-use were that they were told to come back for another insertion visit (45%), missed the postpartum visit (26%), and could not afford LARC (11%). The most common contraceptive methods used instead of LARC were barrier methods (42%) and abstinence (19%); 18% used no contraceptive method. CONCLUSION Two-thirds (65%) of postpartum women who desired to use LARC did not receive it in the postpartum period and used less effective contraceptive methods. Increasing access to immediate postpartum LARC and eliminating two-visit protocols for LARC insertion may increase postpartum LARC use. As the Affordable Care Act moves toward full implementation, it is necessary to understand the barriers that prevent interested patients from receiving LARC.
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Affiliation(s)
- Matthew L Zerden
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology, WakeMed Health and Hospitals, Raleigh, North Carolina.
| | - Jennifer H Tang
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Gretchen S Stuart
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Sarah B Verbiest
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Seth Brody
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology, WakeMed Health and Hospitals, Raleigh, North Carolina
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Abstract
The aim of interconception care is to provide women who have had a prior adverse pregnancy outcome with optimal care in order to reduce risks that may affect the woman׳s health and any future birth she may choose to have. National recommendations call for action, and evidence supports specific clinical interventions. The need for interconception care is documented in national and state survey and surveillance data. Chronic diseases and behavioral risks affect the health of millions of U.S. women of childbearing age. Interconception care demonstration projects have used a "disease management" approach that includes medical care and case management. The increasing use of postpartum visits, as a gateway to interconception interventions, is essential. The Affordable Care Act emphasis on preventive services and expanded health coverage for women offers new opportunities to finance interconception care. Improved and enhanced clinical practices, along with the engagement of women, in interconception care have the potential to improve birth outcomes and reduce disparities.
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Affiliation(s)
- Kay A Johnson
- Department of Pediatrics, Geisel Medical School at Dartmouth, Lebanon, NH
| | - Rebekah E Gee
- Departments of Health Policy and Management, Schools of Public Health and Medicine, Louisiana State University, 2020 Gravier St, New Orleans, LA; Departments of Obstetrics and Gynecology, Schools of Public Health and Medicine, Louisiana State University, New Orleans, LA.
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