Abraham Margaret, Zhao Qiuhong, Peipert Jeffrey F
Department of Obstetrics and Gynecology and Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Obstet Gynecol. 2015 Oct;126(4):823-829. doi: 10.1097/AOG.0000000000001036.
To assess the relationship among young age, nulliparity, and continuation of long-acting reversible contraceptive (LARC) methods.
We performed a secondary analysis of the Contraceptive CHOICE Project database, an observational cohort study of 9,256 sexually active reproductive-aged females. This analysis focused on continuation of the intrauterine device and implant in nulliparous adolescent participants compared with parous, older women. We analyzed our data by age-parity groups and individual characteristics and used multivariable analysis to assess the association of age and parity on continuation.
There were 6,106 participants in our analytic set, including 863 aged 14-19 years. Long-acting reversible contraceptive continuation rates at 12 months were high and similar between all age-parity groups ranging from 82-86%. In the Cox proportional hazards model, nulliparous participants using the copper intrauterine device and implant were more likely to discontinue their LARC method (copper intrauterine device: adjusted hazard ratio [HR] 1.76, 95% CI 1.13-2.73, implant: adjusted HR 1.89, 95% CI 1.35-2.64) than parous participants. This effect was not observed among levonorgestrel intrauterine system users (adjusted HR 1.16, 95% CI 0.92-1.46). Age younger than 20 years was not associated with discontinuation at 12 months (adjusted HR 0.95, 95% CI 0.74-1.22).
We found that LARC continuation rates were high and similar across age and parity. Clinicians should not hesitate to recommend LARC methods to young nulliparous females owing to fear of early discontinuation.
II.
评估年轻、未生育与长效可逆避孕（LARC）方法持续使用之间的关系。
我们对避孕选择项目数据库进行了二次分析，该数据库是一项针对9256名性活跃的育龄女性的观察性队列研究。本分析重点关注未生育的青少年参与者与已生育的年长女性相比，宫内节育器和皮下埋植剂的持续使用情况。我们按年龄-生育状况组和个体特征分析数据，并使用多变量分析评估年龄和生育状况对持续使用的关联。
我们的分析集中有6106名参与者，其中包括863名年龄在14 - 19岁之间的参与者。所有年龄-生育状况组在12个月时的长效可逆避孕持续使用率都很高且相似，范围在82% - 86%之间。在Cox比例风险模型中，与已生育的参与者相比，使用铜宫内节育器和皮下埋植剂的未生育参与者更有可能停止使用其LARC方法（铜宫内节育器：调整后风险比[HR] 1.76，95%置信区间1.13 - 2.73；皮下埋植剂：调整后HR 1.89，95%置信区间1.35 - 2.64）。在左炔诺孕酮宫内节育系统使用者中未观察到这种效应（调整后HR 1.16，95%置信区间0.92 - 1.46）。年龄小于20岁与12个月时的停用无关（调整后HR 0.95，95%置信区间0.74 - 1.22）。
我们发现LARC持续使用率很高，且在年龄和生育状况方面相似。临床医生不应因担心早期停用而犹豫向年轻未生育女性推荐LARC方法。
II级
