Usinger K M, Gola S B, Weis M, Smaldone A
Columbia University School of Nursing, New York, New York.
Columbia University School of Nursing, New York, New York.
J Pediatr Adolesc Gynecol. 2016 Dec;29(6):659-667. doi: 10.1016/j.jpag.2016.06.007. Epub 2016 Jul 4.
Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type.
Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474).
Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.
青少年意外怀孕风险较高。虽然宫内节育器（IUD）作为长效可逆避孕方法，已知在预防怀孕方面非常有效，但对于青少年使用IUD的依从性却知之甚少。在这项系统评价（SR）中，我们比较了25岁及以下年轻女性中IUD的持续使用率与其他避孕方式的持续使用率。
设计、设置、参与者、干预措施及主要结局指标：对1946年至2015年期间的Ovid Medline、Cochrane图书馆和Embase进行了系统检索。纳入的研究考察了25岁及以下女性使用IUD的情况，将IUD的使用与另一种避孕方式进行比较，并测量了12个月时的持续使用率。使用唐斯和布莱克标准对每项研究的质量进行评估，并根据避孕类型对各研究中的12个月持续使用率进行汇总和分析。
在检索到的3597篇文章中，有9项研究符合系统评价的标准。综合各项研究，IUD使用者的12个月持续使用率（86.5%，12761/14747）显著高于口服避孕药（39.6%，1931/4873）、醋酸甲羟孕酮（辉瑞公司，纽约州纽约市）激素注射（39.8%，510/1282）、阴道环（48.9%，196/401）和透皮贴剂（39.8%，37/93；所有P值<0.001）。IUD与另一种长效可逆避孕方法皮下植入依托孕烯之间的12个月持续使用率无统计学显著差异（85.3%，4671/5474）。
该系统评价的结果表明，对于25岁及以下的女性，IUD的持续使用率通常高于其他避孕方法。在意外怀孕率高、依从性普遍较低且其他非长效可逆避孕方法使用不规范的人群中，应鼓励使用IUD。
