Pregnancy and delivery with an intrauterine device in situ: outcomes in the National Inpatient Sample Database.

BACKGROUND

Pregnancy with intrauterine device in place is rare and there are limited data that exist regarding associated perinatal outcomes.

OBJECTIVE

The objective of this study is to determine the association between presence of an intrauterine device during pregnancy and spontaneous abortion, induced abortion, and preterm or small for gestational age delivery outcomes.

STUDY DESIGN

The National Inpatient Sample database was analyzed for the years 2010 and 2011. Maternal records with an intrauterine device in situ during delivery were identified using International Classification of Diseases, Ninth Revision, diagnostic codes. Primary outcome was incidence of spontaneous abortion. Secondary outcomes were incidence of induced abortion, preterm delivery, and small for gestational age. Data were analyzed using Chi-square and Fisher's exact tests to calculate odds ratios (ORs) of abortion in association with intrauterine device in situ during pregnancy. Maternal birth records were further analyzed for adverse neonatal outcomes using logistic regression models, controlling for possible confounding variables.

RESULTS

The data included 8,597,284 maternal birth records; 0.02% with an intrauterine device in situ. Patients with an intrauterine device in situ experienced a higher frequency of the pregnancy ending in spontaneous abortion (OR: 7.15; 95% confidence interval (CI): 5.06-10.09; p < .001) and induced abortion (OR: 23.12; 95% CI: 15.55-34.36; p < .001) than patients without an intrauterine device in place. Adjusted odds ratio for preterm delivery among women with an intrauterine device in situ was 2.04 (95% CI: 1.71-2.43; p < .001) compared with women without an intrauterine device, and adjusted odds ratio for delivery of a small for gestational age infant among intrauterine device cohort was 0.56 (95% CI: 0.34-0.92; p = .022), after controlling for associated demographic and clinical variables.

CONCLUSION

The presence of an intrauterine device in situ during pregnancy was associated with increased spontaneous and induced abortions, and increased incidence of delivery of a preterm, but not small for gestational age infant.