University of Pittsburgh School of Medicine, Pittsburgh, PA.
Center for Health Equity, Research, and Promotion, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA.
Am J Obstet Gynecol. 2018 Feb;218(2):234.e1-234.e9. doi: 10.1016/j.ajog.2017.10.020. Epub 2017 Oct 27.
Women veterans have high rates of medical comorbidities and may be particularly vulnerable to adverse health outcomes associated with unintended pregnancy.
The objective of the study was to estimate the prevalence of medical contraindications to estrogen-containing combined hormonal contraception among women veterans of reproductive age and to evaluate the relationship between contraindications and contraceptive use.
This was a secondary analysis of data from a cross-sectional, telephone-based survey with a national sample of 2302 female veterans, aged 18-45 years, who use the Veterans Administration Healthcare System for primary care. This analysis included women at risk of unintended pregnancy, defined as heterosexually active and not pregnant or trying to conceive and with no history of hysterectomy or infertility. Seven contraindications to combined hormonal contraception were identified using survey data or medical diagnosis codes: hypertension; coronary artery disease; active migraine in women older than 35 years or migraine with aura; smoking in women older than 35 years; and a history of thromboembolism, stroke, or breast cancer. Outcomes were current use of combined hormonal contraception and contraceptive method type (combined hormonal contraception, and other prescription methods, nonprescription methods or no method). Multivariable logistic and multinomial regression were used to assess the relationship between contraindications and combined hormonal contraception use and method type, respectively.
Among 1169 women veterans at risk of unintended pregnancy, 339 (29%) had at least 1 contraindication to combined hormonal contraception. The most prevalent conditions were hypertension (14.9%) and migraine (8.7%). In adjusted analyses, women with contraindications were less likely than women without contraindications to report use of combined hormonal contraception (adjusted odds ratio, 0.54, 95% confidence interval, 0.37-0.79). Relative to use of combined hormonal contraception, women with contraindications were more likely than women without contraindications to use other prescription methods (adjusted odds ratio, 1.74, 95% confidence interval, 1.17-2.60), nonprescription methods (adjusted odds ratio, 1.96, 95% confidence interval, 1.19-3.22), and no method (adjusted odds ratio, 2.29, 95% confidence interval, 1.35-3.89).
Women veterans at risk of unintended pregnancy have a high burden of medical contraindications to estrogen. Women with contraindications were less likely to use combined hormonal contraceptive methods but were more likely to use no method, suggesting an unmet need for contraception in this medically vulnerable population.
女性退伍军人的医疗合并症发生率较高，可能特别容易受到与意外怀孕相关的不良健康后果的影响。
本研究的目的是评估处于生育年龄的女性退伍军人中雌激素含有的联合激素避孕药具的医学禁忌的流行率，并评估禁忌与避孕方法使用之间的关系。
这是一项对来自全国样本的 2302 名年龄在 18-45 岁之间、使用退伍军人事务部医疗保健系统进行初级保健的女性退伍军人的横断面、基于电话的调查数据的二次分析。该分析包括有意外怀孕风险的女性，定义为异性恋活跃、未怀孕或尝试怀孕且无子宫切除术或不孕史。使用调查数据或医疗诊断代码确定了 7 种联合激素避孕药具的禁忌证：高血压；冠状动脉疾病；35 岁以上的女性有活动性偏头痛或有先兆的偏头痛；35 岁以上的女性吸烟；血栓栓塞、中风或乳腺癌病史。结果为当前使用联合激素避孕药具和避孕方法类型（联合激素避孕药具、其他处方方法、非处方方法或无方法）。多变量逻辑和多项回归分别用于评估禁忌与联合激素避孕药具使用和方法类型之间的关系。
在有意外怀孕风险的 1169 名女性退伍军人中，339 名（29%）至少有一种联合激素避孕药具的禁忌证。最常见的病症是高血压（14.9%）和偏头痛（8.7%）。在调整后的分析中，有禁忌证的女性报告使用联合激素避孕药具的可能性低于无禁忌证的女性（调整后的优势比，0.54，95%置信区间，0.37-0.79）。与使用联合激素避孕药具相比，有禁忌证的女性更有可能使用其他处方方法（调整后的优势比，1.74，95%置信区间，1.17-2.60）、非处方方法（调整后的优势比，1.96，95%置信区间，1.19-3.22）和无方法（调整后的优势比，2.29，95%置信区间，1.35-3.89）。
有意外怀孕风险的女性退伍军人的雌激素禁忌证负担很重。有禁忌证的女性使用联合激素避孕药具的可能性较低，但更有可能不使用任何方法，这表明在这个医疗脆弱的人群中存在未满足的避孕需求。
