Kaewkiattikun Kasemsis
Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Bangkok, Thailand.
Adolesc Health Med Ther. 2017 Oct 30;8:115-123. doi: 10.2147/AHMT.S148434. eCollection 2017.
Adolescent pregnancy is a global public health problem, particularly repeated pregnancy. The best strategy to lower prevalence of adolescent pregnancy and repeated pregnancy is promoting highly effective long-acting contraceptive methods along with special counseling programs. Long-acting reversible contraception (LARC) is the ideal contraceptive of choice for adolescents. It is not known whether immediate postpartum contraceptive counseling increases postpartum LARC use in adolescents.
To compare LARC use between immediate and conventional postpartum contraceptive counseling and discover predictive factors of postpartum LARC use.
This prospective, randomized controlled trial was conducted among postpartum adolescents at Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, from 1 July 2016 to 31 March 2017. The participants were assigned to receive immediate postpartum contraceptive counseling or conventional postpartum contraceptive counseling. The primary outcome was postpartum LARC use. The secondary outcome was predictive factors for LARC use in postpartum adolescents.
Of the 233 postpartum adolescents, postpartum LARC use was 87 of 118 (73.7%) in the immediate postpartum counseling group and 49 of 115 (42.6%) in the conventional postpartum counseling group (odds ratio 3.780, 95% CI 2.18-6.57, <0.001). A significant predictive factor for LARC use in postpartum adolescents was immediate postpartum counseling (odds ratio 3.67, 95% CI 2.10-6.41, <0.001).
Immediate postpartum contraceptive counseling led to a significant increase in postpartum use of LARC in adolescents, when compared with conventional (4-6 weeks) postpartum contraceptive counseling. Adolescent mothers who received immediate postpartum counseling were 3.67 times more likely to use LARC than those who received conventional postpartum counseling.
青少年怀孕是一个全球性的公共卫生问题，尤其是重复怀孕。降低青少年怀孕和重复怀孕发生率的最佳策略是推广高效长效避孕方法以及特殊咨询项目。长效可逆避孕法（LARC）是青少年理想的避孕选择。目前尚不清楚产后立即进行避孕咨询是否会增加青少年产后LARC的使用。
比较产后立即避孕咨询和传统产后避孕咨询的LARC使用情况，并发现产后LARC使用的预测因素。
这项前瞻性随机对照试验于2016年7月1日至2017年3月31日在泰国曼谷瓦吉拉医院医学院妇产科的产后青少年中进行。参与者被分配接受产后立即避孕咨询或传统产后避孕咨询。主要结局是产后LARC的使用。次要结局是产后青少年LARC使用的预测因素。
在233名产后青少年中，产后立即咨询组118人中有87人（73.7%）使用了LARC，传统产后咨询组115人中有49人（42.6%）使用了LARC（比值比3.780，95%置信区间2.18 - 6.57，<0.001）。产后青少年使用LARC的一个显著预测因素是产后立即咨询（比值比3.67，95%置信区间2.10 - 6.41，<0.001）。
与传统的（4 - 6周）产后避孕咨询相比，产后立即避孕咨询导致青少年产后LARC的使用显著增加。接受产后立即咨询的青少年母亲使用LARC的可能性是接受传统产后咨询的青少年母亲的3.67倍。
