Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Ben-Gurion University of the Negev, School of Public Health, Beer-Sheva, Israel.
Contraception. 2019 Aug;100(2):155-159. doi: 10.1016/j.contraception.2019.04.005. Epub 2019 Apr 17.
To investigate short-term adverse perinatal outcomes and long-term neuropsychiatric hospitalizations through 18 years of age in offspring conceived during copper intrauterine device (IUD) use.
We conducted a population-based cohort study comparing the pregnancy outcomes after 22 weeks of women who conceived with a copper IUD that was removed, women with a retained IUD and pregnancies without an IUD. Deliveries occurred between the years 1991 and 2014. We used a multivariable generalized estimating equation (GEE) logistic regression model analysis to control for confounders and for maternal clusters, a Kaplan-Meier survival curve to compare cumulative neuropsychiatric hospitalizations incidence and a Cox proportional-hazards model to evaluate long-term neuropsychiatric hospitalizations.
During the study period there were 221,805 deliveries, of which 203 (0.09%) and 149 (0.06%) occurred in patients with removed or retained copper IUD, respectively. Using GEE models, preterm delivery was independently associated with copper IUD use [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.4-3.2 and OR 2.3, 95% CI 1.4-3.7 for removed and retained IUD, respectively]. We did not find an association between copper IUD presence or removal and the offspring's long-term neuropsychiatric hospitalizations (total long-term neuropsychiatric hospitalizations: 2.5%, 4.4% and 3.2% for removed, retained and no IUD, respectively, p=.71). Long-term neuropsychiatric hospitalization rate was comparable between the groups (Kaplan-Meier survival curve log rank p=.23).
Pregnancies in women who conceive with a removed or retained copper IUD are at an increased risk for short-term adverse perinatal outcomes, especially preterm delivery. For pregnancies that continued to at least 22 weeks, we found no benefit in IUD removal. However, the risk of long-term neuropsychiatric hospitalizations is not increased among offspring of these women.
Our data are insufficient to make a recommendation as to whether removal or retention of a copper IUD during pregnancy is best, as after 22 weeks' gestation we have found no benefit in IUD removal. Careful surveillance and categorization of the pregnancy as "high risk" are warranted.
研究在使用铜宫内节育器（IUD）期间受孕的后代在 18 年内短期围产期不良结局和长期神经精神科住院的情况。
我们进行了一项基于人群的队列研究，比较了在妊娠 22 周后取出 IUD、保留 IUD 和未使用 IUD 的孕妇的妊娠结局。分娩发生在 1991 年至 2014 年之间。我们使用多变量广义估计方程（GEE）逻辑回归模型分析来控制混杂因素和母亲聚类，使用 Kaplan-Meier 生存曲线来比较累积神经精神科住院的发生率，使用 Cox 比例风险模型来评估长期神经精神科住院的情况。
在研究期间，有 221805 例分娩，其中 203（0.09%）和 149（0.06%）例分别发生在取出或保留铜 IUD 的患者中。使用 GEE 模型，早产与铜 IUD 的使用独立相关[比值比（OR）2.1，95%置信区间（CI）1.4-3.2 和 OR 2.3，95% CI 1.4-3.7，分别用于取出和保留的 IUD]。我们没有发现铜 IUD 的存在或取出与后代的长期神经精神科住院之间存在关联（总长期神经精神科住院率：取出、保留和无 IUD 分别为 2.5%、4.4%和 3.2%，p=0.71）。组间长期神经精神科住院率无差异（Kaplan-Meier 生存曲线对数秩检验 p=0.23）。
在使用取出或保留的铜 IUD 受孕的女性中，妊娠的短期围产期不良结局风险增加，尤其是早产。对于至少持续到 22 周的妊娠，我们发现取出 IUD 没有益处。然而，这些女性的后代发生长期神经精神科住院的风险并没有增加。
我们的数据不足以推荐在妊娠期间取出或保留铜 IUD 是否最佳，因为在妊娠 22 周后，我们发现取出 IUD 没有益处。需要仔细监测和将妊娠分类为“高危”。
