Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Obstetrics/Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Womens Health (Larchmt). 2021 Oct;30(10):1469-1475. doi: 10.1089/jwh.2020.8536. Epub 2021 Jan 6.
Patients with comorbidities are more susceptible to adverse pregnancy outcomes, morbidity, and mortality than healthy patients. The goal of this study was to evaluate how comorbidities influence contraceptive choice, continuation rates, and the unintended pregnancy rate in reproductive-age participants. We analyzed data from the Contraceptive CHOICE Project. Baseline data included demographic, reproductive, and medical history, including self-reported hypertension (HTN), venous thromboembolism (VTE), migraines, cerebrovascular accidents (CVA), transient ischemic attack (TIA), or stroke. Participants were provided contraceptive counseling and their method of choice at no cost. Among 9253 participants included in our analysis, 659 participants reported a history of HTN (7%), 20 participants reported a history of CVA/TIA/stroke (<1%), 1803 participants reported a history of migraine (19%), and 85 reported a history of VTE (<1%). Compared to baseline, use of long-acting reversible contraceptive methods (long-acting reversible contraception [LARC]: intrauterine devices and implants) increased for participants with all comorbidities: HTN 2.3%-84.2%; CVA/TIA/stroke 0%-85%; migraines 1.7%-77%, and VTE 1.2%-88.2%. Participants with HTN, VTE, and migraines were more likely to choose LARC than those without those conditions: HTN: relative risk (RR) = 1.14, 95% confidence interval (CI) 1.10-1.18; migraines RR = 1.04, 95% CI 1.01-1.07; and VTE RR = 1.18, 95% CI 1.09-1.28. Twelve-month continuation and unintended pregnancy rates did not differ significantly based on comorbidity status. Participants with serious comorbidities were more likely to choose LARC than healthy participants. Contraceptive counseling should always be individualized to the patient. Clinical Trials.gov Identifier: NCT01986439.
患有合并症的患者比健康患者更容易出现不良妊娠结局、发病和死亡。本研究的目的是评估合并症如何影响生殖年龄段参与者的避孕选择、续用率和意外妊娠率。我们分析了避孕选择项目的数据。基线数据包括人口统计学、生殖和病史，包括自我报告的高血压（HTN）、静脉血栓栓塞（VTE）、偏头痛、脑血管意外（CVA）、短暂性脑缺血发作（TIA）或中风。参与者获得了免费的避孕咨询和他们选择的方法。在我们分析的 9253 名参与者中，有 659 名参与者报告有 HTN 病史（7%），20 名参与者报告有 CVA/TIA/中风病史（<1%），1803 名参与者报告有偏头痛病史（19%），85 名参与者报告有 VTE 病史（<1%）。与基线相比，所有合并症患者的长效可逆避孕方法（长效可逆避孕：宫内节育器和植入物）使用率均有所增加：HTN 为 2.3%-84.2%；CVA/TIA/中风为 0%-85%；偏头痛为 1.7%-77%，VTE 为 1.2%-88.2%。患有 HTN、VTE 和偏头痛的参与者比没有这些疾病的参与者更有可能选择 LARC：HTN：相对风险（RR）=1.14，95%置信区间（CI）1.10-1.18；偏头痛 RR=1.04，95%CI 1.01-1.07；VTE RR=1.18，95%CI 1.09-1.28。12 个月的续用率和意外妊娠率与合并症状况无显著差异。患有严重合并症的参与者比健康参与者更有可能选择 LARC。避孕咨询应始终根据患者的个体情况进行。临床试验.gov 标识符：NCT01986439。
