Rodriguez Maria I, Skye Megan, Samandari Ghazaleh, Darney Blair G
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, United States.
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, United States.
Contraception. 2022 Sep;113:49-56. doi: 10.1016/j.contraception.2022.03.018. Epub 2022 Apr 1.
To determine whether the timing of placement of long acting, reversible contraception (LARC) methods postpartum (immediate postpartum (IPP) or interval (within 6 months postpartum) is associated with higher removal rates by 12 months postpartum.
We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data (n = 313,849) from Oregon and South Carolina from January 1, 2010 to December 31, 2018. Our primary outcome was LARC (intrauterine device (IUD) or implant) removal by 12 months postpartum. We compared crude proportions and rates of removal and used a multivariable survival analysis to compare removal over 12 months between IPP and interval LARC placement controlling for sociodemographic and clinical factors and clustered at the woman level.
Our sample included 313,849 births to 247,884 women; a majority did not receive any postpartum contraception (207,058 [66.0%]). Out of the 54,018 (17.2%) of births followed by an immediate postpartum or interval LARC placement, 11.8% discontinued by 12 months. In multivariable analyses, births followed by IPP LARC were 10% more likely to experience discontinuation at any point up to 12 months compared with interval LARC (HR: 1.10, 95% CI: 1.00-1.22), but this was not statistically significant.
IPP LARC devices are removed at similar rates as LARC placed within 6 months postpartum.
Timing of postpartum long acting reversible contraception- interval or immediately postpartum- was not associated with 12 month removal rates.
确定长效可逆避孕（LARC）方法在产后（产后即刻（IPP）或间隔期（产后6个月内））放置的时间是否与产后12个月时更高的取出率相关。
我们使用了2010年1月1日至2018年12月31日来自俄勒冈州和南卡罗来纳州的医疗补助索赔与出生证明数据（n = 313,849）进行了一项回顾性队列研究。我们的主要结局是产后12个月时LARC（宫内节育器（IUD）或皮下埋植剂）的取出情况。我们比较了取出的粗略比例和率，并使用多变量生存分析来比较IPP和间隔期放置LARC的情况下12个月内的取出情况，同时控制社会人口统计学和临床因素，并在女性层面进行聚类分析。
我们的样本包括247,884名女性的313,849次分娩；大多数女性未接受任何产后避孕措施（207,058例[66.0%]）。在产后即刻或间隔期放置LARC的54,018例（17.2%）分娩中，11.8%在12个月内停用。在多变量分析中，与间隔期放置LARC相比，产后即刻放置LARC的分娩在12个月内任何时间点停用的可能性高10%（风险比：1.10，95%置信区间：1.00 - 1.22），但这在统计学上并不显著。
产后即刻放置的LARC装置与产后6个月内放置的LARC装置取出率相似。
产后长效可逆避孕的时间（间隔期或产后即刻）与12个月的取出率无关。
