Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia.
Hunter Medical Research Institute, Newcastle, NSW, Australia.
Reprod Health. 2022 May 7;19(1):111. doi: 10.1186/s12978-022-01413-x.
Given chronic disease is increasing among young women and unintended pregnancies among these women are associated with poor maternal and fetal outcomes, these women would benefit from effective preconception care. However, there is a lack of understanding of how these women use or don't use contraception to inform such interventions. This study examined patterns of contraceptive use among an Australian cohort of young women and investigated the influence of chronic disease on contraceptive use over time.
Using data from 15,244 young women from the Australian Longitudinal Study on Women's Health (born 1989-1995), latent transition analysis was performed to identify distinct contraceptive patterns among women who were at risk of an unintended pregnancy. Multinomial mixed-effect models were used to evaluate the relationship between contraceptive combinations and chronic disease.
Contraceptive use for women with cardiac and autoinflammatory diseases differed to women without chronic disease over the observation period. Compared to women without chronic disease using the pill, women with cardiac disease had double the odds of using 'other' contraception and condoms (OR = 2.20, 95% CI 1.34, 3.59) and a modest increase in the odds of using the combined oral contraceptive pill and condoms (OR = 1.39, 95% CI 1.03, 1.89). Compared to women without chronic disease who used the pill, women with autoinflammatory disease had increased odds of using LARC and condoms (OR = 1.58, 95% CI 1.04, 2.41), using 'other' contraception and condoms (OR = 1.69, 95% CI 1.11, 2.57), and using the combined oral contraceptive pill and condoms (OR = 1.38, 95% CI 1.09, 1.75). No differences in contraceptive patterns over the observation period were found for women with asthma or diabetes when compared to women without chronic disease.
The findings identified a need for effective contraceptive counselling as part of routine chronic disease care and improved communication between health care providers and women with chronic disease to improve young women's contraceptive knowledge and agency in contraceptive choice, particularly for those with cardiac or autoinflammatory conditions. This may be the key to reducing high-risk unintended pregnancies among this vulnerable population.
鉴于慢性病在年轻女性中不断增加，而这些女性的意外怀孕与不良母婴结局有关，因此她们将受益于有效的孕前保健。然而，目前对于这些女性如何使用或不使用避孕措施来了解这些干预措施还缺乏了解。本研究调查了澳大利亚年轻女性队列中的避孕模式，并研究了慢性病对避孕措施随时间变化的影响。
使用来自澳大利亚女性健康纵向研究（1989 年至 1995 年出生）的 15244 名年轻女性的数据，采用潜在转移分析识别有意外怀孕风险的女性的不同避孕模式。使用多项混合效应模型评估避孕组合与慢性病之间的关系。
在观察期间，患有心脏病和自身免疫性疾病的女性与没有慢性疾病的女性相比，避孕方式有所不同。与没有慢性疾病的女性服用避孕药相比，患有心脏病的女性使用“其他”避孕措施和避孕套的几率增加一倍（OR=2.20，95%CI 1.34，3.59），使用复方口服避孕药和避孕套的几率略有增加（OR=1.39，95%CI 1.03，1.89）。与没有慢性疾病的女性服用避孕药相比，患有自身免疫性疾病的女性使用长效可逆避孕法和避孕套（OR=1.58，95%CI 1.04，2.41）、使用“其他”避孕措施和避孕套（OR=1.69，95%CI 1.11，2.57）以及使用复方口服避孕药和避孕套的几率增加（OR=1.38，95%CI 1.09，1.75）。与没有慢性疾病的女性相比，患有哮喘或糖尿病的女性在观察期间的避孕模式没有差异。
研究结果表明，需要将有效的避孕咨询作为常规慢性病护理的一部分，并改善卫生保健提供者与慢性病女性之间的沟通，以提高年轻女性对避孕措施的了解和选择避孕措施的自主权，特别是对患有心脏病或自身免疫性疾病的女性。这可能是降低这一脆弱人群中高风险意外怀孕的关键。
