Lacy Young Megan, Mastronardi Alicia, Shelton Zach, Maples Jill M, Zite Nikki B
Center for Women and Infants, The University of Tennessee Medical Center, Knoxville, TN, United States.
Department of Obstetrics and Gynecology, The University of Tennessee Graduate School of Medicine, Knoxville, TN, United States.
Contraception. 2025 Feb;142:110721. doi: 10.1016/j.contraception.2024.110721. Epub 2024 Oct 1.
To understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with health care barriers and high short-interval birth rates.
We conducted a retrospective cohort study of electronic delivery records between March 2018 and June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using χ or Fisher exact tests. Binary logistic regression explored the relationship between IPP LARC utilization and demographics. Multivariable logistic regression was performed on all statistically significant variables.
Analysis included 10,472 delivery encounters; 2459 (23.5%) requested IPP LARC on admission and 464 (4.4%) changed contraception to IPP LARC after admission. Among those obtaining IPP LARC (n = 2523, 24.1%), 1224 (48.5%) selected arm implants and 1299 selected intrauterine devices (IUDs). Patients who self-reported as non-Hispanic Black and non-Hispanic Other or multiple races utilized IPP LARC less (adjusted Odds Ratio (aOR)=0.84, 95% CI: 0.72-0.98, aOR=0.68, CI 95%: 0.48-0.97, respectively). Patients with cesarean delivery (aOR=1.45, 95% CI: 1.31-1.61) or inadequate prenatal care (aOR=1.54, CI 95%: 1.35-1.75) were more likely to utilize IPP LARC. Maternal age and years of education were inversely associated with utilization. Primiparous patients were less likely to utilize IPP LARC.
Long-acting reversible contraception (LARC) utilization was 24.1% during the immediate postpartum period; higher than the 11% nationally reported interval LARC use among publicly insured patients. Understanding the demographics of those desiring IPP LARC could highlight accessibility gaps. The impact of IPP LARC utilization on rates of short-interval birth is being evaluated.
Understanding the demographics of IPP LARC utilizers may contribute to understanding accessibility gaps and facilitate discernment of factors impacting patient initiation. Evidence suggests that comprehensive contraception access during delivery admission is feasible, patient-desired, and essential.
了解在一个存在医疗保健障碍且短间隔生育率高的州的一家学术医院分娩的公共保险患者中，产后即时长效可逆避孕（IPP LARC）的需求和使用趋势。
我们对2018年3月至2023年6月期间公共保险患者的电子分娩记录进行了一项回顾性队列研究。使用χ检验或Fisher精确检验比较患者的人口统计学特征、IPP LARC需求和使用趋势。二元逻辑回归探讨了IPP LARC使用与人口统计学之间的关系。对所有具有统计学意义的变量进行多变量逻辑回归。
分析包括10472次分娩情况；2459例（23.5%）入院时要求使用IPP LARC，464例（4.4%）入院后将避孕方式改为IPP LARC。在采用IPP LARC的患者中（n = 2523，24.1%），1224例（48.5%）选择了手臂植入物，1299例选择了宫内节育器（IUD）。自我报告为非西班牙裔黑人以及非西班牙裔其他种族或多种族的患者较少使用IPP LARC（调整后的优势比（aOR）分别为0.84，95%置信区间：0.72 - 0.98；aOR为0.68，95%置信区间：0.48 - 0.97）。剖宫产患者（aOR = 1.45，95%置信区间：1.31 - 1.61）或产前护理不足的患者（aOR = 1.54，95%置信区间：1.35 - 1.75）更有可能使用IPP LARC。产妇年龄和受教育年限与使用率呈负相关。初产妇使用IPP LARC的可能性较小。
产后即时长效可逆避孕（LARC）的使用率在产后即时期间为24.1%；高于全国报告的公共保险患者中11%的间隔期LARC使用率。了解希望使用IPP LARC的人群的人口统计学特征可能会凸显可及性差距。正在评估IPP LARC使用对短间隔生育率的影响。
了解IPP LARC使用者的人口统计学特征可能有助于理解可及性差距，并有助于识别影响患者开始使用的因素。有证据表明，在分娩入院时提供全面的避孕措施是可行的、符合患者需求的且至关重要的。
