Yin AnXin, Zhou XiaoYan, Qian Xu, Zhang Lei, Wang XiuRui, Yang HuiBin, Song YuHan, Jin LongMei, Li Mu, Jiang Hong
School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
Minhang District Maternal and Child Health Hospital, Shanghai, China.
JAMA Netw Open. 2024 Dec 2;7(12):e2450635. doi: 10.1001/jamanetworkopen.2024.50635.
The interpregnancy intervals are suboptimal worldwide, and women lack access to high-quality postpartum contraceptive services in China.
To evaluate the effectiveness of integrating postpartum contraceptive interventions into the existing maternal and child health care (MCH) system.
DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized trial randomly allocated 13 communities in Minhang District in Shanghai, China, to the intervention or the control group. Data were collected between September 2020 and February 2023. Eligible participants included women who registered their pregnancy in community health centers and were followed up to 1 year post partum. Data analysis was conducted from April 2023 to May 2024.
Participants in the intervention group received postpartum contraception consultations, online educational videos, a 45-minute class, health prescriptions, and educational pamphlets at 5 stages in alignment with the MCH system of China. The control group received routine MCH services.
The primary outcome was incidence of unintended pregnancy within 1 year after childbirth. The secondary outcomes included knowledge level of postpartum contraception, utilization rate of reliable long-acting reversible contraception (LARC), and incidence of induced abortion.
A total of 1279 participants (698 in intervention from 7 clusters and 581 in control from 6 clusters) were recruited, and 995 (521 older than 30 years [40.7%]; 539 intervention [54.2%] and 456 control [45.8%]) completed the trial. The incidence of unintended pregnancy, LARC utilization, and induced abortion within 1 year after childbirth was 1.5% (8 participants), 3.2% (17 participants), and 0.6% (3 participants), respectively, in the intervention group, and 3.9% (18 participants), 1.1% (5 participants), and 2.0% (9 participants), respectively, in the control group. Participants in the intervention group were significantly less likely to experience unintended pregnancy (adjusted odds ratio [aOR], 0.33; 95% CI, 0.16-0.70), had a higher rate of LARC utilization (aOR, 2.47; 95% CI, 1.02-5.98), and a lower rate of induced abortion due to unintended pregnancy (aOR, 0.30; 95% CI, 0.09-0.99). The postpartum contraception knowledge level in the intervention group was substantially higher than the control group (β = 24.20; 95% CI, 20.92-27.47).
This cluster randomized clinical trial demonstrated the designed postpartum contraceptive interventions were effective in reducing unintended pregnancy and induced abortion and increasing postpartum contraception knowledge and LARC utilization among women at 1-year post partum.
Chictr.org.cn Identifier: ChiCTR2000034603.
全球范围内的孕产间隔都不理想，在中国，女性难以获得高质量的产后避孕服务。
评估将产后避孕干预措施纳入现有的妇幼保健（MCH）系统的有效性。
设计、地点和参与者：这项整群随机试验将中国上海闵行区的13个社区随机分为干预组或对照组。数据收集时间为2020年9月至2023年2月。符合条件的参与者包括在社区卫生中心登记怀孕并产后随访1年的女性。数据分析于2023年4月至2024年5月进行。
干预组的参与者在中国妇幼保健系统的5个阶段接受产后避孕咨询、在线教育视频、45分钟课程、健康处方和教育宣传册。对照组接受常规妇幼保健服务。
主要结局是产后1年内意外怀孕的发生率。次要结局包括产后避孕知识水平、可靠长效可逆避孕（LARC）的使用率和人工流产率。
共招募了1279名参与者（来自7个整群的698名干预组参与者和来自6个整群的581名对照组参与者），995名（521名年龄大于30岁[40.7%]；539名干预组[54.2%]和456名对照组[45.8%]）完成了试验。干预组产后1年内意外怀孕、LARC使用和人工流产的发生率分别为1.5%（8名参与者）、3.2%（17名参与者）和0.6%（3名参与者），对照组分别为3.9%（18名参与者）、1.1%（5名参与者）和2.0%（9名参与者）。干预组参与者意外怀孕的可能性显著降低（调整优势比[aOR]，0.33；95%置信区间[CI]，0.16 - 0.70），LARC使用率更高（aOR，2.47；95% CI，1.02 - 5.98），因意外怀孕导致的人工流产率更低（aOR，0.30；95% CI，0.09 - 0.99）。干预组的产后避孕知识水平显著高于对照组（β = 24.20；95% CI，20.92 - 27.47）。
这项整群随机临床试验表明，所设计的产后避孕干预措施在降低产后一年女性的意外怀孕和人工流产率以及提高产后避孕知识和LARC使用率方面是有效的。
中国临床试验注册中心标识符：ChiCTR2000034603 。
