Polaneczky M, Slap G, Forke C, Rappaport A, Sondheimer S
Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, NY 10021.
N Engl J Med. 1994 Nov 3;331(18):1201-6. doi: 10.1056/NEJM199411033311806.
Although levonorgestrel implants (Norplant) would appear to be a good contraceptive option for adolescent mothers, there is little information about the use of Norplant in this population.
We studied 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital between September 1991 and July 1992. Structured interviews were conducted and medical records were reviewed soon after delivery and at a mean (+/- SD) of 15.5 +/- 2.9 months post partum.
Forty-eight of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and 2 (not further studied) chose barrier methods of contraception. The factors significantly associated with the choice of Norplant were older age (16.7 years among those who chose Norplant, vs. 16.2 years among those who chose oral contraceptives), multiparity (24 subjects vs. 6 subjects), and previous use of oral contraceptives (34 subjects vs. 21 subjects). During follow-up, there were no differences between the Norplant group and the oral-contraceptive group in the frequency of clinic visits (an average of 2.3 visits per subject in each group), failure to return after the postpartum visit (9 subjects vs. 11 subjects), or the incidence of sexually transmitted diseases (42 percent vs. 36 percent). At follow-up, 95 percent of the subjects in the Norplant group and 33 percent of those in the oral-contraceptive group were still using the method they had chosen (P < 0.001). During the first postpartum year 1 subject in the Norplant group and 19 in the oral-contraceptive group became pregnant (P < 0.001). Norplant users did not differ from all other adolescents studied with regard to sexual activity or condom use.
The selection of Norplant by adolescent mothers as a method of contraception is associated with higher rates of continued use and lower rates of new pregnancy than the selection of oral contraceptives and does not affect the use of health care services, sexual activity, condom use, or the rate of sexually transmitted diseases.
尽管左炔诺孕酮植入剂（诺普兰）似乎是青春期母亲的一个不错的避孕选择，但关于该人群使用诺普兰的信息却很少。
我们研究了1991年9月至1992年7月期间在一家城市教学医院选择避孕方法的100名产后青少年。在分娩后不久以及产后平均（±标准差）15.5±2.9个月时进行了结构化访谈并查阅了病历。
48名青春期母亲选择了诺普兰，50名选择了口服避孕药，2名（未作进一步研究）选择了屏障避孕法。与选择诺普兰显著相关的因素有年龄较大（选择诺普兰者为16.7岁，选择口服避孕药者为16.2岁）、多胎妊娠（24名受试者对6名受试者）以及既往使用过口服避孕药（34名受试者对21名受试者）。在随访期间，诺普兰组与口服避孕药组在门诊就诊频率（每组受试者平均就诊2.3次）、产后就诊后未复诊（9名受试者对11名受试者）或性传播疾病发病率（42%对36%）方面没有差异。在随访时，诺普兰组95%的受试者和口服避孕药组33%的受试者仍在使用他们选择的方法（P<0.001）。在产后的第一年，诺普兰组有1名受试者、口服避孕药组有19名受试者怀孕（P<0.001）。诺普兰使用者在性活动或使用避孕套方面与所有其他研究的青少年没有差异。
青春期母亲选择诺普兰作为避孕方法与口服避孕药相比，持续使用率更高，新妊娠率更低，并且不影响医疗保健服务的使用、性活动、避孕套使用或性传播疾病的发生率。
