醋酸甲羟孕酮长效注射剂或产后青少年口服避孕药

Depot medroxyprogesterone acetate or oral contraception in postpartum adolescents.

作者信息

O'Dell C M, Forke C M, Polaneczky M M, Sondheimer S J, Slap G B

机构信息

Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.

出版信息

Obstet Gynecol. 1998 Apr;91(4):609-14. doi: 10.1016/s0029-7844(97)00710-2.

DOI:10.1016/s0029-7844(97)00710-2

PMID:9540951

Abstract

OBJECTIVE

To compare rates of method continuation and repeat pregnancy among postpartum adolescents selecting depot medroxyprogesterone acetate or oral contraceptives (OCs).

METHODS

A retrospective study of 161 adolescents aged 19 years and younger who gave birth at an urban teaching hospital between May 1, 1994, and April 30, 1995, returned to the hospital's family planning clinic within 14 weeks of delivery and chose depot medroxyprogesterone acetate (n=111, 69%), or OC (n=50, 31%) as their postpartum contraceptive method. Most subjects were black (99%), single (97%), and on medical assistance (85%). Data were gathered 12-18 months postpartum (mean+/-standard deviation [SD] 14.5+/-1.6 months) by telephone interview and medical record review. The main outcome measures were method continuation and repeat pregnancy.

RESULTS

The mean (+/-SD) age at delivery was 17.8+/-1.4 years. Variables differentiating subjects selecting depot medroxyprogesterone acetate or OC included multiparity (34% versus 12%, P < .05), mean age at first pregnancy (15.9 versus 16.6 years, P < .05), and mean age at first delivery (16.1 versus 16.9 years, P < .05). The survival curves for depot medroxyprogesterone acetate and OC continuation differed significantly (median duration of use 8.1 versus 5.4 months, respectively), but the continuation rates at 12 months were similar (34% versus 32%). The survival curves for repeat pregnancy among subjects selecting depot medroxyprogesterone acetate differed significantly from curves of those choosing OC, with repeat pregnancy rates of 15% and 36% by 15 months. Postpartum selection of OC was the only variable entering a Cox regression model designed to predict repeat pregnancy (relative risk 3.0, 95% confidence interval 1.4, 6.7).

CONCLUSION

Adolescent mothers choosing depot medroxyprogesterone acetate or OC immediately postpartum face similarly high rates of method discontinuation and repeat pregnancy within 1 year.

摘要

目的

比较选择醋酸甲羟孕酮长效避孕针或口服避孕药（OCs）的产后青少年的方法持续率和再次妊娠率。

方法

对1994年5月1日至1995年4月30日期间在一家城市教学医院分娩的161名19岁及以下青少年进行回顾性研究，这些青少年在分娩后14周内返回医院计划生育门诊，并选择醋酸甲羟孕酮长效避孕针（n = 111，69%）或口服避孕药（n = 50，31%）作为其产后避孕方法。大多数受试者为黑人（99%）、单身（97%）且接受医疗救助（85%）。在产后12 - 18个月（平均±标准差[SD] 14.5±1.6个月）通过电话访谈和病历审查收集数据。主要结局指标为方法持续率和再次妊娠。

结果

分娩时的平均（±SD）年龄为17.8±1.4岁。区分选择醋酸甲羟孕酮长效避孕针或口服避孕药的受试者的变量包括多胎妊娠（34%对12%，P < 0.05）、首次妊娠的平均年龄（15.9对16.6岁，P < 0.05）以及首次分娩的平均年龄（16.1对16.9岁，P < 0.05）。醋酸甲羟孕酮长效避孕针和口服避孕药持续使用的生存曲线有显著差异（中位使用持续时间分别为8.1个月和5.4个月），但12个月时的持续率相似（34%对32%）。选择醋酸甲羟孕酮长效避孕针的受试者再次妊娠的生存曲线与选择口服避孕药的受试者的曲线有显著差异，到15个月时再次妊娠率分别为15%和36%。产后选择口服避孕药是进入旨在预测再次妊娠的Cox回归模型的唯一变量（相对风险3.0，95%置信区间1.4，6.7）。