Original research article| Volume 93, ISSUE 2, P178-183, February 2016

Twelve-month contraceptive continuation and repeat pregnancy among young mothers choosing postdelivery contraceptive implants or postplacental intrauterine devices



      To compare discontinuation rates and incidence of repeat pregnancy within 1 year among young mothers choosing postplacental intrauterine devices (IUDs) versus postpartum contraceptive implants.

      Study Design

      We enrolled a prospective cohort of postpartum adolescents and young women who chose either postplacental IUDs or postpartum contraceptive implants prior to hospital discharge. We used chart review and phone interviews to assess device discontinuation (by request or expulsion) and pregnancy within 12 months.


      Of the 244 13–22 year-old participants, 82 chose IUDs (74 levonorgestrel IUDs and 8 copper IUDs), and 162 chose implants. Both groups had participant-requested discontinuation rates of 14% (9/67 IUD; 19/135 implant) within 1 year. Participants choosing IUDs had a 25% (17/67) expulsion rate. Median time to expulsion was 4.1 weeks (range: 0.4–29.3 weeks, 16/17 within 12 weeks), and participants recognized 15/17 expulsions. IUD initiators had significantly higher pregnancy rates by 12 months (7.6% vs. 1.5%, p=0.04). Most pregnancies occurred when women discontinued their initial device and did not start alternative contraception.


      Participant-requested discontinuation was similar in both groups. Differences in overall device discontinuation rates were due to IUD expulsions. Pregnancy rates by 12 months postpartum were lower than previously reported in this age group in both implant initiators and IUD initiators.


      Young mothers who choose postplacental IUDs or postpartum contraceptive implants are unlikely to request removal within the first year. Clinicians should counsel postplacental IUD users that early expulsion is common (25%) and may be unrecognized (11% of expulsions). Patients should have a plan for contraceptive management should expulsion occur.


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      1. Healthy People 2020: adolescent health.
        (Available at) ([Retrieved September 23,2015])
        • Finer L.B.
        • Zolna M.R.
        Unintended pregnancy in the United States: incidence and disparities, 2006.
        Contraception. 2011; 84: 478-485
        • Lewis L.N.
        • Doherty D.A.
        • Hickey M.
        • Skinner S.R.
        Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy.
        Contraception. 2010; 81: 421-426
        • Han L.
        • Teal SB Sheeder J.
        • Tocce K.
        Preventing repeat pregnancy in adolescents: is immediate postpartum insertion of the contraceptive implant cost effective?.
        Am J Obstet Gynecol. 2014; 211 (e1-7 [24])
        • Baldwin M.K.
        • Edelman A.B.
        The effect of long-acting reversible contraception on rapid repeat pregnancy in adolescents: a review.
        J Adolesc Health. 2013; 52: S47-S53
        • Smith G.C.
        • Pell J.P.
        Teenage pregnancy and risk of adverse perinatal outcomes associated with first and second births: population based retrospective cohort study.
        BMJ. 2001; 323: 476-479
        • Chen X.K.
        • Wen S.W.
        • Fleming N.
        • Demissie K.
        • Rhoads G.G.
        • Walker M.
        Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study.
        Int J Epidemiol. 2007; 36: 368-373
        • Klein J.D.
        Adolescent pregnancy: current trends and issues.
        Pediatrics. 2005; 116: 281-286
        • Nerlander L.M.
        • Callaghan W.M.
        • Smith R.A.
        • Barfield W.D.
        Short interpregnancy interval associated with preterm birth in U S adolescents.
        Matern Child Health J. 2015; 19: 850-858
        • Khashan A.S.
        • Baker P.N.
        • Kenny L.C.
        Preterm birth and reduced birthweight in first and second teenage pregnancies: a register-based cohort study.
        BMC Pregnancy Childbirth. 2010; 10: 36
        • Ruedinger E.
        • Cox J.E.
        Adolescent childbearing: consequences and interventions.
        Curr Opin Pediatr. 2012; 24: 446-452
        • Polit D.F.
        • Kahn J.R.
        Early subsequent pregnancy among economically disadvantaged teenage mothers.
        Am J Public Health. 1986; 76: 167-171
      2. Counting it up: the public costs of teen childbearing: key data.
        (Available at) ([Retrieved September 19,2015])
        • Gavin L.
        • Warner L.
        • O'Neil M.E.
        • Duong L.
        • Marshall C.
        • Hastings P.
        • et al.
        Vital signs: repeat births among teens - United States, 2007-2010.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 249-255
        • Conde-Agudelo A.
        • Rosas-Bermudez A.
        • Kafury-Goeta A.C.
        Birth spacing and risk of adverse perinatal outcomes: a meta-analysis.
        JAMA. 2006; 295: 1809-1823
        • Conde-Agudelo A.
        • Rosas-Bermudez A.
        • Kafury-Goeta A.C.
        Effects of birth spacing on maternal health: a systematic review.
        Am J Obstet Gynecol. 2007; 196: 297-308
        • Tocce K.M.
        • Sheeder J.L.
        • Teal S.B.
        Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?.
        Am J Obstet Gynecol. 2012; 206 ([481]): e1-e7
        • Damle L.F.
        • Gohari A.C.
        • McEvoy A.K.
        • Desale S.Y.
        • Gomez-Lobo V.
        Early initiation of postpartum contraception: does it decrease rapid repeat pregnancy in adolescents?.
        J Pediatr Adolesc Gynecol. 2015; 28: 57-62
        • Mestad R.
        • Secura G.
        • Allsworth J.E.
        • Madden T.
        • Zhao Q.
        • Peipert J.F.
        Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project.
        Contraception. 2011; 84: 493-498
        • Tocce K.
        • Sheeder J.
        • Python J.
        • Teal S.B.
        Long acting reversible contraception in postpartum adolescents: early initiation of etonogestrel implant is superior to IUDs in the outpatient setting.
        J Pediatr Adolesc Gynecol. 2012; 25: 59-63
        • Sheeder J.
        • Scott S.
        • Stevens-Simon C.
        The electronic report on adolescent pregnancy (ERAP).
        J Pediatr Adolesc Gynecol. 2004; 17: 341-346
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gotzsche P.C.
        • Vandenbroucke J.P.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.
        Int J Surg. 2014; 12: 1495-1499
        • Wilson S.
        • Tennant C.
        • Sammel M.D.
        • Schreiber C.
        Immediate postpartum etonogestrel implant: a contraception option with long-term continuation.
        Contraception. 2014; 90: 259-264
        • Rosenstock J.R.
        • Peipert J.F.
        • Madden T.
        • Zhao Q.
        • Secura G.M.
        Continuation of reversible contraception in teenagers and young women.
        Obstet Gynecol. 2012; 120: 1298-1305
        • Chen B.A.
        • Reeves M.F.
        • Hayes J.L.
        • Hohmann H.L.
        • Perriera L.K.
        • Creinin M.D.
        Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial.
        Obstet Gynecol. 2010; 116: 1079-1087
        • Jatlaoui T.C.
        • Marcus M.
        • Jamieson D.J.
        • Goedken P.
        • Cwiak C.
        Postplacental intrauterine device insertion at a teaching hospital.
        Contraception. 2014; 89: 528-533
        • Sucak A.
        • Ozcan S.
        • Celen S.
        • Caglar T.
        • Goksu G.
        • Danisman N.
        Immediate postplacental insertion of a copper intrauterine device: a pilot study to evaluate expulsion rate by mode of delivery.
        BMC Pregnancy Childbirth. 2015; 15: 202
        • Madden T.
        • McNicholas C.
        • Zhao Q.
        • Secura G.M.
        • Eisenberg D.L.
        • Peipert J.F.
        Association of age and parity with intrauterine device expulsion.
        Obstet Gynecol. 2014; 124: 718-726
        • Stevens-Simon C.
        • Kelly L.
        • Kulick R.
        A village would be nice but…it takes a long-acting contraceptive to prevent repeat adolescent pregnancies.
        Am J Prev Med. 2001; 21: 60-65
        • Thurman A.R.
        • Hammond N.
        • Brown H.E.
        • Roddy M.E.
        Preventing repeat teen pregnancy: postpartum depot medroxyprogesterone acetate, oral contraceptive pills, or the patch?.
        J Pediatr Adolesc Gynecol. 2007; 20: 61-65