Abstract
Objective
To evaluate the effect of high-risk pregnancy status on antepartum contraceptive planning
and postpartum use.
Methods
We performed a retrospective cohort study of women delivering at a university hospital
during 2009–2010 who received prenatal care in the faculty or resident clinics. We
defined high-risk status by Society for Maternal-Fetal Medicine guidelines. We abstracted
contraceptive planning and postpartum administration from medical records and categorized
these into World Health Organization tiers of contraceptive effectiveness. We identified
subsequent pregnancies through March 2013. Chi-squared tests and binary logistic regression
were used to assess correlations between risk status and contraceptive choice, actual
postpartum use, and subsequent pregnancy.
Results
This study included 2048 low-risk and 1015 high-risk parturients. The index pregnancy
was more likely to be unintended among low-risk than high-risk women (48.4% vs. 42.9%,
p=.02). Low-risk and high-risk women showed interest in Tier 1 contraceptives while
antepartum (54.4% low-risk vs. 58.0% high-risk, p=.2), with lower interest at discharge (42.3% vs. 50.7%, p<.001) and at the postpartum visit (33.8% vs. 40.1%, p=.002). Just 776 women (25.3%) actually received a Tier 1 method. 656 women (21.4%)
had a subsequent pregnancy lasting more than 20 weeks. Unintended pregnancy rates did not differ between low (36.6%) and high-risk
(32.4%) women (p=.38).
Conclusion
High-risk women had similar rates of planning for Tier 1 contraceptives but similar
rates of subsequent unplanned pregnancy. Intention to use highly effective contraception
did not translate into actual use. Further work is needed to identify barriers to
uptake.
Implications
Identification of barriers to uptake of highly effective contraceptive methods after
high-risk pregnancy represents an important area for future research. Providers should
continue to address postpartum contraception throughout pregnancy and be prepared
to address barriers to such methods in the postpartum period.
Keywords
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Article info
Publication history
Published online: April 15, 2016
Accepted:
April 10,
2016
Received in revised form:
April 4,
2016
Received:
November 16,
2015
Footnotes
☆The authors have no conflicts of interest to disclose with respect to this work. This study was unfunded.
☆☆Presented in part as a poster at the American Congress of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, San Francisco, CA. May 2–5, 2015.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
