Abstract
Objectives
Pregnancies conceived after a short interpregnancy interval (IPI), within 18 months
of delivery, and unintended pregnancies are both associated with health risks. We
studied risk factors for conception after a short IPI among postpartum women who plan
long-acting reversible contraception (LARC).
Study design
A retrospective review of a cohort of women who delivered at University of Illinois
Hospital from 2005 to 2010 and were discharged with a plan for interval LARC was performed.
Outcomes were (1) attendance at a postpartum visit (PPV), (2) LARC placement (3) and
conception after a short IPI. We compared variables using chi-squared test, Student's
t tests and multivariable logistic regression.
Results
Of 3548 women, 62.0% attended a PPV, 36.5% received LARC and 11.4% conceived after
a short IPI. After logistic regression, women who were multiparous [odds ratio (OR)
0.77, 95% confidence interval (CI) 0.65–0.91] or chose a temporary contraceptive “bridge”
to LARC (OR 0.74, 95% CI 0.58–0.94) were less likely to attend their PPV. Women who
missed their PPV (OR 0.06, 95% CI 0.05–0.08) or chose a bridge (OR 0.66, 95% CI 0.50–0.88)
were less likely to receive LARC. Finally, women who did not receive LARC (OR 4.8,
95% CI 3.50–6.70), were multiparous (OR 1.69, 95% CI 1.32–2.15) or teenaged (OR 2.12,
95% CI 1.61–2.79) were more likely to conceive after a short IPI.
Conclusions
Women who receive postpartum LARC are less likely to become pregnant after a short
IPI. Missing the PPV, multiparity and plan for a contraceptive bridge may all contribute
to a patient not receiving planned LARC.
Implications
Efforts to decrease unintended pregnancy after a short IPI should focus on decreasing
barriers to planned postpartum LARC. Provision of temporary bridge contraception until
interval LARC may not mitigate the significant barriers associated with interval postpartum
placement protocols.
Keywords
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Article info
Publication history
Published online: August 30, 2016
Accepted:
August 24,
2016
Received in revised form:
August 24,
2016
Received:
March 16,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
