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Perinatal outcomes including long-term neuropsychiatric hospitalizations of offspring conceived during intrauterine contraceptive device use

  • Author Footnotes
    1 Pariente Gali and Wainstock Tamar are equal contributors to this study.
    Gali Pariente
    Correspondence
    Corresponding author. Tel.: +972 8 640 0700, +972 522899398 (cellular).
    Footnotes
    1 Pariente Gali and Wainstock Tamar are equal contributors to this study.
    Affiliations
    Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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  • Author Footnotes
    1 Pariente Gali and Wainstock Tamar are equal contributors to this study.
    Tamar Wainstock
    Footnotes
    1 Pariente Gali and Wainstock Tamar are equal contributors to this study.
    Affiliations
    Ben-Gurion University of the Negev, School of Public Health, Beer-Sheva, Israel
    Search for articles by this author
  • Eyal Sheiner
    Affiliations
    Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
    Search for articles by this author
  • Author Footnotes
    1 Pariente Gali and Wainstock Tamar are equal contributors to this study.

      Abstract

      Objective

      To investigate short-term adverse perinatal outcomes and long-term neuropsychiatric hospitalizations through 18 years of age in offspring conceived during copper intrauterine device (IUD) use.

      Study design

      We conducted a population-based cohort study comparing the pregnancy outcomes after 22 weeks of women who conceived with a copper IUD that was removed, women with a retained IUD and pregnancies without an IUD. Deliveries occurred between the years 1991 and 2014. We used a multivariable generalized estimating equation (GEE) logistic regression model analysis to control for confounders and for maternal clusters, a Kaplan–Meier survival curve to compare cumulative neuropsychiatric hospitalizations incidence and a Cox proportional-hazards model to evaluate long-term neuropsychiatric hospitalizations.

      Results

      During the study period there were 221,805 deliveries, of which 203 (0.09%) and 149 (0.06%) occurred in patients with removed or retained copper IUD, respectively. Using GEE models, preterm delivery was independently associated with copper IUD use [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.4–3.2 and OR 2.3, 95% CI 1.4–3.7 for removed and retained IUD, respectively]. We did not find an association between copper IUD presence or removal and the offspring's long-term neuropsychiatric hospitalizations (total long-term neuropsychiatric hospitalizations: 2.5%, 4.4% and 3.2% for removed, retained and no IUD, respectively, p=.71). Long-term neuropsychiatric hospitalization rate was comparable between the groups (Kaplan–Meier survival curve log rank p=.23).

      Conclusion

      Pregnancies in women who conceive with a removed or retained copper IUD are at an increased risk for short-term adverse perinatal outcomes, especially preterm delivery. For pregnancies that continued to at least 22 weeks, we found no benefit in IUD removal. However, the risk of long-term neuropsychiatric hospitalizations is not increased among offspring of these women.

      Implications

      Our data are insufficient to make a recommendation as to whether removal or retention of a copper IUD during pregnancy is best, as after 22 weeks’ gestation we have found no benefit in IUD removal. Careful surveillance and categorization of the pregnancy as “high risk” are warranted.

      Keywords

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