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Objectives
This project aimed to determine the impact of immediate postpartum long-acting reversible
contraception (LARC) IPP LARC on short-interval birth (SIB) at our institution among
publicly insured patients after a Medicaid policy change in November 2017.
Methods
State birth certificate records (BCR) for 2015–2020 (n=483,006) were obtained and
matched by SSN, date of birth, and name with hospital delivery records. SIB was defined
as a birth within 24 months of a previous birth. Between July 2018 and December 2018,
276 patients received IPP LARC (44.2% intrauterine device (IUD) and 55.8% implants);
261 patients were identified in BCR and included in this analysis.
Results
From 2018 to 2020, BCR demonstrated the SIB rate among publicly insured patients at
our institution was 24.9%. Among the 261 patients who received IPP LARC, at delivery,
88 (33.7%) were nulliparous and 173 (66.3%) were multiparous. Of the multiparous patients,
41 (23.7%) had a SIB (mean 16.5 months) preceding this delivery. Of the IPP LARC
placed, 18% were adolescents (≤ 20 years old), 17.7% were Hispanic, 88.1% were White,
10% were Black, 8.4% of women had diabetes and 15.3% had diagnosed hypertension.
Of the patients that received IPP LARC, 11 (4.2%) had a SIB (mean 18 months) identified
in the BCR by the end of 2020. Of the 11 patients who had a SIB, the majority (54.5%)
had one living child and 27.2% were ≤ 20 years old.
Conclusions
Despite the known increased risk of expulsion of IPP IUDs, SIB was significantly decreased
with IPP LARC in the population studied. More work on the impact of this policy change
is planned.
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© 2022 Published by Elsevier Inc.
