Does reversible postpartum contraception reduce the risk of pregnancy condition recurrence? A longitudinal claims-based study from Maine.

Autor: Ahrens KA; Associate Research Professor, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA. Electronic address: katherine.ahrens@maine.edu., Palmsten K; Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, MN, USA., Lipkind HS; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York City, NY, USA., Ackerman-Banks CM; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston TX, USA., Grantham CO; Associate Research Professor, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA.
Jazyk: angličtina
Zdroj: Annals of epidemiology [Ann Epidemiol] 2024 Aug; Vol. 96, pp. 58-65. Date of Electronic Publication: 2024 Jun 15.
DOI: 10.1016/j.annepidem.2024.06.001
Abstrakt: Purpose: To estimate the effect of reversible postpartum contraception use on the risk of recurrent pregnancy condition in the subsequent pregnancy and if this effect was mediated through lengthening the interpregnancy interval (IPI).
Methods: We used data from the Maine Health Data Organization's Maine All Payer Claims dataset. Our study population was Maine women with a livebirth index pregnancy between 2007 and 2019 that was followed by a subsequent pregnancy starting within 60 months of index pregnancy delivery. We examined recurrence of three pregnancy conditions, separately, in groups that were not mutually exclusive: prenatal depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes (GDM). Effective reversible postpartum contraception use was defined as any intrauterine device, implant, or moderately effective method (pills, patch, ring, injectable) initiated within 60 days of delivery. Short IPI was defined as ≤ 12 months. We used log-binomial regression models to estimate risk ratios and 95 % confidence intervals, adjusting for potential confounders.
Results: Approximately 41 % (11,448/28,056) of women initiated reversible contraception within 60 days of delivery, the prevalence of short IPI was 26 %, and the risk of pregnancy condition recurrence ranged from 38 % for HDP to 55 % for prenatal depression. Reversible contraception initiation within 60 days of delivery was not associated with recurrence of the pregnancy condition in the subsequent pregnancy (aRR ranged from 0.97 to 1.00); however, it was associated with lower risk of short IPI (aRR ranged from 0.67 to 0.74).
Conclusion(s): Although initiation of postpartum reversible contraception within 60 days of delivery lengthens the IPI, our findings suggest that it does not reduce the risk of prenatal depression, HDP, or GDM recurrence. This indicates a missed opportunity for providing evidence-based healthcare and health interventions in the intrapartum period to reduce the risk of recurrence.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Katherine Ahrens, Kristin Palmsten, and Heather Lipkind reports financial support was provided by National Institutes of Health. Kristin Palmsten has research contracts from AbbVie, GSK, Sanofi, and Pfizer. Heather Lipkind is on the Data Safety Monitoring Board for Pfizer COVID-19 vaccination and is contracted by the Vaccine Safety Datalink for post vaccine surveillance in pregnancy and the post-partum period. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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