Date of this Version
Robbins CL, Farr SL, Zapata LB, et al. Postpartum contraceptive use among women with a recent preterm birth. Am J Obstet Gynecol 2015;213:508.e1-9.
OBJECTIVE: The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth.
STUDY DESIGN: Population-based data from the Pregnancy Risk Assessment Monitoring System in 9 states were used to estimate the postpartum use of highly or moderately effective contraception (sterilization, intrauterine device, implants, shots, pills, patch, and ring) and user-independent contraception (sterilization, implants, and intrauterine device) among women with recent live births (2009-2011). We assessed the differences in contraception by gestational age (<27, 28-33, or 34-36 weeks vs term [>37 weeks]) and modeled the associations using multivariable logistic regression with weighted data.
RESULTS: A higher percentage of women with recent extreme preterm
birth (<27 weeks) reported using no postpartum method (31%)
compared with all other women (15-16%). Women delivering
extreme preterm infants had a decreased odds of using highly or
moderately effective methods (adjusted odds ratio, 0.5; 95% confidence
interval, 0.4-0.6) and user-independent methods (adjusted
odds ratio, 0.5; 95% confidence interval, 0.4-0.7) compared with
women having term births. Wanting to get pregnant was more
frequently reported as a reason for contraceptive nonuse by women
with an extreme preterm birth overall (45%) compared with all other
women (15-18%, P < .0001). Infant death occurred in 41% of
extreme preterm births and more than half of these mothers (54%)
reported wanting to become pregnant as the reason for contraceptive
CONCLUSION: During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant.