Timing of postpartum long acting, reversible contraception was not associated with 12-month removal rates in a large Medicaid sample.

To determine whether the timing of placement of long acting, reversible contraception (LARC) methods postpartum (immediate postpartum (IPP) or interval (within 6 months postpartum) is associated with higher removal rates by 12 months postpartum. We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data (n = 313,849) from Oregon and South Carolina from January 1, 2010 to December 31, 2018. Our primary outcome was LARC (intrauterine device (IUD) or implant) removal by 12 months postpartum. We compared crude proportions and rates of removal and used a multivariable survival analysis to compare removal over 12 months between IPP and interval LARC placement controlling for sociodemographic and clinical factors and clustered at the woman level. Our sample included 313,849 births to 247,884 women; a majority did not receive any postpartum contraception (207,058 [66.0%]). Out of the 54,018 (17.2%) of births followed by an immediate postpartum or interval LARC placement, 11.8% discontinued by 12 months. In multivariable analyses, births followed by IPP LARC were 10% more likely to experience discontinuation at any point up to 12 months compared with interval LARC (HR: 1.10, 95% CI: 1.00-1.22), but this was not statistically significant. IPP LARC devices are removed at similar rates as LARC placed within 6 months postpartum. Timing of postpartum long acting reversible contraception- interval or immediately postpartum- was not associated with 12 month removal rates.

Rodriguez MI ，Skye M ，Samandari G ，Darney BG ... -  《-》

Examining the association between short interpregnancy interval births and the type and timing of postpartum long acting reversible contraception.

To determine whether the type (intrauterine device or implant) or timing (immediately postpartum vs interval) of postpartum long-acting reversible contraception was associated with a reduction in short interpregnancy interval births. We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data from Oregon and South Carolina, 2010 to 2018. Our primary outcome was short interpregnancy interval, defined as repeat pregnancy within 18 months of the index delivery. We determined postpartum contraceptive method and timing of receipt. To assess the association of timing of long acting reversible contraception with short interpregnancy interval, we calculated adjusted probabilities from a logistic regression model incorporating covariate balanced propensity score weights, sociodemographic factors, and clustered at the woman-level. Our study sample included 121,422 births to 97,084 individuals who had more than 1 birth during the study period; 41% had a short interpregnancy interval. A majority of individuals had not received any contraception by 6 months postpartum (68.6%). Overall, 15,477 individuals used long acting reversible contraception postpartum, with the majority receiving interval rather than immediate postpartum long acting reversible contraception (92.9% vs 7.1%). In multivariable analyses, both immediate postpartum (23.0%, 95% CI: 20.5%-25.8%) and interval long acting reversible contraception (15.2%, 95% CI: 14.4%-16.1%) are associated with a lower probability of short interpregnancy interval than short acting methods (42.1%, 95% CI: 41.2%-43.0%). Compared to short-acting methods, receipt of both immediate postpartum and interval long-acting reversible contraception is associated with lower probabilities of a subsequent short interpregnancy interval. All long acting, reversible contraception, whether placed immediately postpartum or on an interval basis, was associated with a significantly lower probability of a short interpregnancy interval than short acting or no contraceptive method.

Rodriguez MI ，Skye M ，Ramanadhan S ，Schrote K ，Darney BG ... -  《-》

Postpartum LARC discontinuation and short interval pregnancies among women with HIV: a retrospective 9-year cohort study in South Carolina.

To evaluate rates of discontinuation and short interval pregnancy among women with HIV who received a postpartum IUD or implant. We conducted a retrospective cohort study of women who had an IUD or implant placed within 3 months postpartum during a 9-year period (1/1/09 to 2/14/18). We assessed the prevalence of discontinuation within 12 months and rates of subsequent delivery within 18 months. We examined differences in these outcomes between women with and without HIV. Of the 794 women who received a long-acting reversible contraception (LARC) within 3 months postpartum, most chose an IUD (85%). Twenty-one percent (165) elected for immediate postpartum placement: 119 IUDs and 46 implants. Women with HIV were more likely to receive an implant (48% vs 13%, p<.0001) and were more likely to have immediate postpartum placement (76% vs 17%, p<.0001). Women with HIV (n=50) were not more likely to remove LARC devices within 12 months of placement (38% vs 36%, p=.9), and they did not experience any short interval pregnancies. Women with HIV in South Carolina were more likely than HIV-negative women to receive immediate postpartum LARC and to receive an implant. They were not more likely to discontinue LARC within 12 months nor experience short interval pregnancies. Further study is needed to evaluate preferences for implants and immediate postpartum insertion among women with HIV.

Lazenby G ，Francis E ，Brzozowski N ，Rucker L ，Dempsey A ... -  《-》

Decomposition analysis of racial and ethnic differences in receipt of immediate postpartum, long-acting, reversible, and permanent contraception.

This study aimed to determine the factors contributing to racial and ethnic disparities in the use of immediate postpartum, long-acting reversible contraception (IPP LARC) and permanent contraception among Medicaid recipients. We conducted a cross-sectional study using 3 years of national Medicaid claims data to examine the rates of IPP LARC use alone and a composite measure of postpartum permanent contraception and IPP LARC within 7 days of delivery by race and ethnicity. We used a Blinder-Oaxaca model to quantify the extent to which medical complexity, age, rurality, mode of delivery, and year explained differences in outcomes among different minoritized groups in comparison to non-Hispanic White women. Our study sample contained 1,729,663 deliveries occurring from 2016 through 2018 among 1,605,199 people living in 16 states. IPP LARC use rates were highest among Black (2.2%), followed by American Indian and Alaska Native at 2.1% and Hawaiian/Pacific Islander beneficiaries at 1.9%, Hispanic (all races) at 1.2%, and Asian at 1.0%. IPP LARC was lowest among White beneficiaries (0.8%). Medical complexity, age, rurality, year, and mode of delivery explained only 12.3% of the difference in IPP LARC rates between Black and White beneficiaries. Postpartum permanent contraception was highest among White (7.6%), Hispanic (7.2%), and American Indian and Alaska Native (6.8%), followed by Black (6.3%), Hawaiian/Pacific Islander (5.1%) and lowest among Asian women (4.1%). When we examined the use of IPP LARC or postpartum permanent contraception together, these same factors explained 94.4% of the differences between Black and White beneficiaries. While differences in the use of IPP LARC by race and ethnicity were identified, our findings suggest that overall use of inpatient highly effective contraception are similar across racial and ethnic groups. When IPP LARC and postpartum permanent contraception are examined jointly, their use is similar across racial and ethnic groups.

Rodriguez MI ，Meath THA ，Watson K ，Daly A ，McConnell KJ ，Kim H ... -  《-》

Associations between immediate postpartum long-acting reversible contraception and short interpregnancy intervals.

We aimed to evaluate the rates of short interpregnancy interval pregnancies and deliveries among women who receive immediate postpartum LARC. We conducted a retrospective cohort study of all women who delivered at Montefiore Medical Center between January 2015 and June 2016 (N = 9561). In this cohort, we identified all repeat deliveries and pregnancies within 18 months of the initial delivery. Using logistic regression models, we compared rates of short interpregnancy interval delivery and pregnancy among recipients of an immediate postpartum IUD, immediate postpartum implant, and no immediate postpartum LARC, adjusting for covariates including patient age, mode of delivery, socioeconomic status, and race. In our cohort, 12.9% of patients received immediate postpartum LARC. The rates of short interpregnancy interval delivery were 3.3% (N = 259/7833) among patients who did not receive immediate postpartum LARC, 1% (N = 6/595) among immediate postpartum IUD recipients, and 0.4% (N = 2/562) among immediate postpartum implant recipients. The rates of short interpregnancy interval pregnancy were 13.8% (N = 1082/7833) among patients who did not receive immediate postpartum LARC, 7.4% (N = 44/595) among immediate postpartum IUD recipients, and 5.2% (N = 29/562) among immediate postpartum implant recipients. Both recipients of immediate postpartum IUDs and immediate postpartum implants had lower rates of short interpregnancy interval delivery and pregnancy compared to patients who did not receive immediate postpartum LARC. This study confirms that women who received immediate postpartum IUDs and implants have lower rates of short interpregnancy interval pregnancies. Making immediate postpartum LARC widely available is a promising public health approach to help women achieve a longer interpregnancy interval.

Wu M ，Eisenberg R ，Negassa A ，Levi E ... -  《-》