The effects of offering immediate postpartum placement of IUDs and implants to pregnant patients with heart disease

Rachel G Sinkey; Christina T Blanchard; Julia Maier; Alexia Novara; Sara E Mazzoni; Alice R Goepfert; Margaret Boozer; Indranee Rajapreyar; Marc Cribbs; Jeff M Szychowski; Alan T N Tita

doi:10.1016/j.contraception.2021.09.005

The effects of offering immediate postpartum placement of IUDs and implants to pregnant patients with heart disease

Contraception. 2022 Jan:105:55-60. doi: 10.1016/j.contraception.2021.09.005. Epub 2021 Sep 14.

Authors

Affiliations

¹ Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States; Center for Women's Reproductive Health, Birmingham, AL, United States. Electronic address: rsinkey@uabmc.edu.
² Center for Women's Reproductive Health, Birmingham, AL, United States.
³ Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States; Center for Women's Reproductive Health, Birmingham, AL, United States.
⁴ Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States.
⁵ Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, AL, United States.
⁶ Center for Women's Reproductive Health, Birmingham, AL, United States; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States.

PMID: 34529951
DOI: 10.1016/j.contraception.2021.09.005

Abstract

Objective: To evaluate the effects of offering immediate postpartum long-acting reversible contraception to pregnant patients with heart disease.

Study design: Retrospective cohort of pregnant patients with cardiac disease managed by a Comprehensive Pregnancy & Heart Program. Patients were divided into 2 cohorts: pre-immediate postpartum LARC Program implementation (March 2015 to January 2017) and post-implementation (February 2017 to June 2019). The primary outcome was LARC (intrauterine device [IUD] or etonogestrel implant) use postpartum, defined as LARC either immediately postpartum or at the postpartum visit. Secondary outcomes included contraception intent at delivery and IUD expulsion rate of IUDs placed immediately postpartum.

Results: Of 159 included patients, 96 (60%) delivered during the post-implementation period. LARC use tripled after program implementation, 11% vs 35%, p < 0.01. Specifically, immediate postpartum IUD use increased from 1 (1.6%) to 10 (10.4%), p = 0.05, and use of immediate postpartum implant increased from 0 to 14 (14.6%), p = 0.002. Rates of women without contraception plans at delivery decreased from 32% to 14%, p < 0.01, as did the number of women using medroxyprogesterone acetate: 16% vs 4%, p = 0.01. Tubal ligation rates were not different before and after program implementation: 24% and 29%, p = 0.46. Postpartum visit rates were similar between Pre and Post groups: 70% and 72%, p = 0.78, respectively. One immediate postpartum IUD expulsion occurred.

Conclusion: LARC use tripled in pregnant patients in an obstetric heart disease program after implementation of an immediate postpartum LARC Program. Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality.

Implications: Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease - as well as all people with high-risk health conditions - to reduce their disproportionate burden of maternal morbidity and mortality.

Keywords: Contraception; Heart disease; Immediate postpartum long-acting reversible contraception; Maternal morbidity; Maternal mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Contraception
Female
Heart Diseases*
Humans
Intrauterine Devices*
Long-Acting Reversible Contraception*
Postpartum Period
Pregnancy
Retrospective Studies