Advertisement
Original Study| Volume 28, ISSUE 1, P57-62, February 2015

Download started.

Ok

Early Initiation of Postpartum Contraception: Does It Decrease Rapid Repeat Pregnancy in Adolescents?

      Abstract

      Study Objective

      Rapid repeat adolescent pregnancy is a significant public health concern. An effective and practical means of decreasing unintended second adolescent pregnancies needs to be identified. The objective of this study is to determine if early initiation of contraception, and in particular long acting reversible contraception (LARC), decreases rapid repeat pregnancy among first time adolescent mothers.

      Design

      Retrospective cohort study.

      Setting

      Urban teaching hospital.

      Participants

      340 first-time adolescent mothers age ≤ 19.

      Interventions

      None, study was retrospective.

      Main Outcome Measures

      Repeat pregnancy within 2 years.

      Results

      340 first time adolescent mothers with a documented follow-up time of 2 years had a repeat pregnancy rate of 35%. Average time from delivery to repeat pregnancy was 9.9 ± 6.4 months. Logistic regression analysis comparing adolescents with and without repeat pregnancy revealed that leaving the hospital postpartum without initiating any contraception was associated with significant increase risk of repeat pregnancy (OR = 2.447, 95% CI 1.326-4.515). Follow-up within 8 weeks postpartum was associated with lower chance of repeat pregnancy (OR = 0.322, 95% CI 0.172-0.603). Initiation of a LARC method (either an intrauterine device or etonogestrel subdermal implant) by 8 weeks postpartum was also associated with decreased chance of rapid repeat pregnancy (OR = 0.118, 95% CI 0.035-0.397).

      Conclusion

      Adolescent mothers who initiate a LARC method within 8 weeks of delivery are less likely to have a repeat pregnancy within 2 years than those who choose other methods or no method. First time adolescent mothers should be counseled about this advantage of using LARC.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention
        Vital signs: Teen pregnancy–United States, 1991-2009.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 414
        • Richio L.
        • Phipps M.G.
        • Raker C.A.
        Repeat teen birth: does delivery mode make a difference?.
        Am J Obstet Gynecol. 2010; 203: 453.e1
        • Centers for Disease Control and Prevention
        Vital signs: Repeat births among teens - United States, 2007-2010.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 249
      1. Klerman L: Another Chance: Preventing Additional Births to Teen Mothers. National Campaign to Prevent Teen Pregnancy, Washington, DC; May, 2004. Available: https://thenationalcampaign.org/sites/default/files/resource-primary-download/anotherchance_final.pdf. Accessed 19 March, 2014

      2. Counting It Up: The Public Costs of Teen Childbearing: Key Data. National Campaign to Prevent Teen Pregnancy, Washington, DC; December, 2013. Available: http://thenationalcampaign.org/sites/default/files/resource-primary-download/counting-it-up-key-data-2013-update.pdf. Accessed 19 March, 2014.

        • Martin J.
        • Hamilton B.
        • Ventura S.
        • et al.
        Births: final data for 2010.
        Natl Vital Stat Rep. 2012; 61: 1
      3. National Center for Health Statistics. Natality public use file. Hyattsville, MD: National Center for Health Statistics. Available: http://wonder.cdc.gov/natality.html. Accessed 19 March, 2014.

        • Stevens-Simon C.
        • Kelly L.
        • Singer D.
        Preventing repeat adolescent pregnancies with early adoption of the contraceptive implant.
        Fam Plann Perspect. 1999; 31: 88
        • Stevens-Simon C.
        • Kelly L.
        • Kulick R.
        A village would be nice but… it takes a long-active contraceptive to prevent rapid repeat adolescent pregnancies.
        Am J Prev Med. 2001; 21: 60
        • Lewis L.N.
        • Doherty D.A.
        • Hickey M.
        • et al.
        Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy.
        Contraception. 2010; 81: 421
        • Berenson A.
        • Wiemann C.
        Contraceptive use among adolescent mothers at 6 months postpartum.
        Obstet Gynecol. 1997; 89: 999
        • Martinez G.
        • Copen C.E.
        • Abma J.
        Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 national survey of family growth.
        Vital Health Stat. 2011; 23: 1
        • Kost K.
        • Singh S.
        • Vaughan B.
        • et al.
        Estimates of contraceptive failure from the 2002 National Survey of Family Growth.
        Contraception. 2008; 77: 10
        • Woods J.L.
        • Shew M.L.
        • Tu W.
        • et al.
        Patterns of oral contraceptive pill-taking and condom use among adolescent contraceptive pill users.
        J Adolesc Health. 2006; 39: 381
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • et al.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 2012; 366: 1998
        • Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, The American College of Obstetricians and Gynecologists
        Committee Opinion no. 539: Adolescents and long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2012; 120: 983
        • Rosenstock J.R.
        • Peipert J.F.
        • Maddlen T.
        • et al.
        Continuation of reversible contraception in teenagers and young women.
        Obstet Gynecol. 2012; 120: 1298
        • Patchen L.
        • Letourneau K.
        • Berggren E.
        Evaluation of an integrated services program to prevent subsequent pregnancy and birth among urban teen mothers.
        Soc Work Health Care. 2013; 52: 642
        • Kost K.
        • Henshaw S.
        U.S. Teenage Pregnancies, Births and Abortions,: State Trends by Age, Race and Ethnicity.
        Guttmacher Institute, New York2008 (Available: http://www.guttmacher.org/pubs/USTPtrendsState08.pdf. Accessed 19 March, 2014)
        • Wilson E.K.
        • Fowler C.I.
        • Koo H.P.
        Postpartum contraceptive use among mothers in seven states.
        J Adolesc Health. 2012; 52: 278
        • Finer L.B.
        • Jerman J.
        • Kavanaugh M.L.
        Changes in use of long-acting contraceptive methods in the United States, 2007-2009.
        Fertil Steril. 2012; 98: 893
        • Tocce K.M.
        • Sheeder J.L.
        • Teal S.B.
        Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?.
        Am J Obstet Gynecol. 2012; 206: 481.e1
        • Tocce K.
        • Sheeder J.
        • Python J.
        • et al.
        Long acting reversible contraception in postpartum adolescents: early initiation of etonogestrel implant is superior to IUDs in the outpatient setting.
        J Pediatr Adolesc Gynecol. 2012; 25: 59