Long-acting Reversible Contraception in Women with Medical Comorbidities Open Access

Abstract

Long-acting Reversible Contraception in Women with Medical ComorbiditiesBy Lucy FuObjectiveTo evaluate how medical comorbidities, which are considered contraindications to combined hormonal (estrogen-progestin) contraception, effect continuation of long acting reversible contraception (LARC).

Methods: We described the patient population who received a LARC method at Grady Memorial Hospital. We then randomly selected a subset of patients for a retrospective chart review. Our exposure of interest was any medical comorbidity listed as category 3 or 4 in the CDC MEC. Our outcome was LARC continuation. Discontinuation included removal, expulsion, or pregnancy. We compared the proportions of patients continuing LARC at one year between exposure and non-exposure groups. We plotted Kaplan Meier Survival plots and performed Cox Proportional Hazards modelling to compare rates of continuation between exposure and non-exposure groups.

Results: From 11/01/2010 to 03/31/2014, LARC methods were inserted in 2338 patients at Grady Memorial Hospital: 1350 Implants (57.8%), 747 Mirenas (32.0%), and 239 Paragards (10.2%). In our selected cohort, there were 347 patients (45.8%) with the exposure of interest and 410 patients (54.2%) without. Continuation of LARC at one year in the exposure group was 55.0%; in the non-exposure group, 61.5%. The hazard ratio for discontinuation in one-year of LARC method comparing exposure and non-exposure groups was 1.17 (95% CI 0.99 - 1.37; p-value 0.06). The Kaplan Meier survival plots for our non-exposure and exposure groups differ significantly (Log-rank test p-value = 0.002, Wilcoxon test p-value 0.005), with the difference occurring in the first two months.

Conclusion: Our study suggests that presence of medical comorbidities does not decrease continuation of LARC at one year but that there is a decrease in the first 2 months. By contributing to the literature of contraceptive use among women with medical comorbidities, we hope our results will increase access to safe, effective contraception for this vulnerable population.

Table of Contents

LIST OF FIGURES AND TABLES. i

INTRODUCTION. 1

BACKGROUND. 3

METHODS. 6

RESULTS. 13

DISCUSSION. 16

REFERENCES. 33

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research Curriculum Program
Degree	MS
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Medicine and Surgery Health Sciences, Public Health
Keyword	comorbidity contraception LARC
Committee Chair / Thesis Advisor	Cwiak, Carrie A, Emory University
Committee Members	Shah, Amit J, Emory University Klein, Mitchel, Emory University

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