Patterns of highly effective contraception use over the postpartum period among women with pregnancy-related cardiometabolic risk conditions Open Access

Abstract

Hypertensive disorders of pregnancy (HDP) and other pregnancy-related cardiometabolic conditions are associated with an increased risk of maternal morbidity and long-term cardiovascular disease, making the postpartum period an important window for ongoing clinical management and reproductive planning. The postpartum period is a particularly important clinical window because blood pressure dysregulation may persist or worsen after delivery and the postpartum period also represents a critical time for metabolic surveillance for women with gestational diabetes. Effective contraception during this period may support pregnancy spacing while women manage ongoing cardiometabolic risk. This study examines patterns of highly effective contraception (HEC) use and associated participant characteristics at 12 weeks and 14 months postpartum among women with pregnancy-related cardiometabolic risk conditions enrolled in the Minding the Gap randomized controlled trial. HEC was defined as the current use of an intrauterine device, contraceptive implant, female sterilization, Essure, or partner vasectomy. The analytic sample included 243 participants at 12 weeks postpartum and 208 at 14 months postpartum. HEC use was reported by 39.5% of participants at 12 weeks and 41.8% at 14 months. Women with 2 or more children had higher odds of using HEC at each time point compared with nulliparous women (odds ratio (OR) 2.96, 95% confidence interval (CI) 1.55, 5.81 at 12 weeks). Women who did not want more children had higher odds of HEC use compared with those who wanted more children at both time points (OR 3.25, 95% CI 1.89, 5.70 at 12 weeks). Among the 199 participants with data at both time points, 85.0% of those using HEC at 12 weeks continued use at 14 months. Among participants not using HEC at 12 weeks, 13.4% initiated HEC by 14 months. Although the majority of participants maintained their contraceptive status between the two time points, a notable minority changed, suggesting that contraceptive use during the postpartum year is not entirely fixed. Contraceptive decision-making in this population appeared to be more closely associated with reproductive preferences such as parity and fertility intentions than with other participant characteristics examined.

Table of Contents

Abstract

Introduction

Methods

Study design and population

Outcome definition

Covariates

Statistical analysis

Results

Discussion

References

Table 1. Characteristics of the Study Population by Highly Effective Contraception Use at 12 Weeks and 14 Months Postpartum

Table 2. Distribution of reported contraceptive methods at 12-weeks and 14-months postpartum

Table 3. Unadjusted odds ratios (OR) and 95% confidence intervals (CI) for participant characteristics and highly effective contraception use at 12 weeks and 14 months postpartum

Table 4. Changes in use of highly effective contraception from 12 weeks to 14 months postpartum among participants completing both surveys

Supplemental Table 1. Change in use of highly effective contraception from 12 weeks to 14 months postpartum by intervention arm

Supplemental Table 2. Continuation and discontinuation of highly effective contraception from 12 weeks to 14 months postpartum by method, among participants using highly effective contraception at 12 weeks and completing both surveys

Figure 1. Odds Ratios and 95% Confidence Intervals for Highly Effective Contraception Use at 12 Weeks and 14 Months Postpartum by Patient Characteristics

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	highly effective contraception
Committee Chair / Thesis Advisor	Penelope Howards, Emory University

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