MIAMI BEACH – Physician champions can spur the adoption of long-acting reversible contraception post partum among teenaged mothers, a study has shown.
Researchers at the Medical University of South Carolina in Charleston assessed the records of 720 adolescents aged 13-19 years who received prenatal care at their institution and were delivered of a viable baby between December 2005 and May 2010.
Dr. Ashlyn H. Savage
Dr. Ashlyn H. Savage and her associates found that if an adolescent mother had a documented postpartum contraception plan in her prenatal record, she was more likely to receive long-acting reversible contraception (LARC) at her 6-week postpartum visit (odds ratio, 3.7), compared with those without such a plan.
An estimated 15%-30% of adolescent mothers become pregnant again within 1 year of delivery, and LARC is one of the best strategies to reduce this risk, Dr. Savage said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
"Early on [in the study] almost no teenagers had a documented plan prenatally for postpartum pregnancy prevention," she said.
Dr. Savage suggested that physician champions are responsible, at least in part, for a significant increase in prenatal documentation for any form of postpartum contraception. Such written plans in the prenatal records increased 13.5-fold between 2006 and 2009.
"At our institution, in the last few years we’ve had an influx of new faculty members, including a family planning specialist. The three of us are physician champions of long-acting reversible contraception in adolescents," said Dr. Savage of the department of obstetrics and gynecology at the university.
LARC use increased 3 years after the physician champions joined the staff, with an odds ratio of 5.2 for 2009 vs. 2006.
She and her colleagues plan to continue emphasizing the importance of prenatal plans for postpartum contraception based on these findings, Dr. Savage said. In addition, because 293 (41%) of 720 adolescent mothers did not return for a postpartum visit, "we are now studying implantation [of LARC] in the hospital before they leave."
Of the 427 teenaged mothers who did return at 6 weeks post partum, 66 (15%) obtained LARC at this visit. LARC was either an intrauterine device or an etonogestrel hormonal implant (Implanon, Organon). Another 218 patients (51%) were using medroxyprogesterone (Depo-Provera) as contraception; 101 (24%) selected a combination hormonal contraceptive; and 21 (5%) chose a barrier method. A total of 21 adolescent mothers (5%) chose no form of contraception.
Race was associated with the likelihood of receiving LARC at 6 weeks. "African American and Hispanic girls had the highest risks of repeat teen pregnancy. Unfortunately, they were also the least likely to use LARC," Dr. Savage said. Compared with white adolescents, for example, the odds ratio for postpartum LARC use at 6 weeks was 0.48 for African American teenagers and 0.15 for Hispanic teens. She and her colleagues plan to focus more effort on encouraging LARC use among African American and Hispanic adolescent mothers.
Age, parity, marital status, and funding for contraception did not predict LARC use in the study.
Dr. Savage said she had no relevant financial disclosures.