Title : Immediate postpartum long-acting reversible contraception use and short-interval pregnancy, a community hospital perspective
Abstract:
Introduction: Short-interval pregnancy (SIP) is defined as an interval of fewer than 18 months between delivery and subsequent conception. It is associated with adverse maternal and fetal outcomes, and significant nationwide costs. Placement of long-acting reversible contraceptive (LARC) devices immediately postpartum (IPP) is safe, convenient, effective, and associated with a lower probability of SIP when compared to use of less effective methods. As a result, PP LARC has been supported by The American College of Obstetricians and Gynecologists (ACOG) as best practice, with the organization calling for health systems to make institutional changes to support its provision. In 2017, Connecticut (CT) Medicaid expanded coverage to reimburse IPP LARC. In March 2020, Stamford Hospital (SH) began providing IPP LARC to patients with Medicaid with the creation of the Division of Family Planning within the Department of OB/GYN. The primary objective of this study is to assess SIP rate between those receiving and not receiving an IPP LARC since the implementation of this institutional change.
Methods: Retrospective chart review was performed among patients with Medicaid who delivered at SH between March 2020 - March 2023 and received their prenatal care at Optimus Clinic, SH's federally-qualified health clinic. Cohorts were defined as “IPP LARC” (Copper-IUD, Levonorgestrel-IUD, or Etonogestrel subdermal implant before hospital discharge) and “No IPP LARC” (no contraception, short-acting reversible contraception initiated prior to hospital discharge or within 12 weeks of delivery, or LARC initiated after hospital discharge). Data on demographics, pregnancy and delivery characteristics and complications, and contraceptive method chosen with timing of initiation was collected. Primary outcome is new documented pregnancy within 18 months of delivery. Secondary outcomes include PP visit attendance rate within 12 weeks, rate of contraception continuation versus method change at 6 & 12 weeks and 12 & 18 months, and rate of IUD expulsion and replacement. Statistical significance is defined as p<0.05.
Results: This IRB-approved study has completed data collection with a sample size of 1050 patients and is currently undergoing statistical analysis. Results will be available at time of presentation.
Conclusions: We hypothesize that the introduction of the IPP LARC program at SH is associated with a reduction of the SIP rate in our population.
