Abstract
BACKGROUND: Short interpregnancy intervals (conception occurring <18 months after delivery or pregnancy loss) are associated with increased risk of adverse outcomes such as preterm delivery, low birth weight, and invasive placental pathologies. To reduce unintended short-interval pregnancy (SIP) among people desiring contraception, our health network in 2019 began offering immediate postpartum long-acting reversible contraception (LARC), using copper and hormonal intrauterine devices (IUDs) and etonogestrel implants. This study evaluated the impact of the initiative on the incidence of SIP at our institution. METHODS: We conducted a retrospective cohort study of patients on government insurance who delivered between July 1, 2019, and March 31, 2020. The exposure of interest was LARC placement in the immediate postpartum period. The outcome of interest was confirmed pregnancy within 18 months of delivery. Exclusion criteria were immediate postpartum sterilization, cesarean or peripartum hysterectomy, or fetal demise. SIP rates were compared between those opting for LARC immediately after delivery (pp LARC group) and those who declined (no pp LARC group). A logistic regression model controlled for potential confounders. RESULTS: Of the 1,126 patients who met the inclusion criteria, there were 140 in the pp LARC group (68 etonogestrel implant, 54 levonorgestrel IUD, and 18 copper IUD) and 986 in the no pp LARC group. The pp LARC group experienced a lower proportion of SIP (7.9% versus 23.8%, P < 0.001). In adjusted analysis, immediate postpartum LARC reduced the rate of SIP (adjusted risk ratio (ARR): 0.28, 95% confidence interval (CI): 0.14-0.55, P < 0.001). CONCLUSION: Providing LARC shortly after delivery shows promise for patient uptake and prevention of SIP among individuals wishing for contraception. Expanded studies are warranted.