Risk of abortion 1-2 years after childbirth in relation to contraceptive choice.
ESC Congress Library. Lichtenstein Liljeblad K. 05/10/18; 208240; ESC101
Karin Lichtenstein Liljeblad
Karin Lichtenstein Liljeblad
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Introduction Fertility may be restored already from the fourth week postpartum. In Sweden, postpartum contraceptive counseling is traditionally given at the free of charge visit at maternity care six to twelve weeks after childbirth. Approximately 25-30% of women do not attend. The aim of the present study was to investigate if the risk of unintended pregnancy during the first to second year postpartum was associated with attendance to the postpartum visit, and to the choice of contraceptive method. We  hypothesized that non-attendants would run a higher risk of abortion and that choice of LARC should be associated with a lower risk. Design and Methods This retrospective cohort study consisted of all women who had given birth at three hospitals in Sweden, during 2013 and 2014 (n= 12147 women). BMI, history of abortion, parity and age were extracted from the medical file. Attendance to and choice of contraception at the postnatal visit was noted, along with breast-feeding status. Unintended pregnancy was measured as an appointment because of decision of abortion. Results 1081 women were excluded. 11066 women were included in the final analyses. Of these, 7745 (70%) women attended the postnatal visit. 76 % of these women made a decision regarding contraception. The risk for an abortion was higher in the group of non-attendants. 118/3321 (3.6%, 24/1000/year) of the women in this group had an abortion whereas the corresponding figure for the attendants, irrespective of contraceptive choice, was 159/7745 (2.1%, 14/1000/year), RR 1.73; 1.37-2.19. The women who choose LARC (n=1945, 17.6%) as contraceptive method had a lower risk of abortion (RR 0.46; 0.31-0.70) compared to any other method or no contraceptive choice at all. Women having an abortion were significantly younger (27.7 vs 30.3 years), compared to the group not having an abortion (p < 0 .001). Conclusion The overall number of abortions was surprisingly low. The non-attendants had a higher risk of abortion.  In accordance with earlier findings only 70% of women attended to the maternal care for a postnatal visit. Our findings support the hypothesis of non-attenders running a higher risk of unintended pregnancy during the first two years postpartum. Users of LARC and especially IUD/LNG-IUS had a lower risk of abortion. The results highlight the need of immediate uptake of contraception after childbirth. Immediate postpartum insertion of intrauterine contraceptives is an attractive option but there still is need of more research of future contraception in the postpartum period.
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