Contraceptive Preference, Continuation Rates, and Unintended Pregnancies in Patients with Comorbidities: A Prospective Cohort Study.

Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 101159262 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-843X (Electronic) Linking ISSN: 15409996 NLM ISO Abbreviation: J Womens Health (Larchmt) Subsets: MEDLINE

Original Publication: Larchmont, NY : Mary Ann Liebert, Inc., [2002]-

Contraceptive Agents, Female* ; Pregnancy, Unplanned*; Comorbidity ; Contraception ; Female ; Humans ; Pregnancy ; Prospective Studies

Background: Patients with comorbidities are more susceptible to adverse pregnancy outcomes, morbidity, and mortality than healthy patients. The goal of this study was to evaluate how comorbidities influence contraceptive choice, continuation rates, and the unintended pregnancy rate in reproductive-age participants. Methods: We analyzed data from the Contraceptive CHOICE Project. Baseline data included demographic, reproductive, and medical history, including self-reported hypertension (HTN), venous thromboembolism (VTE), migraines, cerebrovascular accidents (CVA), transient ischemic attack (TIA), or stroke. Participants were provided contraceptive counseling and their method of choice at no cost. Results: Among 9253 participants included in our analysis, 659 participants reported a history of HTN (7%), 20 participants reported a history of CVA/TIA/stroke (<1%), 1803 participants reported a history of migraine (19%), and 85 reported a history of VTE (<1%). Compared to baseline, use of long-acting reversible contraceptive methods (long-acting reversible contraception [LARC]: intrauterine devices and implants) increased for participants with all comorbidities: HTN 2.3%-84.2%; CVA/TIA/stroke 0%-85%; migraines 1.7%-77%, and VTE 1.2%-88.2%. Participants with HTN, VTE, and migraines were more likely to choose LARC than those without those conditions: HTN: relative risk (RR) = 1.14, 95% confidence interval (CI) 1.10-1.18; migraines RR = 1.04, 95% CI 1.01-1.07; and VTE RR = 1.18, 95% CI 1.09-1.28. Twelve-month continuation and unintended pregnancy rates did not differ significantly based on comorbidity status. Conclusions: Participants with serious comorbidities were more likely to choose LARC than healthy participants. Contraceptive counseling should always be individualized to the patient. Clinical Trials.gov Identifier: NCT01986439.

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T32 GM008425 United States GM NIGMS NIH HHS

Keywords: comorbidity; contraception; long-acting reversible contraception; unplanned pregnancy

ClinicalTrials.gov NCT01986439

0 (Contraceptive Agents, Female)

Date Created: 20210106 Date Completed: 20211021 Latest Revision: 20221003

20240105

PMC8590153

10.1089/jwh.2020.8536

33404367