PDF(Pubmed)
Abstract：
OBJECTIVE: To estimate the effect of reversible postpartum contraception use on the risk of recurrent pregnancy condition in the subsequent pregnancy and if this effect was mediated through lengthening the interpregnancy interval (IPI).
METHODS: We used data from the Maine Health Data Organization\'s Maine All Payer Claims dataset. Our study population was Maine women with a livebirth index pregnancy between 2007 and 2019 that was followed by a subsequent pregnancy starting within 60 months of index pregnancy delivery. We examined recurrence of three pregnancy conditions, separately, in groups that were not mutually exclusive: prenatal depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes (GDM). Effective reversible postpartum contraception use was defined as any intrauterine device, implant, or moderately effective method (pills, patch, ring, injectable) initiated within 60 days of delivery. Short IPI was defined as ≤ 12 months. We used log-binomial regression models to estimate risk ratios and 95 % confidence intervals, adjusting for potential confounders.
RESULTS: Approximately 41 % (11,448/28,056) of women initiated reversible contraception within 60 days of delivery, the prevalence of short IPI was 26 %, and the risk of pregnancy condition recurrence ranged from 38 % for HDP to 55 % for prenatal depression. Reversible contraception initiation within 60 days of delivery was not associated with recurrence of the pregnancy condition in the subsequent pregnancy (aRR ranged from 0.97 to 1.00); however, it was associated with lower risk of short IPI (aRR ranged from 0.67 to 0.74).
CONCLUSIONS: Although initiation of postpartum reversible contraception within 60 days of delivery lengthens the IPI, our findings suggest that it does not reduce the risk of prenatal depression, HDP, or GDM recurrence. This indicates a missed opportunity for providing evidence-based healthcare and health interventions in the intrapartum period to reduce the risk of recurrence.
METHODS: We used data from the Maine Health Data Organization\'s Maine All Payer Claims dataset. Our study population was Maine women with a livebirth index pregnancy between 2007 and 2019 that was followed by a subsequent pregnancy starting within 60 months of index pregnancy delivery. We examined recurrence of three pregnancy conditions, separately, in groups that were not mutually exclusive: prenatal depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes (GDM). Effective reversible postpartum contraception use was defined as any intrauterine device, implant, or moderately effective method (pills, patch, ring, injectable) initiated within 60 days of delivery. Short IPI was defined as ≤ 12 months. We used log-binomial regression models to estimate risk ratios and 95 % confidence intervals, adjusting for potential confounders.
RESULTS: Approximately 41 % (11,448/28,056) of women initiated reversible contraception within 60 days of delivery, the prevalence of short IPI was 26 %, and the risk of pregnancy condition recurrence ranged from 38 % for HDP to 55 % for prenatal depression. Reversible contraception initiation within 60 days of delivery was not associated with recurrence of the pregnancy condition in the subsequent pregnancy (aRR ranged from 0.97 to 1.00); however, it was associated with lower risk of short IPI (aRR ranged from 0.67 to 0.74).
CONCLUSIONS: Although initiation of postpartum reversible contraception within 60 days of delivery lengthens the IPI, our findings suggest that it does not reduce the risk of prenatal depression, HDP, or GDM recurrence. This indicates a missed opportunity for providing evidence-based healthcare and health interventions in the intrapartum period to reduce the risk of recurrence.
摘要：
目的：评估可逆产后避孕对后续妊娠中反复妊娠风险的影响，以及这种影响是否通过延长妊娠间隔（IPI）来介导。
方法：我们使用了缅因州健康数据组织的缅因州所有付款人索赔数据集中的数据。我们的研究人群是缅因州妇女，她们在2007年至2019年之间有分娩指数妊娠，随后在指数妊娠分娩后60个月内开始妊娠。我们检查了三种妊娠情况的复发，分开,在不相互排斥的群体中：产前抑郁，妊娠高血压疾病（HDP），妊娠糖尿病（GDM）。有效的可逆产后避孕使用被定义为任何宫内节育器，植入物,或中等有效的方法(药丸，补丁,戒指,可注射)在分娩后60天内开始。短IPI定义为≤12个月。我们使用对数二项回归模型来估计风险比和95%置信区间，调整潜在的混杂因素。
结果：大约41%（11,448/28,056）的妇女在分娩后60天内开始可逆避孕，短IPI的患病率为26%，妊娠疾病复发的风险从HDP的38%到产前抑郁的55%不等。分娩后60天内开始可逆性避孕与随后妊娠的妊娠情况复发无关(aRR范围为0.97至1.00)；然而，它与较低的短IPI风险相关(aRR范围为0.67~0.74).
结论：尽管在分娩后60天内开始产后可逆避孕会延长IPI，我们的研究结果表明，它不会降低产前抑郁的风险，HDP,或GDM复发。这表明错过了在产时阶段提供循证医疗保健和健康干预措施以降低复发风险的机会。
方法：我们使用了缅因州健康数据组织的缅因州所有付款人索赔数据集中的数据。我们的研究人群是缅因州妇女，她们在2007年至2019年之间有分娩指数妊娠，随后在指数妊娠分娩后60个月内开始妊娠。我们检查了三种妊娠情况的复发，分开,在不相互排斥的群体中：产前抑郁，妊娠高血压疾病（HDP），妊娠糖尿病（GDM）。有效的可逆产后避孕使用被定义为任何宫内节育器，植入物,或中等有效的方法(药丸，补丁,戒指,可注射)在分娩后60天内开始。短IPI定义为≤12个月。我们使用对数二项回归模型来估计风险比和95%置信区间，调整潜在的混杂因素。
结果：大约41%（11,448/28,056）的妇女在分娩后60天内开始可逆避孕，短IPI的患病率为26%，妊娠疾病复发的风险从HDP的38%到产前抑郁的55%不等。分娩后60天内开始可逆性避孕与随后妊娠的妊娠情况复发无关(aRR范围为0.97至1.00)；然而，它与较低的短IPI风险相关(aRR范围为0.67~0.74).
结论：尽管在分娩后60天内开始产后可逆避孕会延长IPI，我们的研究结果表明，它不会降低产前抑郁的风险，HDP,或GDM复发。这表明错过了在产时阶段提供循证医疗保健和健康干预措施以降低复发风险的机会。
