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Immediate postabortion initiation of levonorgestrel implants reduces the incidence of births and abortions at 2 years and beyond.
Contraception 2015; 92(1):17-25C

Abstract

OBJECTIVES

The aims of this study were to compare immediate postabortion uptake of recently subsidized (no-cost) levonorgestrel-releasing implants with already available intrauterine and shorter-acting methods and to compare the incidence of subsequent pregnancies (ending in birth or abortion) within 2 years.

STUDY DESIGN

Retrospective chart review of 4698 women attending a New Zealand public hospital abortion clinic over 2 years (2010-2012) to describe postabortion contraceptive choice, with follow-up via clinic and national births records to assess subsequent pregnancies at 12, 24, 36, and 48 months.

RESULTS

Twenty percent of the cohort (934/4698) received an implant, 26% an intrauterine method (927 copper intrauterine device, 301 levonorgestrel-releasing intrauterine system [LNG-IUS]), and 54% chose other shorter-acting methods (2536/4698). Method choice was significantly associated with age, ethnicity, and pregnancy history (p < .001). At 24 months, the unadjusted incidence of subsequent abortion for implant users was 3.8% (95% confidence interval [CI] = 2.5-5.0) and 11.6% (95% CI = 10.3-12.8) for those choosing other short-acting methods. By 48 months, 6.6% of implant users had a subsequent abortion (compared with 18.3% for short-acting methods). The incidence of continued pregnancy at 24 months was 6.3% (95% CI = 4.4-8.1) for implant users and 15.7% (95% CI = 14-17.2) for those choosing other short-acting methods. Adjusted hazard ratios (HRs) for subsequent abortion were lowest for women initiating an implant (HR = 0.26, 95% CI = 0.20-0.35) or LNG-IUS (HR = 0.26, 0.16-0.44, reference group: short-acting methods).

CONCLUSIONS

Immediate postabortion insertion of an implant significantly reduced rates of subsequent pregnancy for at least 2 years. Abortion service providers should ensure women have barrier-free access to all long-acting reversible contraceptions to delay or prevent pregnancy.

IMPLICATIONS

Initiation of an levonorgestrel implant immediately postabortion was associated with a 74% reduction in subsequent abortion over the next 4 years compared with use of short-acting methods. Implants were popular among adolescents-a group at high-risk of subsequent pregnancy, and who have not historically been considered appropriate candidates for intrauterine contraceptive methods.

Authors+Show Affiliations

Department of Primary Health Care and General Practice, University of Otago, Wellington, P O Box 7343, Wellington South 6242, New Zealand. Electronic address: Sally.Rose@otago.ac.nz.Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, Wellington, P O Box 7343, Wellington South 6242, New Zealand. Electronic address: Susan.Garrett@otago.ac.nz.Biostatistical group, Dean's Department, University of Otago, Wellington, P O Box 7343, Wellington South 6242, New Zealand. Electronic address: James.Stanley@otago.ac.nz.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25818594

Citation

Rose, Sally B., et al. "Immediate Postabortion Initiation of Levonorgestrel Implants Reduces the Incidence of Births and Abortions at 2 Years and Beyond." Contraception, vol. 92, no. 1, 2015, pp. 17-25.
Rose SB, Garrett SM, Stanley J. Immediate postabortion initiation of levonorgestrel implants reduces the incidence of births and abortions at 2 years and beyond. Contraception. 2015;92(1):17-25.
Rose, S. B., Garrett, S. M., & Stanley, J. (2015). Immediate postabortion initiation of levonorgestrel implants reduces the incidence of births and abortions at 2 years and beyond. Contraception, 92(1), pp. 17-25. doi:10.1016/j.contraception.2015.03.012.
Rose SB, Garrett SM, Stanley J. Immediate Postabortion Initiation of Levonorgestrel Implants Reduces the Incidence of Births and Abortions at 2 Years and Beyond. Contraception. 2015;92(1):17-25. PubMed PMID: 25818594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immediate postabortion initiation of levonorgestrel implants reduces the incidence of births and abortions at 2 years and beyond. AU - Rose,Sally B, AU - Garrett,Susan M, AU - Stanley,James, Y1 - 2015/03/27/ PY - 2014/11/03/received PY - 2015/02/02/revised PY - 2015/03/24/accepted PY - 2015/3/31/entrez PY - 2015/3/31/pubmed PY - 2016/3/8/medline KW - Copper multiload Cu375 intrauterine device KW - Levonorgestrel intrauterine system KW - Levonorgestrel-releasing subdermal implant KW - Long-acting reversible contraception (LARC) KW - Unintended pregnancy SP - 17 EP - 25 JF - Contraception JO - Contraception VL - 92 IS - 1 N2 - OBJECTIVES: The aims of this study were to compare immediate postabortion uptake of recently subsidized (no-cost) levonorgestrel-releasing implants with already available intrauterine and shorter-acting methods and to compare the incidence of subsequent pregnancies (ending in birth or abortion) within 2 years. STUDY DESIGN: Retrospective chart review of 4698 women attending a New Zealand public hospital abortion clinic over 2 years (2010-2012) to describe postabortion contraceptive choice, with follow-up via clinic and national births records to assess subsequent pregnancies at 12, 24, 36, and 48 months. RESULTS: Twenty percent of the cohort (934/4698) received an implant, 26% an intrauterine method (927 copper intrauterine device, 301 levonorgestrel-releasing intrauterine system [LNG-IUS]), and 54% chose other shorter-acting methods (2536/4698). Method choice was significantly associated with age, ethnicity, and pregnancy history (p < .001). At 24 months, the unadjusted incidence of subsequent abortion for implant users was 3.8% (95% confidence interval [CI] = 2.5-5.0) and 11.6% (95% CI = 10.3-12.8) for those choosing other short-acting methods. By 48 months, 6.6% of implant users had a subsequent abortion (compared with 18.3% for short-acting methods). The incidence of continued pregnancy at 24 months was 6.3% (95% CI = 4.4-8.1) for implant users and 15.7% (95% CI = 14-17.2) for those choosing other short-acting methods. Adjusted hazard ratios (HRs) for subsequent abortion were lowest for women initiating an implant (HR = 0.26, 95% CI = 0.20-0.35) or LNG-IUS (HR = 0.26, 0.16-0.44, reference group: short-acting methods). CONCLUSIONS: Immediate postabortion insertion of an implant significantly reduced rates of subsequent pregnancy for at least 2 years. Abortion service providers should ensure women have barrier-free access to all long-acting reversible contraceptions to delay or prevent pregnancy. IMPLICATIONS: Initiation of an levonorgestrel implant immediately postabortion was associated with a 74% reduction in subsequent abortion over the next 4 years compared with use of short-acting methods. Implants were popular among adolescents-a group at high-risk of subsequent pregnancy, and who have not historically been considered appropriate candidates for intrauterine contraceptive methods. SN - 1879-0518 UR - https://www.unboundmedicine.com/medline/citation/25818594/Immediate_postabortion_initiation_of_levonorgestrel_implants_reduces_the_incidence_of_births_and_abortions_at_2_years_and_beyond_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0010-7824(15)00130-4 DB - PRIME DP - Unbound Medicine ER -