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Postpartum implants curb adolescent pregnancies

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Giving adolescent mothers postpartum contraceptive implants is an effective curb on further pregnancies within a year, researchers report in an April 18th on-line paper in the American Journal of Obstetrics and Gynecology.”

“Initiation of the etonogestrel implant immediately after delivery,” Dr. Kristina M. Tocce, told Reuters Health by email “significantly reduces the rate of rapid repeat pregnancy in adolescents.”

Dr. Tocce of the University of Colorado, Denver School of Medicine and colleagues note that of adolescent who become pregnant, from 12 to 49% will do so again within a year. Also, compared to first teenage birth, a second almost triples the risk of preterm delivery and stillbirth.

Theoretically, they add, the immediate postpartum period is an ideal time for etonogestrel implant insertion in adolescents, but data on efficacy is scarce.

To investigate, the team conducted a prospective observational study of participants in an adolescent prenatal-postnatal program. Immediate postpartum implant insertion was implemented in 171 subjects. A further 225 who elected to use other contraceptive methods or none at all acted as controls.

At 6 months, 156 of the implant group (96.9%) had continued with use and at 12 months, this was the case in 132 (86.3%). Irregular bleeding was among reasons for discontinuation.

At 6 months, none of the implant mothers had become pregnant, compared to 21 controls (9.%). At 1 year, 4 of the implant group (2.6%) had become pregnant compared to 38 (18.6%) of controls.

Of the 4 pregnancies in the implant group, 1 was due to implant failure and the other 3 occurred after the implant was removed.

Our results, say the investigators, “indicate that the contraceptive strategy most likely to prevent rapid repeat pregnancy in adolescents may be immediate postpartum insertion of the etonogestrel contraceptive implant.”

Given the success of the approach, Dr. Tocce added that “Institutions and reimbursement directives that impede the initiation of immediate postpartum contraception should reevaluate their policies to facilitate the avoidance of repeat pregnancy in adolescent mothers.”

“I would like to see it become standard of care,” she concluded. “It certainly should be an option for those who want it.”

SOURCE:

Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?

Am J Obstet Gynecol 2012.