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Postpartum implants help prevent repeat adolescent pregnancies

NEW YORK (Reuters Health) – Up to half of adolescents who give birth are pregnant again within a year, but a new study suggests that postpartum contraceptive implants can be an effective way to help prevent rapid repeat pregnancies in teenage mothers.

The study was reported online April 18 in the American Journal of Obstetrics and Gynecology.

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

Dr. Tocce and colleagues at the University of Colorado, Denver School of Medicine in Aurora say that of adolescents 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.

They point out that the levonorgestrel subdermal implant (Norplant, Wyeth-Ayerst), which was associated with prevention of rapid repeat pregnancy in adolescents, was withdrawn from the market in 2002 for nonmedical reasons, leaving the etonogestrel implant (Implanon, Merck) as the only subdermal contraception available in the United States.

The U.S. Medical Eligibility Criteria for Contraceptive Use assign a Category 1 rating (no restrictions) to the use of the etonogestrel implant by adolescents, according to a 2010 publication from the Centers for Disease Control and Prevention (see http://1.usa.gov/Kn1FYD).

Dr. Tocce and colleagues write that theoretically, the immediate postpartum period is an ideal time for etonogestrel implant insertion in adolescents, but data on efficacy are scarce.

Their new findings are from an observational study of participants in an adolescent prenatal-postnatal counseling and treatment program, including 171 young mothers who opted for immediate postpartum implant insertion and 225 who elected to use other contraceptive methods. All of the mothers expressed a desire to prevent pregnancy for at least a year after giving birth.

As the research team notes in the report, the manufacturer advises insertion of the etonogestrel implant in lactating women after the fourth postpartum week. The researchers say they informed all the young mothers in their study that the immediate implant protocol differs from the package insert recommendations.

At six months, 156 mothers in the implant group (96.9%) had continued with use; at 12 months, 132 (86.3%) were still using the implants. Irregular bleeding was among reasons for discontinuation.

At six months, none of the implant mothers had become pregnant, compared to 21 controls (9.9%). At one year, four mothers in the implant group (2.6%) and 38 controls (18.6%) had become pregnant.

Of the four pregnancies in the implant group, one was due to implant failure. The other three occurred after the implant was removed.

The 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: http://bit.ly/LQDswd

Am J Obstet Gynecol 2012.