Comparison of Long-Acting Reversible Contraceptive (LARC) Choices by Multiethnic U.S. Adolescents and Young Adults with and without Eating Disorders: A Multicenter Cohort Study.

Abstract

Study objective: Body image concerns may influence contraceptive choices of adolescents and young adults (AYAs) with eating disorders (EDOs). We aimed to compare long-acting reversible contraceptive (LARC) choices and continuation rates for AYAs with and without EDOs.

Methods: We used data on LARC insertions from 2017-2021 from four US adolescent medicine practices measuring demographics, menstrual history, reason for LARC device, follow-up and continuation. Additional record search identified participants with EDOs. We examined associations of EDOs and choice of device using adjusted logistic regression and one-year discontinuation using Cox proportional hazards survival analysis.

Results: The cohort included 2,346 AYAs; 80 (3%) with EDO; 32% White; 29% Hispanic, 15% Black. Mean age at LARC insertion 18.7±2.4 years (range 12-25). Participants with EDO vs. without had higher odds of choosing intrauterine devices (IUD) over implants (OR=2.18; 95% CI:1.31, 3.61; p=0.003). One-year LARC continuation rates were 77% overall and similar for those with and without EDOs. AYAs with EDOs vs. without had similar likelihood of LARC device removal within one-year. Participants identifying as Black non-Hispanic (OR=0.34;95% CI;0.26, 0.45, p<0.001) and Hispanic (OR=0.34;95% CI;0.26, 0.45, p<0.001) vs White non-Hispanic had lower odds of choosing IUDs over implants. Black non-Hispanic AYAs had higher likelihood than White non-Hispanics for LARC removal within one-year (HR=1.58; 95% CI: 1.11, 2.25; p=0.01).

Conclusions: AYAs with EDOs compared to those without EDOs are more likely to choose IUDs over implants and they have similar high one-year LARC continuation rates . AYAs of non-White race/ethnicities independent of EDO diagnosis are less likely to choose IUDs.