Contraception最新文献

{"title":"Lower reporting of venous thromboembolisms events with natural estrogen-based combined oral contraceptives compared to ethinylestradiol-containing pills: A disproportionality analysis of the Eudravigilance database","authors":"Marie Didembourg ,&nbsp;Médéa Locquet ,&nbsp;Lucie Raskin ,&nbsp;Babel Tsague Tchimchoua ,&nbsp;Jean-Michel Dogné ,&nbsp;Charlotte Beaudart ,&nbsp;Jonathan Douxfils","doi":"10.1016/j.contraception.2024.110727","DOIUrl":"10.1016/j.contraception.2024.110727","url":null,"abstract":"<div><h3>Objectives</h3><div>Pharmacovigilance data analysis can accelerate the identification of drug-related safety signals or reassure on the safety profile. This study evaluates the venous thromboembolism (VTE) risk of newer combined oral contraceptive (COC) formulations with natural estrogens, such as estradiol (E2) and estetrol (E4), using data from the EudraVigilance database.</div></div><div><h3>Study design</h3><div>We conducted a disproportionality reporting rate analysis of VTE events associated with various COC formulations by extracting individual case reports from EudraVigilance database up to July 28, 2024. The study compared the proportionality reporting rate between natural estrogen-based COCs (E2 and E4) and conventional synthetic estrogen-based COCs (ethinylestradiol [EE]), with a comparison to EE-levonorgestrel.</div></div><div><h3>Results</h3><div>The analysis revealed that COCs containing natural estrogens exhibited significantly lower proportionality reporting rates for thrombotic events compared to EE-based COCs. Specifically, E4-drospirenone (E4-DRSP) showed the lowest proportionality reporting rate (0.12), similar to progestin-only pills. EE-DRSP had the highest proportionality reporting rate (2.25), suggesting an increased thrombotic risk.</div></div><div><h3>Conclusions</h3><div>The study supports the safer thrombotic profile of natural estrogen-based COCs, particularly E2 and E4 formulations, over synthetic estrogen-based COCs containing EE. These findings support the hypothesis that E2- and E4-based pills are safer than EE-based pills, aligning with a shift toward safer contraceptive options in clinical practice.</div></div><div><h3>Implications</h3><div>Natural estrogens such as E2 and E4 may emerge as safer alternatives to synthetic estrogens like EE, particularly when combined with progestins like DRSP. This multilevel evidence underscores the importance of evidence-based prescribing practices to enhance patient safety and minimize thrombotic risks associated with COC use.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110727"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retail availability of over-the-counter birth control pills at Texas pharmacies: Results from a mystery caller study","authors":"Brandon G. Wagner,&nbsp;Patricia Maloney,&nbsp;Ali Hooks","doi":"10.1016/j.contraception.2024.110729","DOIUrl":"10.1016/j.contraception.2024.110729","url":null,"abstract":"<div><h3>Objectives</h3><div>To estimate the availability of the recently released over-the-counter (OTC) birth control pill (Opill) in retail pharmacies and compare availability across pharmacies based on their chain status and setting.</div></div><div><h3>Study design</h3><div>In April and May 2024, we conducted a mystery caller study of a sample of 500 Texas retail pharmacies. Sampled pharmacies were contacted by female project staff posing as potential customers and asked whether they had OTC birth control pills in stock and, if not, whether they could be ordered. We characterized pharmacies by chain status (independent pharmacy, chain pharmacy inside retail outlet, chain pharmacy with standalone location) and, using geolocation, as located in either rural or urban areas.</div></div><div><h3>Results</h3><div>Overall, 62% of pharmacies (<em>N</em> = 477) reported having Opill available for sale. This stock varied by pharmacy type, with independent pharmacies the least likely to stock it (25%) and standalone chain pharmacies the most likely (82%). Similar patterns were found in terms of pharmacies that had Opill in stock or were willing to order it. We found no significant differences between urban and rural pharmacies.</div></div><div><h3>Conclusions</h3><div>Despite its recent (March 2024) launch, Opill was widely available in retail pharmacies in Texas, though independent pharmacies were less likely to stock it. While removing the need for prescriptions may make birth control pills more accessible, this access may vary by pharmacy type.</div></div><div><h3>Implications</h3><div>Following its retail launch, the first OTC birth control pill in the United States is already widely available in pharmacies in Texas. As they are highly likely to stock these OTC pills, chain pharmacies (e.g., CVS, Walgreens, Rite-Aid) may be well positioned to address existing barriers to accessing birth control pills.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110729"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of etonogestrel bioanalytical assay results in plasma and serum within and across laboratories","authors":"Shawnalyn W. Sunagawa ,&nbsp;Lee C. Winchester ,&nbsp;Christopher S. Wichman ,&nbsp;Sean N. Avedissian ,&nbsp;David W. Erikson ,&nbsp;Molly Kernan ,&nbsp;Mark A. Marzinke ,&nbsp;Timothy M. Mykris ,&nbsp;Renu Nandakumar ,&nbsp;Thomas D. Nolin ,&nbsp;Anthony T. Podany ,&nbsp;Raymond E. West III ,&nbsp;Beatrice A. Chen ,&nbsp;Catherine A. Chappell ,&nbsp;Kimberly K. Scarsi","doi":"10.1016/j.contraception.2024.110720","DOIUrl":"10.1016/j.contraception.2024.110720","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare performance characteristics of etonogestrel bioanalytical assays across laboratories.</div></div><div><h3>Study design</h3><div>We conducted a blinded, six laboratory study: five academic laboratories and one contracted commercial laboratory (reference). Etonogestrel was quantitated at each laboratory in both prepared serum and/or plasma samples of six known etonogestrel concentrations, and in 60 clinical samples from participants using etonogestrel-containing contraceptive methods. Per regulatory guidance, laboratory accuracy (percent bias) and precision (coefficient of variation; CV) were defined as ±15% of the nominal prepared concentration. We compared inter- and intra-laboratory agreement using a Kendall’s Tau-B and Passing-Bablok regression.</div></div><div><h3>Results</h3><div>For prepared samples, six laboratories analyzed serum and three laboratories analyzed plasma. All etonogestrel results were within ±15% for accuracy across all concentrations at four labs, including the reference laboratory. All labs demonstrated high precision, with only one occurrence of CV &gt;15%. We found a positive association between prepared plasma and serum etonogestrel results (Kendall’s Tau-B 0.80–0.88). For clinical samples, five laboratories analyzed serum and three laboratories analyzed plasma. Compared to the reference laboratory, inter-laboratory serum etonogestrel concentrations were positively correlated (Kendall’s Tau-B 0.76–0.95). Proportional bias was observed, meaning individual lab etonogestrel results were consistently higher (slope estimates 0.78–0.95) or lower (slope estimates 1.05–1.10) than the reference laboratory. In clinical samples, intra-laboratory results were well associated between plasma and serum (Kendall’s Tau-B 0.92–0.96).</div></div><div><h3>Conclusions</h3><div>There was good intra-laboratory agreement, irrespective of sample matrix; however, there was inter-laboratory variability in etonogestrel results. Differences between laboratory results should be considered when comparing etonogestrel pharmacokinetics across studies.</div></div><div><h3>Implications</h3><div>Etonogestrel concentrations were highly precise within each laboratory and were comparable between serum and plasma. Results varied between laboratories (5–28% higher to 5–9% lower compared to the Organon commercial laboratory). To minimize variability, we recommend utilizing a single laboratory that conducts routine proficiency testing for etonogestrel analysis within a study.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110720"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pandemic changes in U.S. contraceptive use: National survey estimates reveal significant differences by demographic subgroups","authors":"William G. Axinn ,&nbsp;Brady T. West ,&nbsp;Heather M. Schroeder ,&nbsp;Laura D. Lindberg","doi":"10.1016/j.contraception.2024.110723","DOIUrl":"10.1016/j.contraception.2024.110723","url":null,"abstract":"<div><h3>Objectives</h3><div>The COVID-19 pandemic brought multiple simultaneous consequences, with high potential to change fertility-related behaviors. We use nationally representative sex and contraceptive use event history calendar measures to demonstrate person-specific changes in contraceptive use after the pandemic, showing differences across demographic subgroups.</div></div><div><h3>Study design</h3><div>We use data from the first nationally representative web survey of U.S. fertility, fielded in 2020–2022: the American Family Health Study (AFHS). Using responses from 1357 female-identifying respondents ages 18–49, we analyze 26,274 person-months of sex and contraceptive use data spanning directly before and after the beginning of the pandemic to detect change.</div></div><div><h3>Results</h3><div>Individual-level hazard models of starting and stopping contraception revealed no pandemic-related changes in starting contraception, but significant reductions in the rate of stopping contraception for specific subgroups. Hispanic females reduced their rates of stopping contraceptive use during the pandemic (lowering their odds of stopping use by 71%), ultimately behaving more similarly to individuals from other racial or ethnic subgroups. Additionally, those aged 41 and older significantly reduced their rates of stopping contraceptive use (lowering their odds of stopping use by 78%) relative to other age groups.</div></div><div><h3>Conclusions</h3><div>Sudden large-scale health policy changes can produce significant changes in contraceptive use behaviors. The COVID-19 changes interacted with race, ethnicity, and age to produce different changes in contraceptive behaviors among different subgroups of the U.S. population.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110723"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of multilevel postpartum family planning intervention on the reduction of unintended pregnancy and induced abortion rates within 12 months of delivery: A cluster randomized controlled study in China","authors":"Yuyan Li ,&nbsp;Yan Zhang ,&nbsp;Dong Yuan ,&nbsp;Li Shan ,&nbsp;Xiaojing Dong ,&nbsp;Liqun Wang ,&nbsp;Yuanzhong Zhou ,&nbsp;Weixin Liu ,&nbsp;Xiaojun Wang ,&nbsp;Lifang Jiang ,&nbsp;Xiaoyu Hu ,&nbsp;Wei Xia ,&nbsp;Xiaochen Huang ,&nbsp;Jiandong Song ,&nbsp;Liangping Wang ,&nbsp;Li Jiang ,&nbsp;Hanfeng Ye ,&nbsp;Yanfei Zhou ,&nbsp;Yan Che","doi":"10.1016/j.contraception.2024.110753","DOIUrl":"10.1016/j.contraception.2024.110753","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the effects of a multilevel promoting postpartum family planning (PPFP) intervention on the reduction of unintended pregnancies and induced abortions in China.</div></div><div><h3>Study design</h3><div>We performed a cluster randomized intervention study to assess the effects of a multilevel PPFP intervention on the rates of unintended pregnancy and induced abortion within 12 months postpartum. Thirty-six hospitals were included and randomly allocated to two groups at a 1:1 ratio, enrolling 180 pregnant women per hospital starting in January 2019. The intervention included integrated contraceptive education and counseling at three critical stages, namely, the third trimester, delivery, and several postpartum time points. We used life table and multilevel Cox regression for data analysis.</div></div><div><h3>Results</h3><div>We recruited 6315 participants, namely, 3116 in the intervention group and 3199 in the control group. The 12-month cumulative rates of unintended pregnancy and induced abortion were significantly lower in the intervention group (2.74% [95% CI, 2.16–3.46] and 1.43% [95% CI, 1.01–2.03], respectively) than in the control group (6.99% [95% CI, 6.00–8.14] and 3.85% [95% CI, 3.09–4.79], respectively). Multilevel Cox regression revealed a 63% reduction in the risk of unintended pregnancy (hazard ratio 0.37 [95% CI, 0.19–0.71]) and a 66% reduction in the risk of induced abortion (hazard ratio 0.34 [95% CI, 0.16–0.69]) in the intervention group.</div></div><div><h3>Conclusions</h3><div>This multilevel PPFP intervention was effective in reducing the risk of unintended pregnancy and induced abortion within the first year after childbirth. We recommend scaling up this approach to other hospitals across the country that provide prenatal educational classes and postpartum contraceptive services.</div></div><div><h3>Implications</h3><div>Multifaceted PPFP interventions, which encompass contraceptive education during both pregnancy and the postpartum period, are effective in reducing unintended pregnancy rates in China. This strategy could be adopted in other similar health care settings worldwide.</div></div><div><h3>Clinical Trials</h3><div>ChiCTR1900023790</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110753"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential effect of immediate postpartum use of injectable contraception on lactogenesis","authors":"Maria F. Gallo ,&nbsp;Fernanda L. Schumacher ,&nbsp;Megan Lawley ,&nbsp;Sarah A. Keim ,&nbsp;Amy C. Dupper ,&nbsp;Lisa Keder","doi":"10.1016/j.contraception.2024.110726","DOIUrl":"10.1016/j.contraception.2024.110726","url":null,"abstract":"<div><h3>Objectives</h3><div>We evaluated the effect of immediate postpartum use of depot medroxyprogesterone acetate (DMPA) on the timing of lactogenesis stage II (LS-II).</div></div><div><h3>Study design</h3><div>The initial design randomly assigned adults who delivered a full-term infant in 2019–2021 to receive within 48 hours of delivery: (1) DMPA, (2) placebo injection, or (3) no injection. Due to low enrollment, we changed in 2021–2023 to a nonrandomized design using matching at recruitment for obesity and delivery method and propensity score weighting for analysis. We combined data from both designs to compare immediate postpartum DMPA use (<em>N</em> = 55) vs control (placebo or no injection) group (<em>N</em> = 95). We defined noninferiority a priori as being met if the upper bound of a two-sided 95% CI for mean difference in time to LS-II between groups was &lt;6 hours.</div></div><div><h3>Results</h3><div>The unweighted mean time to LS-II was 57.8 hours in the DMPA group (SD, 29.4) and 64.1 hours in the control group (SD, 36.1). Using propensity score weighting to make the groups comparable with respect to age, race, delivery method, and previous live births, the mean time to LS-II was 5.5 hours shorter (95% CI, −16.4, 5.5) for women in the DMPA relative to control group.</div></div><div><h3>Conclusions</h3><div>We found no evidence that DMPA use inhibits the onset of LS-II. Findings support immediate postpartum DMPA initiation among those intending to engage in human milk feeding.</div></div><div><h3>Implications</h3><div>A controlled trial (<em>N</em> = 150) did not detect any difference in time to lactogenesis stage II (“milk let-down”) between injectable contraception use within the first 48 hours postpartum and those without this exposure.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110726"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142483227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to Society of Family Planning Research Practice Support: Strategies and considerations for addressing race and racism in quantitative family planning studies [Contraception vol 139 (2024) 110534]","authors":"Nicole Quinones ,&nbsp;Liza Fuentes ,&nbsp;Asha Hassan ,&nbsp;Anna K. Hing ,&nbsp;Goleen Samari ,&nbsp;Monica McLemore","doi":"10.1016/j.contraception.2024.110736","DOIUrl":"10.1016/j.contraception.2024.110736","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110736"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The limitations of using Medicaid administrative data in abortion research","authors":"Brittni Frederiksen ,&nbsp;Emily Dennis ,&nbsp;Guodong Liu ,&nbsp;Doug Leslie ,&nbsp;Alina Salganicoff ,&nbsp;Sarah Roberts","doi":"10.1016/j.contraception.2024.110704","DOIUrl":"10.1016/j.contraception.2024.110704","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify limitations of abortion data in national Medicaid claims files by comparing abortion counts in Medicaid claims data with state abortion estimates.</div></div><div><h3>Study design</h3><div>We used procedure (Current Procedural Terminology/Healthcare Common Procedure Coding System) and drug (National Drug Code) codes to identify abortion claims in 2009 and 2010 Medicaid Analytic eXtract (MAX) and 2020 Transformed Medicaid Statistical Information System Analytic File (TAF) data. We compared the number of abortions in MAX and TAF to the number of expected abortions covered by Medicaid overall and by state. Based on recent published research, we estimated expected Medicaid-covered abortions as 62% of total abortions in states using state funds to cover abortion services for Medicaid enrollees and 0.9% in states that follow Hyde restrictions.</div></div><div><h3>Results</h3><div>MAX data identified 11% (38,668/345,480) of expected Medicaid-covered abortions in 2009 and 13% (44,528/330,801) of expected Medicaid-covered abortions in 2010. In 2020 TAF data, we found 25% (69,728/279,048) of the expected Medicaid-covered abortions. Among the 16 states that used state funds to cover abortions for Medicaid enrollees in 2020, the majority had &lt;10% of expected Medicaid-covered abortions (<em>n</em> = 8). Three states had between 10% and 50% of expected abortions. Four states had between 51% and 75% of expected abortions. One state had insufficient data for reporting.</div></div><div><h3>Conclusions</h3><div>Abortion claims in MAX/TAF are an undercount of abortions covered by Medicaid, and this undercount varies across states. Variation in reporting across states and across time likely introduces bias into research trying to use MAX/TAF abortion claims across states and time. Researchers should use extreme caution when using MAX/TAF for abortion-related research.</div></div><div><h3>Implications</h3><div>Researchers should use caution when using the Medicaid Analytic eXtract and Transformed Medicaid Statistical Information System Analytic Files for abortion-related research questions.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110704"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tennessee Medicaid patient immediate postpartum long-acting reversible contraception utilization","authors":"Megan Lacy Young ,&nbsp;Alicia Mastronardi ,&nbsp;Zach Shelton ,&nbsp;Jill M. Maples ,&nbsp;Nikki B. Zite","doi":"10.1016/j.contraception.2024.110721","DOIUrl":"10.1016/j.contraception.2024.110721","url":null,"abstract":"<div><h3>Objectives</h3><div>To understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with health care barriers and high short-interval birth rates.</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of electronic delivery records between March 2018 and June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using χ² or Fisher exact tests. Binary logistic regression explored the relationship between IPP LARC utilization and demographics. Multivariable logistic regression was performed on all statistically significant variables.</div></div><div><h3>Results</h3><div>Analysis included 10,472 delivery encounters; 2459 (23.5%) requested IPP LARC on admission and 464 (4.4%) changed contraception to IPP LARC after admission. Among those obtaining IPP LARC (<em>n</em> = 2523, 24.1%), 1224 (48.5%) selected arm implants and 1299 selected intrauterine devices (IUDs). Patients who self-reported as non-Hispanic Black and non-Hispanic Other or multiple races utilized IPP LARC less (adjusted Odds Ratio (aOR)=0.84, 95% CI: 0.72–0.98, aOR=0.68, CI 95%: 0.48–0.97, respectively). Patients with cesarean delivery (aOR=1.45, 95% CI: 1.31–1.61) or inadequate prenatal care (aOR=1.54, CI 95%: 1.35–1.75) were more likely to utilize IPP LARC. Maternal age and years of education were inversely associated with utilization. Primiparous patients were less likely to utilize IPP LARC.</div></div><div><h3>Conclusions</h3><div>Long-acting reversible contraception (LARC) utilization was 24.1% during the immediate postpartum period; higher than the 11% nationally reported interval LARC use among publicly insured patients. Understanding the demographics of those desiring IPP LARC could highlight accessibility gaps. The impact of IPP LARC utilization on rates of short-interval birth is being evaluated.</div></div><div><h3>Implications</h3><div>Understanding the demographics of IPP LARC utilizers may contribute to understanding accessibility gaps and facilitate discernment of factors impacting patient initiation. Evidence suggests that comprehensive contraception access during delivery admission is feasible, patient-desired, and essential.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110721"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levonorgestrel 52 mg intrauterine device placement without uterine sounding: A feasibility study","authors":"Jewel A. Brown ,&nbsp;Sheeva Yazdani,&nbsp;Nicole Economou,&nbsp;Holly A. Rankin,&nbsp;Anne N. Flynn,&nbsp;Mitchell D. Creinin","doi":"10.1016/j.contraception.2024.110722","DOIUrl":"10.1016/j.contraception.2024.110722","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate feasibility of levonorgestrel 52 mg intrauterine device (IUD) placement without uterine sounding.</div></div><div><h3>Study design</h3><div>We performed a three-phase feasibility study from February 2023-May 2024. In phase one, participants had levonorgestrel 52 mg IUD placement with sounding. In the experimental phases, placement occurred without sounding and with (phase two) or without (phase three) concurrent transabdominal sonography and participants had 3-month follow-up. We defined feasibility as successful IUD placement without uterine sounding based on ultrasound confirmation. We measured total instrumentation time from the sound or inserter touching the cervix to inserter removal. Participants reported maximal pain experienced using a 100-mm Visual Analog Scale when the inserter was removed. We calculated a sample size of 30 per phase so that if there was one failed placement, the lower 95% confidence interval of the successful placement rate would be no less than 90.0%.</div></div><div><h3>Results</h3><div>Successful placement without sounding occurred in 30(100%) participants in phase two and 28(93.3%) in phase three. Median instrumentation was longest in phase one (49.5 [interquartile range (IQR) 42.3–55.0] seconds) compared to phases two (16.0 [IQR12.0–28.0] seconds, <em>p</em> &lt; 0.0001) and three (25.0 [IQR 18.5–32.2] seconds, <em>p</em> &lt; 0.0001). Participants’ median placement pain was 21.0 (IQR 10.3–32.8) mm in phase one with no difference in phase two (25.5 [IQR 14.3–47.0] mm, <em>p</em> = 0.35), but was higher in phase three (36.0 [IQR 22.8, 61.0] mm, <em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>Levonorgestrel 52 mg IUD placement without sounding is feasible with concurrent sonography. Placement without sounding results in shorter instrumentation time but does not decrease maximum placement pain.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"142 ","pages":"Article 110722"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}