Contraception最新文献

{"title":"ADOLESCENT DEMAND FOR MEDICATION ABORTION FROM AN ONLINE TELEMEDICINE SERVICE BEFORE AND AFTER THE DOBBS V JACKSON WOMEN’S HEALTH ORGANIZATION DECISION","authors":"DM Johnson,&nbsp;J Starling,&nbsp;R Gomperts","doi":"10.1016/j.contraception.2024.110563","DOIUrl":"10.1016/j.contraception.2024.110563","url":null,"abstract":"<div><h3>Objectives</h3><div>We sought to understand adolescent demand for medication abortion from an online telemedicine service, and to understand if demand varies due to state-level abortion bans and state-level parental involvement laws.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data from an online telemedicine organization providing medication abortion in the US. We compared average weekly request rates by adolescent (under 18, 18-21) and adult (22+) age- groups and state policy environment pre and post the <em>Dobbs vs. JWHO</em> decision.</div></div><div><h3>Results</h3><div>From September 1, 2021 and October 31, 2023, 232,089 people in 50 states requested medications, and 6% of requestors were under 18, 24% were 18-21, and 70% were 22+. The average per-capita weekly request rate among ages 18-21 increased from 8.3 in the baseline period to 25.7 post-<em>Dobbs</em>, a 17.4 increase (15.6-19.2, p&lt;0.001); average requests among adults increased from 3.3 in the baseline period to 11.1, a 7.8 increase (7.1-8.4, p&lt;0.001). The most restrictive abortion law states saw the highest increase in post-<em>Dobbs</em> requests among adolescents (25.4, 20.7-30.0; p&lt;0.001), compared to smaller increases among adolescents in states without restrictions (8.3, 7.2-9.5; p&lt;0.001). Among adolescents under 18, requests in states with parental involvement laws were higher than in states without, both at baseline (1.1, 0.8-1.4; p&lt;0.001) and post-<em>Dobbs</em> (4.4, 3.7-5.1; p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Demand for medications among adolescents increased post-<em>Dobbs</em> in similar patterns to adults, and requests among 18-21 were higher than other ages groups. This may be because of internet engagement or fewer financial resources for clinic-based care. Specialized support is needed to assist adolescents pursuing medication abortion via online telemedicine.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426318","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":"EFFICACY AND SAFETY OF THE ESTETROL/DROSPIRENONE ORAL CONTRACEPTIVE IN US STUDY PARTICIPANTS WITH AND WITHOUT OBESITY","authors":"AD Beasley,&nbsp;T Kimble,&nbsp;B Kaneshiro,&nbsp;R Maamari,&nbsp;JM Foidart,&nbsp;MD Creinin","doi":"10.1016/j.contraception.2024.110562","DOIUrl":"10.1016/j.contraception.2024.110562","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to compare contraceptive efficacy and safety of estetrol 15 mg/drospirenone 3 mg in US study participants with and without obesity.</div></div><div><h3>Methods</h3><div>We analyzed US population data from a phase 3 trial of estetrol/drospirenone use for up to 13 cycles. The study enrolled 1,864 healthy US and Canadian participants 16-50 years old with body mass index (BMI) 18-35 kg/m². We evaluated efficacy (Pearl Index, pregnancies/100-person-years) in participants 16-35 years and safety (adverse events [AEs]) in all participants, with obesity defined as BMI≥30 kg/m².</div></div><div><h3>Results</h3><div>We included 1,712 (91.8%) US participants; 1,531(89.4%) were 16-35 years. BMIs for 418 (24.4%) participants with obesity were 32.6±1.7 kg/m² overall and 32.6±1.8 kg/m² for 365 participants aged 16-35. For participants without obesity, BMIs were 23.9±3.2 kg/m2 and 23.8±3.3 kg/m², respectively. Pearl indices for participants with and without obesity were 3.04 (95% CI, 1.116.61) and 2.86 (95% CI, 1.754.42), respectively (p&gt;0.05). AEs were reported by 418 (56.0%) and 670 (51.8%) of participants with and without obesity (p=0.13). The most common AE that differed between groups was weight gain (5.3% vs 2.7%, respectively, p=0.02). Two serious AEs (1 per group) were considered study treatment related. Discontinuation for an AE occurred in 40(9.6%) and 116 (9.0%), respectively (p=0.7).</div></div><div><h3>Conclusions</h3><div>Contraceptive efficacy did not differ for US estetrol/drospirenone users with and without obesity. Although participants with obesity more frequently report weight gain, overall AE discontinuation rates did not differ. These results demonstrate a favorable efficacy and safety profile of estetrol/drospirenone users with obesity.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426319","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":"EFFICACY OF A STANDARDIZED, MULTIMODAL APPROACH TO PAIN CONTROL DURING IUD INSERTION","authors":"M Dart,&nbsp;C Sublett,&nbsp;M Hurwitz,&nbsp;L Edinger,&nbsp;M Coleman,&nbsp;T Gilmore,&nbsp;D Redick","doi":"10.1016/j.contraception.2024.110637","DOIUrl":"10.1016/j.contraception.2024.110637","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate the efficacy of a multimodal “bundle” to reduce pain and complications associated with intrauterine device (IUD) insertion. This bundle included oral naproxen, a high-potency topical anesthetic applied to the cervix, and the presence of an emotional support person. When available, ultrasound guidance was included in the bundle.</div></div><div><h3>Methods</h3><div>This is a prospective cohort study comparing pain and complications associated with IUD insertion in patients using standard practice, Cohort 1 (n=133), vs. using the pain reduction bundle, Cohort 2 (n=231). We enrolled patients undergoing IUD insertion from May 2022 to March 2024. We prospectively evaluated patient pain scores and qualitative experiences during IUD insertion using a visual analog scale and patient survey. Complications, including expulsion, malposition, infection, and laceration, were evaluated at six weeks.</div></div><div><h3>Results</h3><div>The mean reported pain score was not significantly lower in the intervention group compared to the control group (4.87/10 vs. 5.02/10, p=0.679) when controlling for parity, history of prior IUD placement, prior cervical procedure, concurrent procedure, type of IUD, age, BMI, and race/ethnicity distribution between groups. Subgroup analyses of copper IUD and nulliparous patients also revealed no significant difference (p=0.85, p= 0.811).</div></div><div><h3>Conclusions</h3><div>Patients experience pain during IUD insertion despite intervention with a multimodal pain bundle. Despite experiencing pain during IUD insertion, a majority of patients would undergo the procedure in the future and recommend the procedure to a friend. Further research is needed to explore pain control options during IUD insertion.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426345","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":"ULTRASOUND ASSESSMENT FOR PLACENTA ACCRETA SPECTRUM PRIOR TO SECOND TRIMESTER DILATION AND EVACUATION","authors":"M Coley,&nbsp;K Meadows,&nbsp;M Hou,&nbsp;M Chen","doi":"10.1016/j.contraception.2024.110596","DOIUrl":"10.1016/j.contraception.2024.110596","url":null,"abstract":"<div><h3>Objectives</h3><div>Ultrasound (US) markers for placenta accreta spectrum (PAS) are often undetectable until late second trimester, increasing the risk of complications during dilation and evacuation. We assessed the prevalence of these markers and their predictive value for complications in patients with prior cesarean delivery (CD) undergoing dilation and evacuation.</div></div><div><h3>Methods</h3><div>We included patients with prior CD who underwent dilation and evacuation between 14 0/7 and 23 6/7 weeks’ gestation from 05/2020-12/2021. We abstracted obstetric history, placental US findings, and perioperative data from electronic records. We compared complications between those with and without PAS-associated US markers defined by the Society of Maternal-Fetal Medicine. Bleeding complications were defined as ≥2 uterotonics use, blood transfusion, intrauterine balloon placement, uterine artery embolization, and hysterectomy.</div></div><div><h3>Results</h3><div>Of 770 patients undergoing dilation and evacuation, 209(27%) had one or more prior CDs. On US, 24(11%) patients had lacunae, 20(10%) had placenta previa, 12(6%) had abnormal flow, 7(3%) had bridging vessels, and 6(3%) had an abnormal uteroplacental interface. Based on these markers, 16(8%) were considered moderate risk for PAS. Complications occurred in 25(12%) patients, most commonly use of ≥2 uterotonics (10, 40%), blood transfusion (6, 24%), and intrauterine balloon placement (5, 20%). Patients with pre-procedure US indicating moderate risk for PAS were not more likely to have complications compared to those considered low risk [4(25%) vs 18 (9%); p=0.07].</div></div><div><h3>Conclusions</h3><div>US assessment for PAS did not predict higher bleeding complications during dilation and evacuation. Enhanced early second-trimester PAS risk characterization is necessary for improved perioperative readiness.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426347","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":"AWARENESS AND BELIEFS RELATED TO SELF-MANAGED ABORTION IN OHIO AFTER THE DOBBS DECISION","authors":"KV McFarland","doi":"10.1016/j.contraception.2024.110599","DOIUrl":"10.1016/j.contraception.2024.110599","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to analyze the awareness and beliefs related to self-managed abortion after <em>Dobbs v Jackson Women’s Health Organization</em>.</div></div><div><h3>Methods</h3><div>Utilizing a population-representative sample of adult, reproductive-age women in Ohio collected in September 2022 to August 2023 (n=2,473), we calculated the prevalence of three outcomes: (1) awareness of self-managed medication abortion (SMMA) measured with the question, “Have you heard of pills that you can buy and use at home to conduct an abortion without going to a clinic or consulting a doctor?”, (2) perceived meaning of term “self-managed abortion,” and (3) hypothetical actions if the respondent or someone close to them needed an abortion that was not legal in Ohio. We used chi-square tests to identify factors associated with SMMA awareness.</div></div><div><h3>Results</h3><div>About 41.6% of women reported being aware of SMMA. Awareness was statistically significantly associated with race and ethnicity (p=0.01) and socioeconomic status (p&lt;0.01), with non-Hispanic Black women and women with some college or less and &lt;$75K income reporting the lowest levels of awareness. Women selected a range of responses to describe what self-managed abortion means to them, including the morning after pill (30.3%). Few women (6.1%) would buy abortion pills online in response to the hypothetical question.</div></div><div><h3>Conclusions</h3><div>A minority of adult, reproductive-age women in Ohio are aware of SMMA, and awareness varies by race and socioeconomic status. The morning after pill was commonly indicated as a method of self-managed abortion. These findings highlight the need for more education about SMMA, to tailor education to specific populations, and distinguish it from emergency contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426350","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":"KNOWLEDGE OF MEDICATION ADMINISTRATION INSTRUCTIONS AMONG TRADITIONAL MEDICATION ABORTION PATIENTS","authors":"TX Chen,&nbsp;R Soon,&nbsp;M Tschann","doi":"10.1016/j.contraception.2024.110602","DOIUrl":"10.1016/j.contraception.2024.110602","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate patients’ immediate recall of medication abortion administration instructions.</div></div><div><h3>Methods</h3><div>This is a descriptive analysis of one cohort in a prospective non-inferiority study. We surveyed a convenience sample of medication abortion patients immediately after their appointment in Honolulu, HI between April 2023 and March 2024. Surveys assessed knowledge of medication abortion indications/contraindications, administration, and side effects/precautions, as well as their confidence in correctly completing the regimen. Incidentally, the clinic modified its written instructions for readability approximately halfway through recruitment; we compared outcomes before and after modification.</div></div><div><h3>Results</h3><div>We surveyed 100 patients. Mean age was 27.9 years (SD, 6.6). Thirty-two (32%) had undergone a medication abortion before. On average, patients correctly answered 79% (SD, 18%) of questions about medication abortion indications/contraindications, 97% (SD, 8.3%) of questions about medication regimen administration, and 93% (SD, 11%) of questions about side effects/precautions; the overall average number of correct answers for all questions was 90% (SD, 7.7%). Patients were completely or quite confident they could independently complete the process (n=95, 95%), teach a friend how to complete the process (n=86, 86%), recognize side effects (n=84, 84%), and seek emergency help when needed (n=95, 95%). Patient age, history of medication abortion, and the new medication abortion instructions were not associated with more accurate recall or higher confidence.</div></div><div><h3>Conclusions</h3><div>These findings may be a foundation for future studies that seek to compare the medication abortion knowledge and confidence of patients who pursue medication abortion outside of the clinic setting, such as advance provision or self-managed abortion, with that of traditional patients.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426353","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":"COMPLICATIONS ASSOCIATED WITH MIFEPRISTONE USE FOR DILATION AND EVACUATION ABORTION PROCEDURES BETWEEN 22 AND 24 WEEKS’ GESTATION","authors":"MB Wergeles,&nbsp;P Lohr,&nbsp;R Scott,&nbsp;M Lewandowska,&nbsp;A Andreeva","doi":"10.1016/j.contraception.2024.110606","DOIUrl":"10.1016/j.contraception.2024.110606","url":null,"abstract":"<div><h3>Objectives</h3><div>Dilation and evacuation is the most common method of procedural abortion after 20 weeks’ gestation. Adequate cervical dilation is essential for safe dilation and evacuation. In 2017, the British Pregnancy Advisory Service (BPAS) added mifepristone to their regimen of osmotic dilators for cervical ripening before dilation and evacuation. This retrospective study analyzed the risk for complications associated with the use of mifepristone for cervical ripening.</div></div><div><h3>Methods</h3><div>BPAS provided data which included dilation and evacuation procedures that occurred between 22 weeks’ and 23 weeks and 6 days’ gestation, between February 2012 and February 2017 (osmotic dilators only), and November 2017 to November 2022 (mifepristone and osmotic dilators). Using time as a proxy for mifepristone use, the association between mifepristone use and dilation and evacuation complications was established. Multivariate logistic regression was used to calculate the odds for complications with and without mifepristone use while controlling for potential confounders.</div></div><div><h3>Results</h3><div>There were 6,516 dilation and evacuation procedures at BPAS during this time. Those who received mifepristone were more likely to experience any complication (OR: 2.40, 95% CI: 1.62, 3.54). They also had higher odds of bleeding (OR: 3.08, 95% CI: 1.12, 8.48). Odds for cervical injury (OR: 2.21, 95% CI: 0.84, 5.80) and infection (OR: 1.89, 95% CI: 0.46, 7.69) were not different between those who did and did not receive mifepristone.</div></div><div><h3>Conclusions</h3><div>The addition of mifepristone to osmotic dilators was associated with an increase in the odds of complications of dilation and evacuation, without attenuating the risk of complications related to cervical dilation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426513","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":"“IT DEPENDS ON THE PERSON AND…ON THE SITUATION TOO”: FACTORS INFLUENCING ABORTION METHOD PREFERENCES AMONG BLACK AND LATINX COMMUNITIES IN THE US SOUTHEAST","authors":"HV McMahon,&nbsp;P Bhandari,&nbsp;IC Stevenson,&nbsp;T Vyavahare,&nbsp;S Ayala,&nbsp;T Hailstorks,&nbsp;I Hairston,&nbsp;Z Jah,&nbsp;D Dixon Diallo,&nbsp;EA Mosley","doi":"10.1016/j.contraception.2024.110570","DOIUrl":"10.1016/j.contraception.2024.110570","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to qualitatively explore factors influencing abortion method preferences among Black and Latinx communities in the US Southeast.</div></div><div><h3>Methods</h3><div>We conducted in-depth interviews (n=32) and focus groups (n=30) with Black and Latinx women in Georgia, as well as key informant interviews (n=12) with abortion providers and community-based organization leaders. Data were analyzed using Strauss and Corbin’s Grounded Theory protocol. We validated the resulting model through methodological triangulation.</div></div><div><h3>Results</h3><div>Participants named perceptions of privacy and stigma, accessibility, safety, timing, and pain as core determinants of abortion method preferences. Medication abortion was largely characterized as more private, more accessible, and less stigmatizing than procedural abortion; however, some participants were concerned that medication abortion could feel lonely. Participants’ conceptualizations of safety and pain were more varied. While many viewed procedural abortion as invasive and therefore inherently higher risk and more painful, others worried that passing a pregnancy without clinician oversight during a medication abortion could be less safe and produce longer-lasting pain. Views on ideal timing also differed: Some liked that procedural abortion had a shorter recovery time even if it required longer appointments, while others felt strongly about the control of timing and shorter waits associated with medication abortion.</div></div><div><h3>Conclusions</h3><div>There are a number of factors that influence abortion method preferences among Black and Latinx communities. Considerations of privacy and stigma, accessibility, safety, timing, and pain should be addressed in abortion patient counseling to further empower informed decision making. Likewise, it is critical that both procedural and medication abortion are accessible to promote patient autonomy and meet individuals’ needs.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426164","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":"PATIENT PERSPECTIVES ON OUT-OF-STATE TRAVEL FOR ABORTION CARE POST-DOBBS","authors":"H Simons,&nbsp;K Przytula","doi":"10.1016/j.contraception.2024.110583","DOIUrl":"10.1016/j.contraception.2024.110583","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examines the travel experiences of patients receiving abortion services out of state including financial, logistical, and social-emotional barriers.</div></div><div><h3>Methods</h3><div>We electronically administered a post-visit survey to abortion patients traveling to two Planned Parenthood affiliates located in the Midwest and Southwest in 2023 (N_tot=510). We conducted descriptive and bivariable analysis to examine travel distance and travel-related barriers and whether they differed by race/ethnicity and age.</div></div><div><h3>Results</h3><div>86% of respondents traveled because abortion was not legal in their home state. The median one-way travel distance was 450 miles. Half of the respondents reported taking unpaid time off work, 46% reported concealing whereabouts from family/friends, and 32% reported paying to stay overnight. Nearly 1 in 3 reported not getting care as early as desired (30%) - top reasons were not being able to get an appointment (46%), not having enough money (43%), not being able to take time off from work / school (32%) and not knowing abortion was not available in their home state (32%). Median distance was greater for Hispanic/Latina respondents (median=700 miles) compared to other racial/ethnic groups (median_wht=300, median_blk=160, p=0.001). Younger respondents were more likely to pay to stay overnight (40%) than older respondents (29%, p=0.004). White (55%) and Hispanic/Latina (51%) respondents were more likely to conceal their whereabouts than Black respondents (30%, p&lt;0.0001).</div></div><div><h3>Conclusions</h3><div>Abortion patients traveling regionally in the Southwest and Midwest experienced notable barriers, including delays in obtaining care and taking unpaid time off work. Travel barriers may differentially affect patient subgroups, such as young people.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426170","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 IMMEDIATE POSTPARTUM USE OF INJECTABLE CONTRACEPTION ON HUMAN MILK FEEDING","authors":"MF Gallo,&nbsp;FL Schumacher,&nbsp;M Lawley,&nbsp;S Keim,&nbsp;L Keder","doi":"10.1016/j.contraception.2024.110574","DOIUrl":"10.1016/j.contraception.2024.110574","url":null,"abstract":"<div><h3>Objectives</h3><div>US guidelines permit depot medroxyprogesterone acetate (DMPA) use among people intending to feed their infant with their milk. However, DMPA use is often restricted in practice due to lack of high-quality evidence. We evaluated the effect of immediate postpartum DMPA use on the timing of lactogenesis stage-II (LS=II).</div></div><div><h3>Methods</h3><div>The initial design randomly assigned adults who delivered a full-term infant in 2019-2021 to receive within 48 hours of delivery: DMPA, placebo injection, or no injection. Due to low enrollment, we changed in 2021-2023 to a non-randomized design using propensity score weighting for analysis and balancing recruitment for obesity and delivery method. Here, we combined data from both designs to compare immediate postpartum DMPA use (n=55) vs. control arm (n=95). We defined noninferiority <em>a priori</em> as being met if the upper bound of a two-sided 95% confidence interval (CI) for the mean difference in time to LS-II between the immediate DMPA and control groups was &lt;6 hours.</div></div><div><h3>Results</h3><div>In the unweighted analysis, the mean time to LS-II was 57.8 hours in the DMPA arm (SD=29.4) and 64.1 hours in the control arm (SD=36.1). Using propensity score weighting to make the arms comparable with respect to age, race, and gravidity, we found that the mean time to LS-II was 5.4 hours shorter (95% CI, -16.3, 5.4) for women in the DMPA relative to control arm.</div></div><div><h3>Conclusions</h3><div>We found no evidence that DMPA use inhibits the initiation of LS-II. Our findings support the immediate postpartum use of DMPA among those intending to engage in human milk feeding.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426180","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}