INTRODUCTION: Intrauterine device insertion may be more challenging as a patient's body mass index (BMI) increases leading to a higher incidence of complications. However, few studies have evaluated this, particularly in a diverse population. This study aims to describe levonorgestrel intrauterine device (LNG-IUD) complications in obese women.
METHODS: We evaluated BMI in relation to difficulty with IUD insertion (utilization of additional instruments or anesthesia beyond standard practice), 12-month IUD continuation, and IUD complications (expulsion, infection, perforation, pregnancy, and malposition) in a retrospective cohort study of women with a LNG-IUD inserted at Kaiser Permanente-Hawaii between January 2009 and December 2010.
RESULTS: Of the 1,071 eligible patients, 36% were obese (18% Class I obesity; 10% Class II obesity; 8% Class III obesity). The most common races were Native Hawaiian/Pacific Islander (36%) and Asian (31%). No differences in difficulty with insertion (P=.59) and 12-month continuation (P=.69) were noted between BMI groups. Class III obese women had a higher proportion of any complication [Class III obesity 24% (20/82); Class II obesity 13% (14/107); Class I obesity 10% (19/199); P=.001]. In multivariable logistic regression, Class III obese patients had a 3.06 times higher odds (OR 3.06 95% CI 1.69-5.57) of LNG-IUD expulsion compared to the control group (normal weight, overweight, and Class I obesity) when adjusting for age, insurance, race and breastfeeding.
CONCLUSION: Class III obesity was associated with higher rates of LNG-IUD complications, particularly expulsions. Further studies that include a larger number of obese women are needed to better understand these findings.
(C) 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.