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Role of Bridge Contraception in Postpartum Long-Acting Reversible Contraception and Sterilization Fulfillment Rates

Montague, Mary, MD; Ascha, Mustafa, MS; Wilkinson, Barbara, MD, MA; Verbus, Emily, MD; Morris, Jane, MD; Mercer, Brian M., MD; Arora, Kavita Shah, MD, MBE

doi: 10.1097/AOG.0000000000002803
Contraception: Original Research: PDF Only

OBJECTIVE: To estimate the association of bridge contraception with interval long-acting reversible contraception (LARC) and sterilization fulfillment rates.

METHODS: This is a secondary analysis of a retrospective single-center cohort chart review study examining 1,851 postpartum women who requested LARC or sterilization after discharge. Bridge contraception was requested by 597 of these women. Primary outcomes included LARC or sterilization fulfillment, time to fulfillment, postpartum visit attendance, and pregnancy within 365 days of delivery.

RESULTS: The rate of LARC or sterilization fulfillment within 90 days of delivery was 147 of 597 (24.6%) women using bridge contraception and 287 of 1,254 (22.9%) women not using bridge contraception (P=.41). After adjusting for maternal age, parity, gestational age, mode of delivery, adequacy of prenatal care, race–ethnicity, and education level, the use of bridge contraception was associated with LARC or sterilization fulfillment (adjusted odds ratio [OR] 1.30, 95% CI 1.02–1.67). Adequacy of prenatal care and black race was associated with fulfillment. The use of bridge contraception was not associated with time to fulfillment (adjusted hazard ratio 1.17, 95% CI 0.95–1.44) or postpartum visit attendance (adjusted OR 0.97, 95% CI 0.77–1.23). The use of bridge contraception was not associated with increased pregnancy within 365 days of delivery (OR 1.00, 95% CI 0.95–1.05; adjusted OR 0.96, 95% CI 0.73–1.26).

CONCLUSION: Bridge contraception is associated with increased LARC and sterilization fulfillment after postpartum discharge. Long-acting reversible contraception or sterilization fulfillment after discharge occurred in less than one in four women. Strategies to improve provision of LARC or sterilization before hospital discharge are necessary.

Postpartum bridge contraception is associated with increased long-acting reversible contraception and sterilization fulfillment after hospital discharge.

School of Medicine and the Department of Epidemiology and Biostatistics, Case Western Reserve University, and the Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio.

Corresponding author: Kavita Shah Arora, MD, MBE, Department of Obstetrics and Gynecology, MetroHealth Medical Center, MBE, 2500 MetroHealth Drive, Cleveland, OH 44109; email: Kavita.Shah.Arora@gmail.com.

Dr. Arora is funded by the Clinical and Translational Science Collaborative of Cleveland, KL2TR000440 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. This manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received April 04, 2018

Received in revised form June 05, 2018

Accepted June 14, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.