American Association for Cancer Research And American College of Obstetricians and Gynecologists.

In an obstetric office treating women at high risk for comorbid disease and unplanned pregnancies, a prenatal contraceptive education program influenced long-acting reversible contraceptive (LARC) choice and will likely reduce unplanned pregnancies, according to a prospective cohort study of 55 pregnant women. Ms. Torre described the study’s findings in a poster presentation. Approximately half of pregnancies occurring in the United States annually are unintended. While LARCs could help reduce unintended pregnancy, they are used by less than 3% of women in the U.S. In addition, women with unintended pregnancies tend to have a less optimal age distribution, present later for prenatal care, partake in risky behaviors, or have more chronic medical problems with higher rates of pregnancy complications. The study objective was to determine if prenatal contraceptive counseling for high-risk pregnant women would impact their postpartum LARC choice. Participants in the study, which was conducted at the Perinatal Center of Women and Children’s Hospital of Buffalo in Buffalo, New York, were between 18 and 45 years of age and were within 34 weeks of gestation. All women had comorbid conditions, including chronic hypertension, diabetes, and venous thromboembolism. LARCs have proven to be safe in high-risk pregnant women with chronic conditions, such as diabetes (types 1 and 2), congenital heart disease, human immunodeficiency virus infection, and rheumatic disease. Investigators conducted two prenatal counseling sessions and postpartum follow-up within eight weeks of delivery. The prenatal counseling sessions were based on a standardized, easy-to-follow script. Before baseline, only 18% of the participants had LARC histories, and only 27% expressed interest in LARC use pre-counseling (with 20% intending to use LARC). The rest intended to use non-LARC methods (69%) or undergo bilateral tubal ligation (4%). Analysis showed that differences in religious affiliation, marital status, and contraceptive history were not reflected in postpartum LARC choice. Women interested in LARC before the intervention, however, were more likely to choose a LARC postpartum (P = 0.011). “That lets us know that increased societal awareness of LARCs could be helpful in inducing women to adopt one of these methods,” Ms. Torre said in an interview. Overall, after counseling, LARC intent rose to 42% compared with 20% in the historical cohort. LARC intended use also increased significantly in women planning to become pregnant again after counseling (P = 0.013). Ms. Torre noted that future studies will look at postpartum LARC insertion rates and postpartum LARC continuation rates. She concluded, “Our study suggests that instituting a prenatal contraceptive education program can improve LARC rates in high-risk pregnant women.” Commenting on the findings, Althea M. O’Shaughnessy, MD, of Conceptions Reproductive Associates of Colorado in Littleton and Presbyterian St. Luke’s Medical Center in Denver, Colorado, concurred that educating women about LARCs is important; this is because LARCs have a low failure rate (less than 1% for hormone-infused intrauterine devices [IUDs]), compared with 9% to 18% for non-LARC methods. She also noted the value of education about emergency contraceptives based on the same type of progesterone (levonorgestrel) that is used in infused IUDs. About half of women may need emergency contraception in their lifetimes, but only about one in 10 make use of it. If used within 72 hours of unprotected intercourse, they are effective in seven out of eight women, Dr. O’Shaughnessy explained. She underscored, “Levonorgestrel prevents ovulation and has no effect on on going pregnancies, which is important.”