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Obstetric Quality and Safety

Poster Session 3

(820) High-Risk Pregnancy in North Carolina: Predictors of High Efficacy Postpartum Contraception Use

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

MC

Maya Cox-Terry, BA

Medical Student
Campbell University School of Osteopathic Medicine
Lillington, NC, United States

Coauthor(s)

JE

James Edwards, MD

WakeMed
Raleigh, NC, United States
GD

Godwin Dogbey, PhD

Campbell University School of Osteopathic Medicine
Lillington, NC, United States

Objective: Postpartum high efficacy contraception use is particularly recommended for patients with a history of high-risk pregnancy. Several studies on high-risk pregnancy and high efficacy contraceptive use have shown inconsistent results. This study examined factors that influence the use of high efficacy contraception postpartum in respondents with reported high-risk pregnancy at a state population level.

Study Design: North Carolina Pregnancy Risk Assessment Monitoring System data for 2012-2020 was analyzed. High efficacy contraceptive (IUD, implant, tubal ligation, vasectomy) use postpartum was the outcome of interest. The predictors and covariates included: demographics, high-risk pregnancy history, parity, pregnancy intention, infant mortality, interpersonal violence during pregnancy, and prenatal and postpartum counseling. High-risk pregnancy was defined as a history of preterm birth, low birth weight infant, obesity, diabetes, hypertension, depression, or no prenatal care. A multivariable logistic regression analysis was conducted with adjusted odds ratios (aORs) determined.

Results: Significant predictors of high efficacy contraception use: history of high-risk pregnancy, multiparity, trying to get pregnant with their most recent pregnancy, living infant, postpartum contraception counseling, postpartum visit inquiry about depression, Black and Asian races, attainment of a bachelor’s or master’s degree, and age groups 30-34 and 35-39 years-old. (See Table 1 for aORs, p-values, and Confidence Intervals.)

Conclusion: At a state population level, high-risk pregnancy history is associated with high efficacy contraception use postpartum. Patients who use high efficacy contraception are more likely to plan their pregnancies and have multiple children. Postpartum contraception counseling is a predictor of high efficacy contraception use. Thus, based on the study findings, patients who are younger, have lower education levels, and have a history of unplanned pregnancy should be identified and provided comprehensive postpartum contraception counseling.