Title:
Immediate Postpartum Long-Acting Reversible Contraception in Women with Heart Disease

Authors:
Julia Maier^1,2; Christina T. Blanchard, MPH^1,2; Jeff M. Szychowski, PhD^{1,2, 3}; Sara Mazzoni, MD, MPH^1,2; Indranee Rajapreyar, MD⁴; Alexia Novara, MD⁵; Macie Champion, MD^1,2; Alice Goepfert, MD^1,2; Margaret Boozer, MD^1,2; Marc Cribbs, MD⁴; Lorie Harper, MD, MSCI^1,2; Alan Tita, MD, PhD^1,2; Rachel Sinkey, MD^1,2

Institutions:

1. Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
3. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
4. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
5. Department of Obstetrics and Gynecology, Ochsner Health System, New Orleans, Louisiana
   

• Cardiovascular disease in pregnancy is a leading cause of maternal morbidity and mortality.
• SMFM recommends that long-acting reversible contraception (LARC) be offered to high-risk women.
• Immediate postpartum LARC (IPP LARC) allows patients reliable contraception prior to discharge from the delivery-associated hospitalization.
• Little is known about IPP LARC in women with cardiovascular disease.

• To compare postpartum contraception in women with heart disease before and after implementation of an immediate postpartum LARC (IPP LARC) program.

• Observational cohort of women with cardiac disease managed by the UAB Comprehensive Pregnancy & Heart Program
• Delivery at UAB between 3/1/2015 – 6/30/2019
• Pre-implementation (Pre) group:

• • Delivery before IPP LARC implementation (3/1/2015 – 1/31/2017)

• Post-implementation (Post) group:

• • Delivery after IPP LARC implementation (2/1/2017 – 6/30/2019)

• Primary outcome

• • LARC (intrauterine device (IUD) or etonogestrel implant) use postpartum (PP), defined as IPP LARC or LARC at PP visit.

• Secondary outcomes

• • Contraception intent at delivery
  • IPP IUD expulsion rate

• Results

• • 159 women were included, 63 (40%) were Pre, 96 (60%) were Post
  • Baseline characteristic were similar between groups.
  • Total LARC use tripled after IPP LARC implementation, 10% vs 35%, p < 0.01, despite similar LARC intent at delivery: 33% vs 43%, p=0.21.
  • Rates of women without contraception plans at delivery decreased from 32% to 14%, p < 0.01
  • Medroxyprogesterone acetate use decreased: 16% vs 4%, p=0.01.
  • Female sterilization rates remained similar before and after IPP LARC implementation: 24% and 29%, p = 0.46.
  • PP visit rates were similar between Pre and Post groups: 70% and 72%, p=0.78
  • 1 IPP IUD expulsion occurred.

• LARC use in women with heart disease tripled after implementing IPP LARC.
• LARC is the most effective way to prevent unintended pregnancies; thus, IPP LARC should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality.