Original Studies
Preventing Repeat Teen Pregnancy: Postpartum Depot Medroxyprogesterone Acetate, Oral Contraceptive Pills, or the Patch?

https://doi.org/10.1016/j.jpag.2006.11.006Get rights and content

Abstract

Study Objective

To prospectively evaluate the repeat teen pregnancy rates, within one year of delivery, among adolescents who choose the contraceptive patch (Ortho Evra) versus oral contraceptive pills (OCP) versus Depot Medroxyprogesterone Acetate (Depo Provera, DMPA) for postpartum contraception.

Design

Observational, prospective cohort study. Comparison groups are postpartum teens, who self-select the contraceptive patch (n = 55) versus DMPA (n = 142) versus OCPs (n = 55) immediately postpartum.

Setting

Medical University of South Carolina, a tertiary medical center.

Participants

Postpartum teens, 11–19 years old; 72% were African American, and 96% qualified for Medicaid insurance.

Interventions

A structured telephone interview was performed every 3 months.

Main Outcome Measures

The primary outcome measure was a repeat pregnancy within 12 months of the index delivery. Secondary outcome variables were contraceptive continuation rates, reasons for discontinuation, side effects and condom usage.

Results

At 1-year follow-up, repeat pregnancy rates were 14.2%, 29.7%, and 31.8% among DMPA, OCP, and patch users respectively (P = 0.02). DMPA users were significantly more likely to be using any form of hormonal contraception 1 year postpartum than patch or OCP users. Condom use was similarly low among all cohorts.

Conclusion

Adolescents who choose DMPA for postpartum contraception are significantly less likely to become pregnant within 1 year of delivery, as compared to teens who choose OCPs or the patch.

Introduction

Of adolescents who give birth, 17–35% will become pregnant again within 1 year of delivery.1, 2 Most adolescent pregnancies are unintended and result from non-use of contraception.1 A major focus in adolescent prenatal care is educating teens on postpartum contraception, so that they can gain better control of their reproductive outcomes.

In United States, adolescents most commonly choose oral contraceptive pills (OCP) for birth control.3 However, teens have high contraceptive failure rates, and difficulty with every day dosing.4 The contraceptive patch (Ortho Evra, Ortho McNeil Pharmaceuticals, Raritan, NJ), was approved by the Federal Drug Administration (FDA) in 2001 and its convenient, once-weekly dosing regimen is heavily marketed. In adults, the contraceptive patch has improved dosing compliance when compared with OCPs5 but longitudinal data on its efficacy in postpartum teens is lacking.

The objective of this study is to compare repeat pregnancy rates among adolescents selecting the patch, depot medroxyprogesterone acetate (DMPA), or OCPs for postpartum contraception. Secondary outcome measures are contraceptive continuation rates, reasons for discontinuation, side effects, and condom usage.

Section snippets

Materials and Methods

This prospective, observational cohort study was approved by the Institutional Review Board at the Medical University of South Carolina (MUSC). All English speaking, primiparous adolescents, age 11–19, admitted as inpatients to MUSC after a singleton, term, live birth were eligible to participate in the study. The study authors interviewed the teens after they selected postpartum contraception, in consultation with a separate inpatient team of resident and attending physicians providing

Results

A total of 252 teens were recruited for the study. The cohorts were not randomized, but differed only with regard to ethnicity, as shown in Table 1. We believed that it was unethical to randomize the participants to different forms of postpartum contraception. During the 12-month follow-up period, 40 teens became pregnant, and we experienced a 21.8–32.9% loss to follow-up, as shown in Table 2. As shown in Table 3, index DMPA and patch users were significantly more likely to continue the index

Discussion

In the United States, 85 per 1000 girls age 15–19 give birth each year.3 The United States has the highest adolescent pregnancy rate in the industrialized world.8 This study focuses on the adolescents who are most likely to experience a pregnancy, teen mothers. Teen mothers are at high risk for a multitude of health, economic, and social problems including single parenthood, unemployment, domestic violence, chronic disease, substance abuse, poverty, and welfare dependency.1, 9

Medline, MD

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The interim data were presented as an oral presentation at the North American Society for Pediatric and Gynecology Meeting, Orlando, FL, 19 May 06.

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