Original StudiesPreventing Repeat Teen Pregnancy: Postpartum Depot Medroxyprogesterone Acetate, Oral Contraceptive Pills, 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
References (19)
- et al.
Contraceptive use among adolescent mothers at 6 months postpartum
Obstet Gynecol
(1997) - et al.
Postpartum contraceptive use among adolescent mothers
Obstet Gynecol
(2000) - et al.
Depot medroxyprogesterone acetate or oral contraception in postpartum adolescents
Obstet Gynecol
(1998) - et al.
Rapid repeat pregnancy and experiences of interpersonal violence among low-income adolescents
Am J Prev Med
(1999) - et al.
Contraceptive outcomes among post-partum and post-abortal adolescents
Contraception
(1994) - et al.
A village would be nice but…It takes a long-acting contraceptive to prevent repeat adolescent pregnancies
Am J Prev Med
(2001) - et al.
Quick Start: A novel oral contraceptive initiation method
Contraception
(2002) - et al.
Short and long-term impact of adolescent pregnancy on postpartum contraceptive use: Implications for prevention of repeat pregnancy
J Adolesc Health
(2003) - et al.
Pregnant adolescents at risk: Sexual behaviors and sexually transmitted disease prevalence
Am J Obstet Gynecol
(2003)
Cited by (51)
Progestin-only pill use over 6 months postpartum
2020, ContraceptionCitation Excerpt :Clinicians often prescribe progestin-only pills (POPs) in the postpartum period either as a woman’s preferred method or as a bridge to estrogen-containing contraception as POPs are well-tolerated, have few contraindications, and are safe in lactating women [1–4].
Directive clinique sur la grossesse chez les adolescentes
2016, Journal of Obstetrics and Gynaecology CanadaAdolescent Pregnancy Guidelines
2015, Journal of Obstetrics and Gynaecology Canada
The interim data were presented as an oral presentation at the North American Society for Pediatric and Gynecology Meeting, Orlando, FL, 19 May 06.