Preventing repeat teen pregnancy: postpartum depot medroxyprogesterone acetate, oral contraceptive pills, or the patch?
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.


METHODS
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.


METHODS
Medical University of South Carolina, a tertiary medical center.


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


METHODS
A structured telephone interview was performed every 3 months.


METHODS
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.


CONCLUSIONS
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.
Thurman
Andrea Ries
AR
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA. thurmana@uthscsa.edu
Hammond
Natalie
N
Brown
Helen E
HE
Roddy
Mary Ellen
ME
D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D003268:Contraception Behavior; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D004338:Drug Combinations; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D009644:Norgestrel / Q000008:administration & dosage / Q000031:analogs & derivatives*; D049590:Postpartum Period; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000706:statistics & numerical data; D011446:Prospective Studies
D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; D004338:Drug Combinations; C511292:Ortho Evra; D009644:Norgestrel; D004997:Ethinyl Estradiol; D017258:Medroxyprogesterone Acetate