title: Early initiation of postpartum contraception: does it decrease rapid repeat pregnancy in adolescents?
abstract: OBJECTIVE
  Rapid repeat adolescent pregnancy is a significant public health concern. An effective and practical means of decreasing unintended second adolescent pregnancies needs to be identified. The objective of this study is to determine if early initiation of contraception, and in particular long acting reversible contraception (LARC), decreases rapid repeat pregnancy among first time adolescent mothers.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Urban teaching hospital.
  
  
  METHODS
  340 first-time adolescent mothers age ≤ 19.
  
  
  METHODS
  None, study was retrospective.
  
  
  METHODS
  Repeat pregnancy within 2 years.
  
  
  RESULTS
  340 first time adolescent mothers with a documented follow-up time of 2 years had a repeat pregnancy rate of 35%. Average time from delivery to repeat pregnancy was 9.9 ± 6.4 months. Logistic regression analysis comparing adolescents with and without repeat pregnancy revealed that leaving the hospital postpartum without initiating any contraception was associated with significant increase risk of repeat pregnancy (OR = 2.447, 95% CI 1.326-4.515). Follow-up within 8 weeks postpartum was associated with lower chance of repeat pregnancy (OR = 0.322, 95% CI 0.172-0.603). Initiation of a LARC method (either an intrauterine device or etonogestrel subdermal implant) by 8 weeks postpartum was also associated with decreased chance of rapid repeat pregnancy (OR = 0.118, 95% CI 0.035-0.397).
  
  
  CONCLUSIONS
  Adolescent mothers who initiate a LARC method within 8 weeks of delivery are less likely to have a repeat pregnancy within 2 years than those who choose other methods or no method. First time adolescent mothers should be counseled about this advantage of using LARC.
authors.affiliation: MedStar Washington Hospital Center, Department of Women and Infant Services, Washington, DC. Electronic address: Lauren.F.Damle@medstar.net.
authors.forename: Lauren F
authors.initials: LF
authors.lastname: Damle
authors.affiliation: MedStar Washington Hospital Center, Department of Women and Infant Services, Washington, DC.
authors.forename: Amir C
authors.initials: AC
authors.lastname: Gohari
authors.affiliation: MedStar Washington Hospital Center, Department of Women and Infant Services, Washington, DC; Georgetown University School of Medicine, Washington, DC.
authors.forename: Anna K
authors.initials: AK
authors.lastname: McEvoy
authors.affiliation: MedStar Health Research Institute, Washington, DC.
authors.forename: Sameer Y
authors.initials: SY
authors.lastname: Desale
authors.affiliation: MedStar Washington Hospital Center, Department of Women and Infant Services, Washington, DC; Department of Pediatric Surgery, Children's National Medical Center, Washington, DC.
authors.forename: Veronica
authors.initials: V
authors.lastname: Gomez-Lobo
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D005260:Female; D020073:Gravidity; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Adolescent pregnancy; Contraception; Intrauterine device; Long acting reversible contraception; Subdermal contraceptive implant; Unintended pregnancy