title: Postpartum contraceptive use among women with a recent preterm birth.
abstract: OBJECTIVE
  The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth.
  
  
  METHODS
  Population-based data from the Pregnancy Risk Assessment Monitoring System in 9 states were used to estimate the postpartum use of highly or moderately effective contraception (sterilization, intrauterine device, implants, shots, pills, patch, and ring) and user-independent contraception (sterilization, implants, and intrauterine device) among women with recent live births (2009-2011). We assessed the differences in contraception by gestational age (≤27, 28-33, or 34-36 weeks vs term [≥37 weeks]) and modeled the associations using multivariable logistic regression with weighted data.
  
  
  RESULTS
  A higher percentage of women with recent extreme preterm birth (≤27 weeks) reported using no postpartum method (31%) compared with all other women (15-16%). Women delivering extreme preterm infants had a decreased odds of using highly or moderately effective methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.6) and user-independent methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.7) compared with women having term births. Wanting to get pregnant was more frequently reported as a reason for contraceptive nonuse by women with an extreme preterm birth overall (45%) compared with all other women (15-18%, P < .0001). Infant death occurred in 41% of extreme preterm births and more than half of these mothers (54%) reported wanting to become pregnant as the reason for contraceptive nonuse.
  
  
  CONCLUSIONS
  During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: ggf9@cdc.gov.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Robbins
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Farr
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Zapata
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Denise V
authors.initials: DV
authors.lastname: D'Angelo
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: William M
authors.initials: WM
authors.lastname: Callaghan
mesh_terms: D000293:Adolescent; D000328:Adult; D001721:Birth Intervals; D015331:Cohort Studies; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data; D003276:Contraceptives, Oral / Q000627:therapeutic use; D004343:Drug Implants / Q000627:therapeutic use; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D007434:Intrauterine Devices / Q000706:statistics & numerical data; D016015:Logistic Models; D008484:Medicaid / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D066087:Perinatal Death; D049590:Postpartum Period; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D013245:Sterilization, Reproductive / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; D004343:Drug Implants
keywords: Medicaid; contraception effectiveness; insurance; postpartum; preterm birth