title: Twelve-month contraceptive continuation and repeat pregnancy among young mothers choosing postdelivery contraceptive implants or postplacental intrauterine devices.
abstract: OBJECTIVE
  To compare discontinuation rates and incidence of repeat pregnancy within 1 year among young mothers choosing postplacental intrauterine devices (IUDs) versus postpartum contraceptive implants.
  
  
  METHODS
  We enrolled a prospective cohort of postpartum adolescents and young women who chose either postplacental IUDs or postpartum contraceptive implants prior to hospital discharge. We used chart review and phone interviews to assess device discontinuation (by request or expulsion) and pregnancy within 12 months.
  
  
  RESULTS
  Of the 244 13-22 year-old participants, 82 chose IUDs (74 levonorgestrel IUDs and 8 copper IUDs), and 162 chose implants. Both groups had participant-requested discontinuation rates of 14% (9/67 IUD; 19/135 implant) within 1 year. Participants choosing IUDs had a 25% (17/67) expulsion rate. Median time to expulsion was 4.1 weeks (range: 0.4-29.3 weeks, 16/17 within 12 weeks), and participants recognized 15/17 expulsions. IUD initiators had significantly higher pregnancy rates by 12 months (7.6% vs. 1.5%, p=0.04). Most pregnancies occurred when women discontinued their initial device and did not start alternative contraception.
  
  
  CONCLUSIONS
  Participant-requested discontinuation was similar in both groups. Differences in overall device discontinuation rates were due to IUD expulsions. Pregnancy rates by 12 months postpartum were lower than previously reported in this age group in both implant initiators and IUD initiators.
  
  
  CONCLUSIONS
  Young mothers who choose postplacental IUDs or postpartum contraceptive implants are unlikely to request removal within the first year. Clinicians should counsel postplacental IUD users that early expulsion is common (25%) and may be unrecognized (11% of expulsions). Patients should have a plan for contraceptive management should expulsion occur.
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, 12631 East 17th Avenue B198-6, Aurora, CO, 80045, USA. Electronic address: Rebecca.h.cohen@ucdenver.edu.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, 12631 East 17th Avenue B198-6, Aurora, CO, 80045, USA.
authors.forename: Jeanelle
authors.initials: J
authors.lastname: Sheeder
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, 12631 East 17th Avenue B198-6, Aurora, CO, 80045, USA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Arango
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, 12631 East 17th Avenue B198-6, Aurora, CO, 80045, USA.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Teal
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, 12631 East 17th Avenue B198-6, Aurora, CO, 80045, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tocce
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004343:Drug Implants; D005260:Female; D006801:Humans; D007433:Intrauterine Device Expulsion; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D007435:Intrauterine Devices, Copper; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D013997:Time Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D004343:Drug Implants; D016912:Levonorgestrel
keywords: Adolescent; Implant; Intrauterine device; Postpartum