title: Effects of Obstetric Complications on Adolescent Postpartum Contraception and Rapid Repeat Pregnancy.
abstract: OBJECTIVE
  To determine whether complications during pregnancy or at delivery influence postpartum contraception choices and rapid repeat pregnancy rates in adolescent women. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This retrospective cohort study included 321 adolescents delivering at UMASS Memorial Healthcare. Complications during pregnancy and delivery along with subsequent contraception use were investigated. Postpartum contraception choice (long-acting reversible contraception [LARC] vs non-LARC) at either delivery, hospitalization discharge, or at postpartum outpatient appointment, and rapid repeat pregnancy rate (pregnancy confirmed within 12 months of index delivery), were analyzed according to pregnancy complications. Comparisons were made with χ2and Fisher exact tests for categorical variables, and with Wilcoxon rank sum test for continuous variables.
  
  
  RESULTS
  Of the study population, 27.7% (n = 89/321) used LARC in the postpartum period. The LARC and non-LARC patient populations differed significantly regarding history of abortion (P = .029), with no differences in obstetric complications between the groups. Of the population, 16.6% (n = 53/320) became pregnant again within 1 year of their index delivery. Those with a rapid repeat pregnancy had significantly increased gravidity (P = .002), parity (P = .003), number of previous spontaneous or therapeutic abortions (P = .026); they were also more like to have nonlive birth as a complication (P = .028), compared with those without repeat pregnancy. No other obstetrical complications were statistically significantly different between the compared groups.
  
  
  CONCLUSIONS
  Obstetrical complications seem to have little effect on postpartum contraception choice or repeat pregnancy rate with the notable exception of nonlive birth being associated with rapid repeat pregnancy.
authors.affiliation: University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: gianna.wilkie@umassmed.edu.
authors.forename: Gianna L
authors.initials: GL
authors.lastname: Wilkie
authors.affiliation: Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts.
authors.forename: Katherine
authors.initials: K
authors.lastname: Leung
authors.affiliation: Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts.
authors.forename: Tara
authors.initials: T
authors.lastname: Kumaraswami
authors.affiliation: Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts.
authors.forename: Erin
authors.initials: E
authors.lastname: Barlow
authors.affiliation: Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Moore Simas
mesh_terms: D000028:Abortion, Induced / Q000523:psychology / Q000706:statistics & numerical data; D000293:Adolescent; D003267:Contraception / Q000379:methods; D003268:Contraception Behavior / Q000523:psychology*; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology; D005260:Female; D020073:Gravidity; D006801:Humans; D010298:Parity; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D018873:Pregnancy Rate; D011253:Pregnancy in Adolescence / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
keywords: Contraception use; Pregnancy in adolescence; Rapid repeat pregnancy