Few women with chronic conditions use highly effective contraceptives despite pregnancy risks
Approximately a third of reproductive-age women have a chronic condition that could lead to adverse pregnancy outcomes, but few used highly effective birth control methods, according to a study published in the Journal of General Internal Medicine.
“As women with chronic conditions frequently receive care through primary care providers and medical specialists, the study highlights opportunities to discuss reproductive planning and preconception health in these settings and avoid the risk of an unplanned pregnancy when a woman's condition is poorly controlled,” Lori M. Gawron, MD, MPH, an assistant professor in the department of obstetrics and gynecology at the University of Utah School of Medicine, told Healio Primary Care.
Researchers evaluated the prevalence of chronic conditions and contraception use among women aged 16 to 49 years in a retrospective cohort study. The women received care from 2010 and 2014 at two large health systems in the United States.
The most common chronic conditions among women in the study were depression, asthma, obesity, thyroid diseases, hypertension and diabetes. Among the 741,612 women who received care during the study period, 32.4% had at least one chronic condition and 7.3% had two or more conditions.
Highly effective contraception use, including long-acting reversible contraceptives and permanent contraceptives, was only slightly higher in women with chronic conditions (7.6%) compared with women without chronic conditions (5.1%).
The prevalence of long-acting reversible contraception use did not increase with the number of chronic conditions, researchers said. While 5.8% of those with one condition used these contraceptives, only 3.2% of women with five or more conditions did so.
After adjusting their analysis, researchers found that women with chronic conditions were more likely to use long-acting reversible contraceptives (adjusted RR = 1.4; 95% CI, 1.4- 1.5), permanent contraception (adjusted RR = 1.7; 95% CI, 1.7-1.8), or have had a hysterectomy (adjusted RR = 2.1; 95% CI, 2-2.3).
Women with public insurance were more likely to use long-acting reversible contraception (adjusted RR = 2.2; 95% CI, 2.1-2.3) and permanent contraception (adjusted RR = 2.9; 95% CI, 2.7-3.1) than privately insured women, according to the researchers.
Gawron explained that women with chronic conditions are more likely to have an unplanned pregnancy, and those with poorly controlled conditions or who take treatments that are unsafe during pregnancy are at higher risk for preterm delivery, worsened maternal health or fetal malformations.
“Ensuring safe and effective contraception use can avoid an unplanned pregnancy while optimizing preconception health,” she said.
She recommends that physicians use shared decision-making with women for reproductive planning and contraception use, and that they discuss the safety, efficacy, acceptability and availability with each woman during contraceptive counseling.
“The best method is a safe option that the woman is willing to use and supports her reproductive goals,” Gawron said. – by Erin Michael
Disclosures: The authors report no relevant financial disclosures.