Contraception最新文献

Objectives: To assess 3-year efficacy, safety, and tolerability of the Cu 175mm² copper intrauterine device (IUD).

Study design: This single-arm trial recruited participants at risk of pregnancy aged 17-45 years at 42 U.S. centers to receive a Cu 175mm² IUD with a flexible nitinol frame. We assessed efficacy in participants ≤35 years old at enrollment and assessed all other outcomes in the entire population. We calculated the Pearl Index (pregnancies/100 person-years) through 3 years as the primary efficacy outcome. Secondary outcomes included pregnancy percentages by life-table analysis, placement success, safety (adverse events), and tolerability.

Results: Of 1620 enrollees, 1601 (98.8%) had successful IUD placement, with 1397 ≤35 years at enrollment. We observed a 1-year Pearl Index of 0.94 (95%CI 0.43-1.78) and 1-year and cumulative 3-year life-table pregnancy rates of 1.26% (95%CI 0.57%-1.95%) and 2.47% (95%CI 1.34%-3.60%), respectively. The most common adverse events included bleeding and pain. Over 3 years, 15.4% of participants discontinued due to bleeding or pain. Device expulsions occurred in 36 (2.2%) and 63 (3.9%) participants over 1 and 3 years, respectively. Eight related serious adverse events occurred, including five ectopic pregnancies and one each of uterine perforation, anemia, and uterine hemorrhage. One- and three-year continuation rates were 78.9% and 49.6%, respectively.

Conclusion: These data support efficacy, safety, and tolerability of the Cu 175mm² IUD during the first 3 years of use.

Clinical trial: NCT03633799.

Objectives: To examine the association between state-level immigrant policy climate (IPC) and use of most or moderately effective contraceptive methods among US-born White, US-born Mexican Origin, and foreign-born Mexican Origin women.

Study design: We linked nationally representative survey data from three waves of the National Survey of Family Growth (2013-2019) with a novel and dynamic state-level measure of IPC. We compared use of a most or moderately effective contraceptive method at the time of survey among the three ethnicity and nativity groups alone and as an interaction with State Immigration Policy Climate (IPC) index score above or below the national mean in the year of survey. We used multivariable logistic regression to adjust for individual- and state-level characteristics and test for heterogeneity of the effect of IPC.

Results: Weighted study sample included 31,528,602 respondents: 26,029,129 (82.5%; unweighted n = 5,441) non-Latina White, 2,958,960 (9.4%; unweighted n = 971) Mexican American, and 2,540,513 (8.1%; unweighted n = 719) foreign-born Mexican Origin. After adjusting for confounders, living in a state with a more inclusive immigrant policy environment was associated with higher use of moderately or most effective contraception among Mexican-origin respondents, both US (59.8% vs 52.2% less inclusive) and foreign-born (62.1% vs 55.9% less inclusive), but not US-Born white (65.2% vs 67.8% less inclusive) respondents.

Conclusions: Our results support the "spillover" hypothesis; more exclusionary immigrant policies were associated with lower utilization of effective contraceptive methods among both US-born Mexican Origin and Mexican immigrant women.

Implications: Mexican-origin women in states with more inclusive immigrant policies are more likely to use effective contraception than those in states with exclusionary policies; this suggests that immigrant policy climate may "spill over" into US-born Mexican origin populations.

Objectives: To examine the association of body mass index (BMI, kg/m²) with time to fetal expulsion for individuals undergoing medication abortion over 13 weeks METHODS: This is a retrospective cohort study of singleton pregnancies undergoing medication abortion > 13 weeks at a single academic medical center between 2020 and 2024. Our primary outcome was time to fetal expulsion. We categorized BMI into three groups (>25, 25-29.9, and ≥30) and compared median time to fetal expulsion. We used multivariable logistic regression models to assess the association of BMI with time to delivery ≥24 hours.

Results: Of the 428 charts reviewed, 382 patients met the inclusion criteria with an average gestational duration of 25.0 weeks. Of these, 162 (42.4%) had a BMI greater than 30; 120 individuals fell into the BMI 25-29.9 group (31.4%) and the remaining 100 individuals made up the BMI <25 group (26.2%). The median time to expulsion differed significantly among BMI categories (12 hours for BMI < 25 (IQR 8-18), 14 hours for BMI 25-29.9 (IQR 8-22), 20 hours for BMI ≥ 30 (IQR 12-28, p<0.001). After adjusting for gestational duration, history of cesarean section or prior vaginal deliveries, individuals with a BMI ≥30 had 6.62 times the odds (95% CI 3.27-13.44) of having a time to expulsion ≥24 hours compared to BMI <25.

Conclusions: We found individuals with a BMI >30 had significantly longer second and third trimester time to fetal expulsion. Induction protocols and counseling may need to be adjusted based on body size.

Objectives: The debate over extending the legal time limit for abortion in Belgium has intensified in recent years. Healthcare providers must refer patients seeking abortion beyond the legal deadline to other countries, such as the Netherlands, where the time limits are more permissive. In light of this situation, we analyzed the demographic and social characteristics of patients requesting abortion after 14 weeks of gestation and compared them with those seeking the procedure within the legal limits.

Study design: This retrospective study examines the sociodemographic characteristics of individuals requesting abortion at City Planning Brussels between first January 2022 and 30 March 2023. We employed logistic regression to identify predictive factors for late abortion.

Results: We analyzed 627 abortion requests, with 593 occurring before 14 weeks and 34 after 14 weeks. Patients seeking abortion due to precarity or rape had a higher risk of presenting beyond the legal time limit (OR 3.64, p = 0.001, and OR 3.96, p = 0.009, respectively). Factors that appeared to reduce this risk included requests for abortion based on personal reasons (lack of desire for a child) and being covered by mutual health insurance (OR 0.22, p < 0.001, and OR 0.25, p 0.001).

Conclusion: Management of late abortion in Belgium is difficult due to law's restriction. Our data indicate that the circumstances resulting in late abortion requests are often complex, frequently involving factors such as financial difficulties and precarity. A law modification is necessary to provide uniform and effective care for these patients.

Objectives: To evaluate the effects of a multilevel postpartum family planning (PPFP) intervention on the reduction of unintended pregnancies and induced abortions in China.

Study design: We performed a cluster randomized intervention study to assess the effects of a multilevel PPFP intervention on the rates of unintended pregnancy and induced abortion within 12 months postpartum. Thirty-six hospitals were included and randomly allocated to two groups at a 1:1 ratio, enrolling 180 pregnant women per hospital starting in January 2019. The intervention included integrated contraceptive education and counseling at three critical stages, namely, the third trimester, delivery, and several postpartum time points. We used life table and multilevel Cox regression for data analysis.

Results: We recruited 6,315 participants, namely, 3,116 in the intervention group and 3,199 in the control group. The 12-month cumulative rates of unintended pregnancy and induced abortion were significantly lower in the intervention group (2.74% [95% CI, 2.16-3.46] and 1.43% [95% CI, 1.01-2.03], respectively) than in the control group (6.99% [95% CI, 6.00-8.14] and 3.85% [95% CI, 3.09-4.79], respectively). Multilevel Cox regression revealed a 63% reduction in the risk of unintended pregnancy (HR 0.37 [95% CI, 0.19-0.71]) and a 67% reduction in the risk of induced abortion (HR 0.34 [95% CI, 0.16-0.69]) in the intervention group.

Conclusions: This multilevel PPFP intervention was effective in reducing the risk of unintended pregnancy and induced abortion within the first year after childbirth. We recommend scaling up this approach to other hospitals across the country that provide prenatal educational classes and postpartum contraceptive services.

Clinical trials: ChiCTR1900023790.

Objectives: To understand the rates of first trimester medication and procedural abortion provision, sufficiency in abortion training, and factors associated with abortion provision among Obstetrician-Gynecologists (OB/GYNs) in Massachusetts.

Study design: Electronically fielded surveys of a census of OB/GYNs in Massachusetts in 2021 queried physicians on abortion provision, training, practice type, and demographics. Using weighting to account for non-response, we generated estimates of the proportion of OB/GYNS providing abortion and used multivariate regression analysis to explore factors associated with abortion provision including practice type, physician sex, and sufficient abortion training.

Results: 198 OB/GYNs responded to the survey (response rate = 29%). Of 158 OB/GYNs not in training, 55% provide some abortion care. More respondents reported sufficient training for surgical abortion (84%) than for medication abortion (43%). The most cited reasons for not providing abortion care were lack of integration into their clinical practice (29%), institutional opposition (27%), or personal opposition to abortion (23%). In multivariate analysis, female physicians were more likely to provide abortion care (aOR 2.72, 95% CI [1.63-4.55], P< 0.01), and those with insufficient training less likely to provide abortion (aOR 0.18, 95% CI [0.10-0.33], P=0.01). Those in private practice (aOR 0.47, 95% CI [0.28-0.80], P< 0.01) or "other" practice types (aOR 0.16, 95% CI [0.09-0.27], P< 0.01) were less likely to provide abortion compared to physicians in academic practices.

Conclusions: Only half of OB/GYNs in a state supportive of abortion provide abortion. Despite high patient interest in medication abortion, a majority of OB/GYNs report insufficient training in medication abortion.

Health care insurance claims are an increasingly common data source for health outcomes research. While researchers have successfully used several claims data sources for many obstetric and gynecologic questions, use of claims data for abortion and contraception research poses a number of challenges. In this update on the state of the science in identifying abortion in claims data, we review claims data generally, describe commonly used claims data sources, and detail specific reasons why abortion may be underestimated in claims even when employing best practices. We provide examples of successful approaches for identifying abortion in claims, and importantly, spell out limitations when making comparisons across site of care, states, and policy contexts. As increased attention is turned to identifying abortion across diverse settings, it is critical best practices are applied so that the most appropriate inferences regarding abortion incidence across contexts over time are drawn.

Objective: To describe the childfree population seeking permanent contraception, identify barriers to receiving care, and characterize the incidence of regret.

Study design: We conducted a cross-sectional survey of people in the US, 18 years and older, without biological children, and who are seeking or have previously sought a permanent contraception procedure. Participants completed an online REDCap survey distributed over social media platforms, including Reddit, TikTok, and Facebook.

Results: 400 respondents completed the survey, of whom a151 (38%) underwent a permanent contraception procedure, 44 (11%) had found a doctor to perform a procedure, but not yet undergone it, 32 (8%) had been unable to find a doctor to do the procedure, 83 (21%) were seeking a doctor, and 90 (22%) had not yet sought a doctor. Respondents were predominantly white (88%), identified as women (83%), and were diverse in sexual orientation (heterosexual 42%, bisexual 41%). Reasons for seeking permanent contraception included not wanting children (96%), fear of pregnancy/childbirth (70%), the current state of the world (68%), environmental reasons (59%), and medical reasons (32%). Barriers to care included cost of the procedure (30%) and inability to find a doctor who would perform the procedure (42%). Of the 151 respondents who had undergone a permanent contraception procedure, 70 (46%) asked more than one doctor for the procedure. Of those with permanent contraception, 97% answered "yes" to "Do you think sterilization as a permanent method of birth control was a good choice for you?"

Conclusion: Childfree individuals have a variety of reasons for seeking sterilization and may be at a lower risk of regret than reported in the literature for parous people with permanent contraception.

Implications: Clinicians should be aware of the barriers to permanent contraception for patients who do not desire to have children. Providing patient-centered, individualized care to patients seeking permanent contraception can ensure that patients do not face unnecessary barriers to care and feel heard and empowered to enact their reproductive preferences.

Abortion is a critical public issue in Brazil where over 800,000 abortions might occur each year, with approximately 250,000 admitted to emergency departments due to complications from unsafe procedures. A new bill seeks to amend the Brazilian Penal Code (Código de Processo Penal), classifying the practice as a felony for patients over 22 gestational of weeks, even in cases where the practice is already legally foreseen (e.g., derived from sexual abuse, as an attempt to save pregnant individuals at high-risk, or due to fetuses' anencephaly). This bill undermines several Sustainable Development Goals (SDGs) endorsed by the United Nations, particularly those related to health (Goal 3), gender equality (Goal 5), and inequality and poverty reduction (Goal 10). Amongst the extensive list of potential solutions to the abortion challenge that Brazil currently faces, a feasible and plausible alternative relates to investment in education, in particular sexual education aimed at adolescents.