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Two plans cut rapid repeat teen pregnancies.

MIAMI BEACH--Compliance with postpartum visits and long-acting reversible contraception significantly reduced repeat pregnancies among 210 first-time adolescent mothers, according to a retrospective chart review.

These are "the most important tools for preventing subsequent adolescent pregnancy," Dr. Lauren F. Dark said.

"We are currently at an all-time low in teenage pregnancies. However, despite this, rates are still higher in our country than in most other industrialized countries," Dr. Damle said.

"Rapid repeat pregnancy is a major problem, with up to 50% of adolescent mothers becoming pregnant again within 2 years of their first delivery. Adolescent mothers in general are also more likely to be living in poverty, and those who have a second child during their adolescence are less likely to ever achieve economic self-sufficiency," according to Dr. Damle, a gynecology fellow at MedStar Washington (D.C.) Hospital Center.

Dr. Damle and her associates conducted a study to answer two questions: Does early initiation of contraception post partum prevent rapid repeat pregnancy? Do adolescent mothers who use long-acting reversible contraception (LARC) have a lower chance of a repeat pregnancy?

Of the 4,721 deliveries at MedStar Washington Hospital Center in 2008, 757 involved adolescents 18 years and younger. The group included 210 first time mothers who had a live birth, and this group was studied further.

A minority of the 210 first-time moms, 19%, received a medroxyprogesterone (Depo-Provers, Pharmacia & Upjohn Company) injection before going home. The remaining 81% received no contraception prior to discharge.

At their 6-week postpartum follow-up visit, 23% had received a medroxyprogesterone shot, 11% had an IUD placed, and 4% received an etonogestrel 68 mg implant (Implanon). "Interestingly, only 10% were using oral contraceptives, a very, very common form of birth control," Dr. Damle said.

In terms of LARC usage, 16% had an implant or IUD placed within the first 8 weeks. Another 5% had documented their intention to start LARC.

The rapid repeat pregnancy rate was high in this cohort, Dr. Damle said. A total of 74 adolescent mothers had another pregnancy within 2 years, comprising 35% of the entire cohort and 49% of those within the 2 year follow-up. "This is in line with what is reported in the literature, but it is still very concerning.

Mean time between delivery and conception was 424 days. In all, 74 of 152 (49%) first time adolescent mothers had a repeat pregnancy within 2 years.

Follow-up within 8 weeks post partum was associated with lower chance of repeat pregnancy (odds ratio, 0.246). Initiation of LARC also was associated with decreased chance of rapid repeat pregnancy (OR, 0.135).

An interesting finding was no significant difference in the repeat pregnancy rate between adolescent mothers who received medroxyprogesterone and those who did not, Dr. Damle said. She added that this was the only form of contraception administered at the hospital in 2008.

All participated in prenatal care at the institution, including 103 teenagers who participated in Teen Alliance for Prepared Parenting (TAPP), a program specifically aimed at preventing repeat teenage pregnancies. The TAPP cohort, however, did not have a significantly lower rapid repeat pregnancy rate, compared with the non-TAPP group.

The mean age at first delivery was 17.5 years. The majority of first time adolescent mothers, 197 of the 210 (94%), were black. A total 91% had Medicaid or other form of public insurance.

A meeting attendee asked if the lower repeat pregnancy rate for the group who returned for postpartum care within 8 weeks could be due to patient self-selection.

"I don't think my study answers that question," Dr. Damle said. "Those who come in may be more responsible adolescents in starting contraception." The next study is to do an intervention before people leave the hospital, although that is difficult to do without research funding because patients are typically not reimbursed by their insurance for LARC in the hospital setting.

The retrospective cohort design of the study is a potential limitation. She and her colleagues assumed all the adolescent pregnancies were undesired and unplanned, but admitted that may not have been the case in all instances.


Major Finding: In all, 74 of 152 (49%) first-time adolescent mothers had a repeat pregnancy within 2 years.

Data Source: This was a retrospective chart review of adolescent pregnancies at an urban hospital in 2008.

Disclosures: Dr. Damle said she had no relevant financial disclosures.


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Title Annotation:GYNECOLOGY
Author:McNamara, Damian
Publication:OB GYN News
Article Type:Medical condition overview
Date:Aug 1, 2012
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