Reproductive Health| Volume 28, ISSUE 5, P393-400, September 2018

Increasing IUD and Implant Use Among Those at Risk of a Subsequent Preterm Birth: A Randomized Controlled Trial of Postpartum Contraceptive Counseling



      To assess the impact of contraceptive counseling on the uptake of long-acting reversible contraception (LARC), namely, intrauterine devices and the contraceptive implant, by 3 months postpartum among women with a recent preterm birth.


      We enrolled patients in a single-blinded, one-to-one, randomized, controlled trial to assess the impact of enhanced family planning counseling immediately after a viable preterm birth in the inpatient setting. Participants received either structured counseling with an emphasis on LARC by a family planning specialist (intervention) or routine postpartum care (control). We followed participants to the primary outcome of LARC use 3 months postpartum.


      We followed 121 participants for 3 months. Primary outcome data were available for 119 participants (61 intervention, 58 control). We found no demographic differences between the groups. Participants in the intervention group were significantly more likely to use LARC at 3 months postpartum compared with controls (51% vs. 31%; p < .05). For every six women who received the counseling intervention, one additional woman was using a LARC method at 3 months.


      After a preterm birth, brief LARC-focused, structured counseling before hospital discharge significantly increased LARC method use at 3 months postpartum.
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      Leah N. Torres, MD, MS, is a generalist obstetrician/gynecologist practicing in Salt Lake City, Utah. She completed her Family Planning Fellowship at the University of Utah in 2014 and has special interest and focus in this area of her practice.


      David K. Turok, MD, MPH, an Associate Professor of Obstetrics and Gynecology at the University of Utah, directs the Family Planning Division. He is an active clinician, educator, and researcher focused on improving access to and developing new methods of contraception.


      Erin A. S. Clark, MD is an Associate Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center. She serves as Chief of the Division of Maternal-Fetal Medicine. Her research focuses on preterm birth and neurodevelopmental sequelae.


      Jessica N. Sanders, PhD, MSPH, is an Assistant Professor in the Department of Obstetrics and Gynecology at the University of Utah. She is the Director of Family Planning Research.


      Emily M. Godfrey, MD, MPH, is an Associate Professor of Family Medicine and Obstetrics and Gynecology at the University of Washington. She graduated from the University of Rochester Family Planning Fellowship in 2003. Her research interests include contraceptive counseling in the clinical setting.