TOPLINE

People with sickle cell disease (SCD) had 82% higher odds of receiving immediate postpartum long-acting reversible contraception (LARC) than those without SCD in a study.

METHODOLOGY

• A cross-sectional study analyzed 29,822,518 delivery hospitalizations from the 2012-2019 National Inpatient Sample, including 18,860 deliveries among people with SCD and 29,803,658 among people without SCD.
• Researchers evaluated rates of immediate postpartum LARC uptake (intrauterine device or contraceptive implant) during delivery admissions for live births and stillbirths among individuals aged 12-55 years. A subanalysis restricted to deliveries among Black individuals was also conducted.
• Multivariate logistic regression adjusted for maternal age, delivery mode, presence of severe maternal morbidity, insurance type, median household income, region, hospital type, and calendar year.

TAKEAWAY

• People with SCD had a threefold higher unadjusted rate of immediate postpartum LARC uptake during the study period compared with those without SCD (16.4 vs 4.7 per 1000 deliveries; P < .001).
• After adjusting for clinical and demographic factors, people with SCD had 82% higher odds of receiving immediate postpartum LARC than those without SCD (adjusted odds ratio [aOR], 1.82; P < .001).
• Among Black individuals, SCD was associated with 44% higher adjusted odds of immediate postpartum LARC use.
• Severe maternal morbidity (aOR, 1.49; P < .05), cesarean delivery (aOR, 1.25; P < .001), and delivery at an urban teaching hospital (aOR, 10.30; P < .001) were also linked to higher LARC uptake.

IN PRACTICE

"Given the observed increased uptake of highly effective immediate postpartum contraception options, including LARC, among people with SCD, this study invites the opportunity for future research and implementation work to evaluate whether this contraceptive strategy represents noncoercive, high-quality contraceptive care," the authors wrote.

SOURCE

The study was led by Preetha Nandi, MD, MPH, Tufts Medical Center, Boston. It was published online on July 16 in O&G Open.

LIMITATIONS

The study could not adjust for all potential confounders including education level, prenatal care engagement, obesity, emergency delivery, or hospital religious affiliation. Coding limitations may reflect lack of service availability rather than nonuse of immediate postpartum LARC. The study period intersected with policy changes in unbundling payments for immediate postpartum LARC provision, which may have differentially affected hospital systems.

DISCLOSURES

The study was supported by the Society of Family Planning, the National Institute of Mental Health, and the National Heart, Lung, and Blood Institute. Nandi reported receiving research support from the Society of Family Planning. Other authors also reported receiving research support from a NIMH, NIH, and ort from multiple organizations, and serving as a consultant for several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.