Twenty-four-month continuation of reversible contraception.
Twenty-four-month continuation of reversible contraception.
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DOI：
10.1097/aog.0b013e3182a91f45
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发表时间：
2013-11
影响因子：
7.2
通讯作者：
Secura G
中科院分区：
文献类型：
--
作者：
O'Neil-Callahan M;Peipert JF;Zhao Q;Madden T;Secura G
估计参加避孕选择项目的妇女所有可逆避孕方法的24个月持续率。我们分析了参加避孕选择项目的9，256名参与者的24个月数据，该项目是一项前瞻性观察性队列研究，为圣路易斯地区的女性提供免费避孕。该项目推广使用长效可逆避孕（LARC;宫内避孕器（IUD）和植入物），以努力降低意外怀孕率。该分析包括在入组后3个月内接受基线避孕方法并完成24个月随访调查的参与者（n= 6，153）。LARC和非LARC方法的24个月持续率分别为77%和41%。左炔诺孕酮和铜宫内节育器的继续使用率相似（79%对77%），而在24个月时植入继续使用率显著低于宫内节育器（69%，p<0.001）。四种非LARC方法之间的24个月持续率无统计学显著差异（口服避孕药43%，贴剂40%，环41%，长效醋酸甲羟孕酮（DMPA）38%，p=0.72）。与选择非LARC方法的女性相比，在入组时选择LARC方法的参与者避孕方法中止的风险显著降低（调整后的风险比=0.29，95%置信区间0.26，0.32）。宫内节育器和植入物在24个月时的持续率最高。鉴于其有效性和高续用率，宫内节育器和植入物应作为一线避孕选择，而OCP、贴片、环和DMPA等短效方法应作为二线避孕选择。
To estimate 24-month continuation rates of all reversible contraceptive methods for women enrolled in the Contraceptive CHOICE Project. We analyzed 24-month data from the 9,256 participants enrolled in the Contraceptive CHOICE Project, a prospective observational cohort study that provides no-cost contraception to women in the St. Louis region. The project promoted the use of long-acting reversible contraception (LARC; intrauterine devices (IUDs) and implants) in an effort to reduce the rates of unintended pregnancy. This analysis includes participants who received their baseline contraceptive method within 3 months of enrollment and who completed a 24-month follow-up survey (n=6,153). Twenty-four month continuation rates for LARC and non-LARC methods were 77% and 41%, respectively. Continuation rates for the levonorgestrel and the copper IUDs were similar (79% versus 77%), whereas the implant continuation rate was significantly lower (69%, p<0.001) compared to IUDs at 24 months. There was no statistically significant difference in 24-month continuation rates among the four non-LARC methods (oral contraceptive pill 43%, patch 40%, ring 41%, depot medroxyprogesterone acetate (DMPA) 38%, p=0.72). Participants who chose a LARC method at enrollment were at significantly lower risk of contraceptive method discontinuation (adjusted hazard ratio=0.29, 95% confidence interval 0.26, 0.32) compared with women who selected a non-LARC method. IUDs and the implant have the highest rates of continuation at 24-months. Given their effectiveness and high continuation rates, IUDs and implants should be first-line contraceptive options and shorter-acting methods such as OCPs, patch, ring, and DMPA should be second tier.