DEPOT MEDROXYPROGESTERONE ACETATE OR ORAL CONTRACEPTION IN POSTPARTUMADOLESCENTS

Objective: To compare rates of method continuation and repeat pregnanc y among postpartum adolescents selecting depot medroxyprogesterone ace tate or oral contraceptives (OCs). Methods: A retrospective study of 1 61 adolescents aged 19 years and younger who gave birth at an urban te aching hospital between May 1, 1994, and April 30, 1995, returned to t he hospital's family planning clinic within 14 weeks of delivery and c hose depot medroxyprogesterone acetate (n = 111, 69%), or OC (n = 50, 31%) as their postpartum contraceptive method. Most subjects were blac k (99%), single (97%), and on medical assistance (85%). Data were gath ered 12-18 months postpartum (mean +/- standard deviation [SD] 14.5 +/ - 1.6 months) by telephone interview and medical record review. The ma in outcome measures were method continuation and repeat pregnancy. Res ults: The mean (+/- SD) age at delivery was 17.8 +/- 1.4 years. Variab les differentiating subjects selecting depot medroxyprogesterone aceta te or OC included multiparity (34% versus 12%, P < .05), mean age at f irst pregnancy (15.9 versus 16.6 years, P < .05), and mean age at firs t delivery (16.1 versus 16.9 years, P < .05). The survival curves for depot medroxyprogesterone acetate and OC continuation differed signifi cantly (median duration of use 8.1 versus 5.4 months, respectively), b ut the continuation rates at 12 months were similar (34% versus 32%). The survival curves for repeat pregnancy among subjects selecting depo t medroxyprogesterone acetate differed significantly from curves of th ose choosing OC, with repeat pregnancy rates of 15% and 36% by 15 mont hs. Postpartum selection of OC was the only variable entering a Cox re gression model designed to predict repeat pregnancy (relative risk 3.0 , 95% confidence interval 1.4, 6.7). Conclusion: Adolescent mothers ch oosing depot medroxyprogesterone acetate or OC immediately postpartum face similarly high rates of method discontinuation and repeat pregnan cy within 1 year. (C) 1998 by The American College of Obstetricians an d Gynecologists.