Postpartum contraceptive use among adolescent mothers

Objective: To compare the incidence of repeat pregnancy and method continua tion rate at 12 months postpartum in young women who chose either depot med roxyprogesterone acetate or oral contraceptives (OCs) as contraception. Methods: We conducted a prospective cohort study of 122 postpartum women yo unger than 18 years of age who delivered between January 8, 1997 and Decemb er 31, 1997. patients choosing depot medroxyprogesterone acetate (n = 76) a nd OCs (n = 46) were accrued for 12 months and were followed-up for a minim um of 12 months. Main outcome measures were median contraceptive method con tinuation and the incidence of repeat pregnancy at 12 months postpartum. Results: There was no difference in mean age at delivery (P = .47), parity (P = .84), or gravidity (P = .78) between depot medroxyprogesterone acetate and OC users. At 12 months postpartum, 27.4% of OC users and 55.3% of depo t medroxyprogesterone acetate users were still using contraception. Median time to contraceptive discontinuation was longer for those choosing depot m edroxyprogesterone acetate compared with OCs (17.8 vs 7.4 months, respectiv ely, P = .002). The overall incidence of repeat pregnancy at 12 months post partum was 10.6%. Among OC and depot medroxyprogesterone acetate users, res pectively, 24% and 2.6% became pregnant again, producing a relative risk (R R) of 9.09 (95% confidence interval [CI] 2.1, 39.2) for repeat pregnancy am ong OC users. The mean time to repeat pregnancy (this was reported instead of the median time whenever the pregnancy rate had not reached 50% at the e nd of the follow-up period) was longer for depot medroxyprogesterone acetat e compared with OC users (17.1 months vs 13.2 months, respectively, P < .00 1). Conclusion: Adolescent mothers using depot medroxyprogesterone acetate inje ction for contraception have a higher method continuation rate and a lower incidence of repeat pregnancy at 12 months postpartum than those selecting OCs during the same period. (C) 2000 by The American College of Obstetricia ns and Gynecologists.