Immediate vs delayed postpartum insertion of long-acting reversible contraception methods: meta-analysis of randomized controlled trials - 18/10/24

Doi : 10.1016/j.ajog.2024.09.019

Henrique Provinciatto, MD ^a, Yasmin Jardim Meirelles Dias, MD ^b, Sabrina Lara Abonizio Magdalena, MS ^c, Marcus Vinicius Barbosa Moreira, MS ^d, Lucas Rezende de Freitas, MS ^e, Caroline Cristine Almeida Balieiro, MS ^f, Cristina Aparecida Falbo Guazzelli, PhD ^g, Edward Araujo Júnior, PhD ^g,^⁎
^a Department of Medicine, Barão de Maua University Center, Ribeirão Preto, Brazil
^b Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
^c Department of Medicine, Jundiaí College of Medicine (FMJ), Jundiaí, Brazil
^d Department of Medicine, Potiguar University (UnP), Natal, Brazil
^e Department of Medicine, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
^f Department of Medicine, State University of Amazonas (UEA), Manaus, Brazil
^g Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil

^∗Corresponding author: Edward Araujo Júnior, PhD.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 18 October 2024

Abstract

Objective

We aimed to conduct a meta-analysis of randomized trials comparing the immediate vs delayed provision of long-acting reversible contraceptives in postpartum subjects, focusing on short-interval pregnancies, utilization rates, and adverse events.

Data sources

Cochrane Central, Embase, PubMed, and ClinicalTrials.gov were systematically searched from inception up to December 19, 2023, without filters or language limitation.

Study eligibility criteria

We selected randomized controlled trials assessing the immediate insertion of long-acting reversible contraceptives in women during postpartum period in comparison with the delayed provision.

Study appraisal and synthesis methods

We calculated relative risks with 95% confidence intervals to analyze the primary outcome of utilization rates and secondary endpoints, including initiation rates, pregnancy, any breastfeeding, exclusive breastfeeding, and serious adverse events. A random-effects model was employed in the R software. Moreover, we assessed the risk of bias of selected randomized controlled trials using version 2 of the Cochrane Risk of Bias Assessment Tool.

Results

We included 24 randomized trials comprising 2507 participants, of whom 1293 (51.6%) were randomized to the immediate insertion. Postpartum women in the immediate group had lower risk of pregnancy (relative risk 0.16; 95% confidence interval 0.04–0.71; P=.02) compared with delayed group, and higher rates of long-acting reversible contraceptives at 6 months of follow-up (relative risk 1.23; 95% confidence interval 1.09–1.37; P<.01).

Conclusion

Inserting long-acting reversible contraceptives before hospital discharge was associated with a reduction in the risk of pregnancy, and increased rates of its utilization at 6 months of follow-up. This intervention may be an effective contraception strategy for postpartum women.

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Key words : contraception, contraceptive implant, intrauterine device, long-acting reversible contraception, long-acting reversible contraceptives, postpartum contraception

Plan

Assessment of risk of bias

Data synthesis

Results

Study selection

Study characteristics

Risk of bias of included studies

Synthesis of results

Comment

Principal findings

Comparison with existing literature

Strengths and limitations

Conclusion and implications

	The authors report no conflict of interest.
	This systematic review and meta-analysis was accepted for oral presentation at the XXIX Brazilian Meeting of Gynecology and Obstetrics, organized by the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) in Salvador, Bahia, Brazil, scheduled from May 9 to May 11, 2024.
	Date of PROSPERO registration: August 24, 2023.
	Number of PROSPERO registration: CRD42023454006.