One-year follow-up of immediate postpartum contraceptive implant insertion in adolescents

Abstract

Purpose

Our study aimed to evaluate the acceptability, adverse effects and continuation rates among adolescents who accepted the etonogestrel (ENG) subdermal implant and compared to adolescents who chose other methods during the immediate postpartum period before hospital discharge, with one year follow-up up.

Materials and methods

We conducted a cohort non-randomised study at the Women’s Hospital, University of Campinas. All women up to 19 years of age, who gave birth at the hospital between July 2019 and April 2020, were invited to participate and were offered the ENG-implant or the routine contraceptive methods. They were followed for one year postpartum.

Results

We included 100 teenagers and 72 accepted the ENG-implant. Students are more likely to accept the ENG-implant than non-students (PR: 1.25 [95%CI 0.99–1.59]). Up to one year of follow-up, survival analysis showed that the time of adherence to the method was longer for the ENG-implant users (p = 0.0049). More than 90% of the adolescents were satisfied with the implant; however, five requested early removal due to menstrual irregularity and local discomfort.

Conclusion

Provision ENG-implant for adolescents in the immediate postpartum demonstrated high acceptance and ensured effective contraception. After one year, most of them were satisfied, with a high continuation rate and without unplanned pregnancies.

摘要

目的：我们的研究旨在评估接受依托孕烯(ENG)皮下植入的青少年的接受程度、不良反应和继续植入率, 并与选择其他避孕方法的青少年在产后出院前进行比较, 并进行一年的随访。

材料与方法：我们在坎皮纳斯大学妇女医院进行了一项非随机队列研究。 2019年7月至2020年4月期间在该医院分娩的所有19岁以下的妇女都被邀请参加, 并进行依托孕烯皮下植入或常规避孕方法。产后随访一年。

结果：研究包括100名青少年, 其中72名接受了依托孕烯(ENG)皮下植入。学生比非学生更容易接受植入物(PR:1.25[95%CI0.99-1.59])。在长达一年的随访中, 生存分析显示依托孕烯皮下植入使用者坚持该方法的时间更长(P=0.0049)。90%以上的青少年对皮下植入物满意； 但有5例因月经不规律、局部不适要求提前摘除。

结论：在产后即刻为青少年提供依托孕烯皮下植入可获得较高的接受度, 确保有效避孕。 一年后, 多数患者满意, 延续率高, 无计划外妊娠。

Keywords:

• Adolescents
• postpartum
• contraception
• etonogestrel subdermal implant
• unplanned pregnancy

Author contributions

MMB, FGS, LB, CRTJ and SSM contributed to the overall study design and specific methodologies. MMB, ADS, LSC and FGS conducted clinical activities, such as insertion of implants and all follow-ups for one year postpartum. FGS and LB were responsible for funding acquisition. MMB, SSM and FGS wrote the first draft. All authors contributed to the approval of the final version for submission.

Disclosure statement

Luis Bahamondes received honoraria for lectures and Board members from Bayer and MSD. The other authors have declared that no competing interests exist.

Additional information

Funding

This study received financial support from the Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) award 2018/20868-9. The study also was partially funded by MSD (Oss, The Netherland), award # IISP #58581.

The institutions which provided financial support for the conduct of this research do not have any participation in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.