Current evidence of contraceptive uptake, pregnancy and continuation rates in young women: a systematic review and Meta-analysis

Abstract

Objective

Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents.

Methods

Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only.

Results

At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I² = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I² = 99%). Pregnancy during LARC use was rare.

Conclusion

LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality.

PROSPERO registration number

CRD42017055452.

摘要

目的：全世界有一半的怀孕是意外怀孕, 在≤25岁女性中这一比例更高。我们试图确定哪种避孕方法是预防年轻女性和青少年意外怀孕最有效的方法。

方法：系统检索PubMed、Embase、Lilacs和Cochrane数据库, 无语言限制, 检索时间自建立起至2020年7月。对观察性研究和随机对照试验的全文文章进行了筛选和综述, 比较了年轻女性和青少年中应用长效可逆避孕药（LARC）和短效可逆避孕药（SARC）的多种方法。风险比（RRs）和其95%的置信区间（CI）的均值差异是通过随机效应分析模型得出。荟萃分析提供了对年轻女性和青少年中LARC方法的不良反应、持续率和疗效的汇总估计。纳入的25项研究中有9项比较了LARC和SARC, 16项仅比较了LARC方法。

结果：12个月时, 年轻女性LARC的依从性优于SARC（n=1606；RR 1.60; 95% CI 1.21, 2.12; I2=88%）, 这表明对年轻女性有更好的预防意外怀孕的效果。然而, 更多的年轻女性选择了SARC（n=2835; RR 0.37；95% CI 0.17, 0.80; I2=99%）。LARC应用期间怀孕是罕见的。

结论：如果女性以预防妊娠为主, 应提前告知LARC方法是预防妊娠最有效的方法。然而证据的质量很低。

Keywords:

• Adolescent
• contraception
• meta-analysis
• treatment outcome
• young women

Disclosure statement

No potential conflict of interest was reported by the author(s).