Adverse pregnancy outcomes tied to postpartum contraceptive choices

In seeking to determine whether adverse pregnancy outcomes shaped patients’ contraception use in the postpartum period, investigators of a study published in Obstetrics & Gynecology found multiple associations.

Patients who experienced 3 or more adverse pregnancy outcomes were less likely to use contraception after delivery, and those with at least 1 adverse outcome who did use contraception were more likely to choose a permanent method, the study authors noted.

How were contraceptive methods categorized?

The analysis drew on the Pregnancy Risk Assessment Monitoring System (PRAMS) phase 8 cohort from 2016-2022. Exposures included maternal hypertension, diabetes, preterm birth, prolonged infant hospitalization, and infant death.

Based on the level of clinical engagement each requires, contraceptive methods were sorted into 4 groups: permanent contraception, long-acting reversible contraception, prescription-start methods (patch, ring, pill, or injectable), and patient-start methods (condoms, natural family planning, withdrawal, or abstinence). The investigators used multivariable logistic regression to assess links between adverse pregnancy outcomes and postpartum contraceptive use. Among contraceptive users, they applied multinomial logistic regression to evaluate method selection.

Infant death linked to sharply lower contraceptive use

Of the 222,412 individuals in the analysis, 32.7% had at least 1 adverse pregnancy outcome, and 77.4% reported using contraception. In weighted models, having 3 or more adverse pregnancy outcomes was associated with lower odds of postpartum contraceptive use (adjusted odds ratio [aOR] 0.89; 95% CI, 0.82–0.97). Patients whose infant died had lower odds of using any postpartum contraception than those whose infant survived (aOR 0.39; 95% CI, 0.33–0.46).

Preterm birth, prolonged infant hospitalization, gestational diabetes, and hypertension each showed no association with postpartum contraceptive use. Among patients who did use contraception, having at least 1 adverse pregnancy outcome was associated with a higher likelihood of choosing permanent contraception over patient-start methods.

According to the authors, patients who have experienced adverse pregnancy outcomes need patient-centered contraceptive counseling and shared decision-making to help them identify and act on their postpartum reproductive goals.

Reference:

Trompeter GA, Miller VE, Arora KS. Association between adverse pregnancy outcomes and postpartum contraceptive method selection and use. Obstet Gynecol. Published online November 10, 2026. doi:10.1097/AOG.0000000000006461