Pregnancy intentions and contraception after a miscarriage

According to a new study in Contraception, patients with unplanned pregnancy who miscarried were twice as likely to use contraception as those with planned pregnancy. The authors noted, however, that pregnancy intentions sometimes changed after miscarriage.

The study analyzed 244 participants with available contraceptive outcomes using data from a multicenter, randomized, controlled trial of medical management regimens for miscarriage between 5 and 12 completed weeks. 

The researchers measured pregnancy intention via patient report after miscarriage diagnoses. Participants were offered contraception once their miscarriage was completed.

One hundred twenty-one participants (50%) noted that the pregnancy was planned and 219 (90%) participants planned to continue the pregnancy to term.

Of the participants, 97 (40%) initiated contraception with varied methods: 44 (18%) chose to implement short-acting reversible methods and 20 (8%) used condoms or emergency contraception. One hundred forty-seven participants (60%) declined contraception after their miscarriage was completed.

According to the study, unplanned pregnancy (aRR 2.13, 95% CI 1.45-3.13.) and lack of intention to continue the pregnancy (aRR 1.61, 95% CI: 1.18-2.20) were independently associated with the implementation of contraception.

Of the 147 (60%) participants that declined contraception after miscarriage, 85 (57%) did so in order to conceive again. The researchers noted that nearly a quarter of participants who declined contraception said that their pregnancy was unplanned, but following the miscarriage, planned to conceive again.

The authors concluded that their results underscore the importance of clarifying pregnancy goals and providing counseling on contraception. The study also calls for further research into the best ways to measure pregnancy intention and its relationship to the experience of miscarriage.