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News|Articles|June 25, 2024

Study shows low pregnancy risk with same-day contraceptive initiation

A recent study found that starting contraceptives on the same day of consultation poses a low pregnancy risk, offering a viable option to reduce unintended pregnancies.

Same-day contraceptive initiation has low pregnancy risk, according to a recent study published in the American Journal of Obstetrics & Gynecology.1

Takeaways

  1. Initiating contraceptives on the same day of consultation has a low pregnancy risk, making it a safe option for preventing unintended pregnancies.
  1. The practice of same-day contraceptive initiation is becoming more prevalent, with data supporting its safety and effectiveness across various contraceptive methods.
  1. The study involved a control period followed by an intervention period, with over 4,400 participants, highlighting the effectiveness of removing out-of-pocket costs and stocking all contraceptive methods.
  1. The study focused on first-cycle pregnancy risk and same-day start across different contraceptive methods, with oral contraceptives showing the highest risk at 1%.
  1. The findings suggest that clinicians can confidently offer same-day contraceptive initiation, using their best clinical judgment to provide reproductive health care.

According to the Centers for Disease Control and Prevention, approximately 45% of US pregnancies are unintended.2 Unintended pregnancies are associated with increased risks of adverse maternal and infant outcomes, making strategies to prevent them vital.

Traditionally, contraceptive use begins within the first 7 days of the menstrual cycle, meaning patients have to wait for the next cycle after those 7 days.1 While this practice is utilized to reduce the risk of a luteal-phase pregnancy, researcher have reported the use of same-day start, where the birth control method is used regardless of the last menstrual period (LMP).

The method of contraceptive initiation at any time has become more prevalent, with data indicating low pregnancy risk. However, more information is necessary to determine outcomes of same-day contraceptive initiation across multiple contraception methods.

Investigators conducted a study to evaluate pregnancy risk by all contraceptive methods initiated among same-day start users. At the start of the study, a 6-month control period occurred where patients received usual care at 3 Title X sites, while a fourth site did not provide Title X support but had no-cost implants available.1

The control period was followed by a 12-month intervention period where all out-of-pocket costs were removed for contraception and all contraception methods received adequate stocking. Additionally, clients were able to discontinue or switch methods for up to 3 years following initial care.

Eligible participants were invited to participate in the 3-year prospective study. There were 4425 participants enrolled in this trial, aged 18 to 45 years and with a desire for at least 1 year of pregnancy prevention, a mobile phone, and income under 300% of the federal poverty level.

Data was obtained about participant age, race, prior contraceptive use, parity, LMP date, socioeconomic characteristics, unprotected or underprotected intercourse in the previous 2 weeks, and oral emergency contraception (EC) use.1

Contraceptive categories included etonogestrel contraceptive implant, copper T380A intrauterine device (IUD), levonorgestrel 52-mg IUD, medroxyprogesterone acetate injection, oral hormonal contraception, and combined vaginal hormonal contraception.

Same-day start of contraceptive use and first-cycle pregnancy risk across all pregnancy methods were the primary outcomes reported. Secondary outcomes included same-day start and first-cycle pregnancy risk for each contraceptive method, oral EC receipt, and frequency of unprotected intercourse (UPI) within 5 days and 6 to 14 days of initiation.

There were 3568 participants included in the final analysis, 2575 of whom used the same-day start method and 993 started within the first 7 days of their menstrual cycle. Of patients taking oral contraceptives, 920 used combined oral hormonal contraceptive pills and 50 progesterone-only pills.1

Pregnancy was reported among 0.4% of same-day start users vs 0.1% of those starting within 7 days from LMP. Oral contraceptive same-day start users had the highest risk at 1%, with 1 of these patients being a progesterone-only pill user. Among all IUD and implant users, only 1 patient who was a same-day implanter user reported pregnancy.

At least 1 UPI episode was reported in 20.1% of patients. Additionally, 2.3% of patients with UPI in the 5 days before enrollment that used oral EC reported pregnancy, which is consistent with previously reported EC failure rates.

These results indicated low pregnancy risk among patients with same-day start contraceptive initiation. Investigators concluded clinicians should use their best clinical judgement when providing reproductive health care.1

Reference

  1. Torres E, Carter G, Gero A, et al. Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods. Am J Obstet Gynecol. 2024;230:661.e1-7.doi:10.1016/j.ajog.2024.02.014
  2. Curtis KM, Jatlaoui TC, Tepper NK, et al. US selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(No. RR-4):1–66. doi:10.15585/mmwr.rr6504a1

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