Gretchen Stuart, MD, MPH - Division of Women's Primary Healthcare
Unintended pregnancies account for 50% of all pregnancies in the U.S. One approach to decrease this high rate of unintended pregnancies is to provide contraception at opportune times for women such as immediately postpartum. The levonorgestrel-releasing intrauterine system (LNG-IUS) is particularly promising because it is popular, and highly effective. However, barriers to increased postpartum use of the LNG-IUS include data, and theoretical and biological plausibility, suggesting that LNG-IUS use immediately postpartum may be associated with decreased breastfeeding prevalence compared to women who receive LNG-IUS at the postpartum visit.
We propose a randomized controlled trial to compare breastfeeding outcomes in women who receive the LNG-IUS after birth but prior to leaving the hospital to women who receive the LNG-IUS at the postpartum visit 4-6 weeks after birth.
Specific Aim 1: To assess and compare the prevalence of women breastfeeding 6 months after birth, with LNG-IUS placement occurring; 1) after transfer to the postpartum floor, but prior to discharge from the hospital; or 2) at the “standard” postpartum office visit 4-6 weeks later.
Specific Aim 2: To compare the proportions of women in each group who have an LNG-IUS in place at 6 months. To explore which characteristics at baseline, or at the time of insertion, are associated with having an LNG-IUS in place at the 6-month study visit. To report the proportions of women in each group whose LNG-IUS expulsed and to further evaluate what characteristics may be associated with expulsion.
Our proposal is highly relevant to the stated research priorities for the Society of Family Planning Grant Cycle for 2011. The results of our study, whether they are positive or negative, will inform practice, and future research endeavors, of immediate postpartum LNG-IUS.