To investigate the prevalence of hormonal contraindications in postpartum women.
A prospective cohort study from 8 Texas hospitals recruited low-income postpartum women who planned to delay childbearing for at least two years after delivery. According to the Centers for Disease Control and Prevention’s 2016 Medical Eligibility Criteria for Contraceptive Use, women self-reported health issues that corresponded to category 3 and 4 contraindications to combination hormonal contraception and progestin-only methods. Researchers used mixed-effects Poisson regression models to examine the factors associated with reporting any contraindications 6 months after delivery. They looked at the percentage of women who utilized a contraindicated approach.
19.1 percent of the 1,452 women who completed the 6-month interview indicated a category 3 or 4 contraindication to combination hormonal contraception, while 5.4% reported a contraindication to depot medroxyprogesterone acetate. Only 0.8% had a category 3 or 4 contraindication to progestin-only tablets, and 0.6% had a category 3 or 4 contraindication to the implant. The most prevalent contraindications were migraine with aura and hypertension. Women who were 30 years or older (prevalence ratio 1.45 95% CI 1.21–1.73), overweight (prevalence ratio 1.39, 95% CI 1.07–1.80), obese (prevalence ratio 1.55, 95% CI 1.16–2.07), and insured (prevalence ratio 1.34, 95% CI 1.04–1.74) had a greater prevalence of any contraindication. Contraindications were more common in Black women (prevalence ratio 1.37, 95% CI 1.14–1.64) than in the U.S.-born Latina women (prevalence ratio 0.71, 95% CI 0.59–0.86), but less common in foreign-born Latina women. Among women with contraindications, 28 (10.3%) were using combination hormonal contraception; six (8%) were utilizing a contraindicated progestin-only technique.
Almost one in every five individuals reported a contraindication to combination hormonal contraception in category 3 or 4. Contraindications are more common in patients who are at a higher risk of bad birth outcomes.