Tackling Recurrent Pregnancy in Adolescents Through Postpartum Contraception Counseling [ID 1487]

INTRODUCTION: Postpartum contraceptive (PPC) choices are known to affect recurrent pregnancy rates. We examine the effect of PPC choices in adolescents on recurrent pregnancy rates. METHODS: This was a retrospective cohort study of delivering adolescents in a single health system between May 1, 2013, and April 30, 2023. Adolescents (age 10–17) delivering after 20 weeks were included. Patients missing PPC data were excluded. Demographic and pregnancy-related variables and PPC choice were abstracted from the electronic medical record. Exposure of interest was PPC: long-acting reversible contraceptive (LARC) (intrauterine device [IUD], Nexplanon), hormonal (HC: combined hormonal methods, depo injections, and progesterone-only pills), and nonhormonal (NHC: condoms, abstinence, none). Primary outcome was recurrent pregnancy before age 18 (RAP). Secondary outcomes include short interpregnancy interval (SIP), median interpregnancy interval (MIPI), and MIPI under 18. Bivariate statistics were used for data analysis. Regression models controlled for confounders. RESULTS: Of 395 patients with contraception data, only race/ethnicity correlated with PPC choice. Black adolescents selected HC over LARC over NHC ( P =.009). Latinx adolescents selected NHC over LARC over HC ( P =.006). No other demographic, obstetric, or intrapartum factors correlated with PPC choice. Overall, SIP was less common among LARC users (23.8% versus HC: 79.4% versus NHC: 66.7%; P <.001), with longer MIPI among LARC users (32.5 months) versus HC (24.0) versus NHC (32.0) ( P =.007). Individuals experiencing RAP (n=61, 15%) had no differences between PPC methods. However, PPC choice affected MIPI among RAP patients (LARC, 21.0 months; HC, 10.5 months; NHC, 14.5 months) ( P <.001). After controlling for race/ethnicity, RAP was not associated with PPC choice. Compared to LARC, HC users were 17.7-fold more likely to experience SIP (95% CI, 2.86, 109), with 9.3-month shorter MIPI (95% CI, −16.0, −2.69). CONCLUSIONS/IMPLICATIONS: Pregnant adolescents choosing postpartum LARC experienced fewer SIPs and longer MIPIs. Given RAP implications, LARC should be recommended post-delivery. Further research is needed to improve PPC counseling and identify barriers to LARC use.