Association Between Adverse Pregnancy Outcomes and Postpartum Contraceptive Method Selection and Use

OBJECTIVE: To evaluate whether adverse pregnancy outcomes are associated with self-reported postpartum contraceptive use and method selection. METHODS: We performed a secondary data analysis of data from the Pregnancy Risk Assessment Monitoring System (phase 8 cohort, 2016–2022). The exposures of interest were adverse pregnancy outcomes, including maternal hypertension, diabetes, preterm birth, prolonged infant hospitalization, and infant death. Contraceptive methods were grouped into four categories: permanent contraception, long-acting reversible contraception, prescription-start methods (patch, ring, pill, or injectable), and patient-start methods (condoms, natural family planning, withdrawal, or abstinence) based on the level of clinical engagement required. We employed multivariable logistic regression to examine the association between adverse pregnancy outcomes and postpartum contraceptive use. Among postpartum contraceptive users, we used multinomial logistic regression to analyze whether adverse pregnancy outcomes influenced method selection. RESULTS: In this analysis of 222,412 individuals, 32.7% of the study sample experienced at least one adverse pregnancy outcome and 77.4% of the sample reported using contraception. In weighted models, experiencing three or more adverse pregnancy outcomes was associated with lower odds of postpartum contraception usage (adjusted odds ratio [aOR] 0.89; 95% CI, 0.82–0.97). Patients who experienced infant death had lower odds of using any postpartum contraception than those who did not (aOR 0.39; 95% CI, 0.33–0.46). We observed no association between experiencing preterm birth, prolonged infant hospitalization, gestational diabetes, or hypertension and postpartum contraceptive use. Among postpartum contraceptive users, experiencing at least one adverse pregnancy outcome was associated with a higher likelihood of using permanent contraception relative to patient-start methods. CONCLUSION: Experiencing an increasing number of adverse pregnancy outcomes was associated with lower odds of postpartum contraceptive use. Adverse pregnancy outcomes were associated with permanent contraception use. Patient-centered contraceptive counseling and shared decision making to support patients in identifying and actualizing their postpartum reproductive goals are necessary in the wake of adverse pregnancy outcomes.