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Long-acting reversible contraception in adolescents: a systematic review and meta-analysis

Published:December 27, 2016DOI:https://doi.org/10.1016/j.ajog.2016.12.024

      Background

      Among adolescent pregnancies, 75% are unintended. Greater use of highly-effective contraception can reduce unintended pregnancy. Although multiple studies discuss adolescent contraceptive use, there is no consensus regarding the use of long-acting reversible contraception as a first-line contraception option.

      Objective

      We performed a systematic review of the medical literature to assess the continuation of long-acting reversible contraceptives among adolescents.

      Study Design

      Ovid-MEDLINE, Cochrane databases, and Embase databases were searched using key words relevant to the provision of long-acting contraception to adolescents. Articles published from January 2002 through August 2016 were selected for inclusion based on specific key word searches and detailed review of bibliographies. For inclusion, articles must have provided data on method continuation, effectiveness, or satisfaction of at least 1 long-acting reversible contraceptive method in participants <25 years of age. Duration of follow-up had to be ≥6 months. Long-acting reversible contraceptive methods included intrauterine devices and the etonogestrel implant. Only studies in the English language were included. Guidelines, systematic reviews, and clinical reviews were examined for additional citations and relevant points for discussion. Of 1677 articles initially identified, 90 were selected for full review. Of these, 12 articles met criteria for inclusion. All studies selected for full review were extracted by multiple reviewers; inclusion was determined by consensus among authors. For studies with similar outcomes, forest plots of combined effect estimates were created using the random effects model. The meta-analysis of observational studies in epidemiology guidelines were followed. Primary outcomes measured were continuation of method at 12 months, and expulsion rates for intrauterine devices.

      Results

      This review included 12 studies, including 6 retrospective cohort studies, 5 prospective observational studies, and 1 randomized controlled trial. The 12 studies included 4886 women age <25 years: 4131 intrauterine device users and 755 implant users. The 12-month continuation of any long-acting reversible contraceptive device was 84.0% (95% confidence interval, 79.0–89.0%). Intrauterine device continuation was 74.0% (95% confidence interval, 61.0–87.0%) and implant continuation was 84% (95% confidence interval, 77.0–91.0%). Among postpartum adolescents, the 12-month long-acting reversible contraceptive continuation rate was 84.0% (95% confidence interval, 71.0–97.0%). The pooled intrauterine device expulsion rate was 8.0% (95% confidence interval, 4.0–11.0%).

      Conclusion

      Adolescents and young women have high 12-month continuation of long-acting reversible contraceptive methods. Intrauterine devices and implants should be offered to all adolescents as first-line contraceptive options.

      Key words

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      References

        • Martinez G.
        • Copen C.E.
        • Abma J.C.
        Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 National Survey of Family Growth.
        Vital Health Stat 23. 2011; 23: 1-35
        • Finer L.B.
        • Zolna M.R.
        Declines in unintended pregnancy in the United States, 2008-2011.
        N Engl J Med. 2016; 374: 843-852
        • Hamilton B.E.
        • Mathews T.J.
        Continued declines in teen births in the United States, 2015.
        NCHS Data Brief. 2016; : 1-8
      1. United Nations. Demographic yearbook 2013. Sixty-four. New York; 2014. Available at: http://unstats.un.org/unsd/demographic/products/dyb/dyb2009-2010.htm. Accessed March 2, 2015.

        • Jeha D.
        • Usta I.
        • Ghulmiyyah L.
        • Nassar A.
        A review of the risks and consequences of adolescent pregnancy.
        J Neonatal Perinatal Med. 2015; 8: 1-8
        • Daniels K.
        • Daugherty J.
        • Jones J.
        Current contraceptive status among women aged 15-44: United States, 2011-2013.
        NCHS Data Brief. 2014; : 1-8
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • et al.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 2012; 366: 1998-2007
        • Committee on Adolescent Health Care Long-Acting Reversible Contraception Working Group, the American College of Obstetricians and Gynecologists
        Adolescents and long-acting reversible contraception: implants and intrauterine devices. Committee opinion no. 539.
        Obstet Gynecol. 2012; 120: 983-988
        • Committee on Adolescence
        Contraception for adolescents.
        Pediatrics. 2014; 134: e1244-e1256
        • Curtis K.M.
        • Tepper N.K.
        • Jatlaoui T.C.
        • et al.
        US medical eligibility criteria for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1-103
        • Curtis K.M.
        • Jatlaoui T.C.
        • Tepper N.K.
        • et al.
        US selected practice recommendations for contraceptive use, 2016.
        MMWR Recomm Rep. 2016; 65: 1-66
        • Gavin L.
        • Moskosky S.
        • Carter M.
        • et al.
        Providing quality family planning services: recommendations of CDC and the US Office of Population Affairs.
        MMWR Recomm Rep. 2014; 63: 1-54
        • Stroup D.F.
        • Berlin J.A.
        • Morton S.C.
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group.
        JAMA. 2000; 283: 2008-2012
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377-384
        • Alton T.M.
        • Brock G.N.
        • Yang D.
        • Wilking D.A.
        • Hertweck S.P.
        • Loveless M.B.
        Retrospective review of intrauterine device in adolescent and young women.
        J Pediatr Adolesc Gynecol. 2012; 25: 195-200
        • Aoun J.
        • Dines V.A.
        • Stovall D.W.
        • Mete M.
        • Nelson C.B.
        • Gomez-Lobo V.
        Effects of age, parity, and device type on complications and discontinuation of intrauterine devices.
        Obstet Gynecol. 2014; 123: 585-592
        • Garbers S.
        • Haines-Stephan J.
        • Lipton Y.
        • Meserve A.
        • Spieler L.
        • Chiasson M.A.
        Continuation of copper-containing intrauterine devices at 6 months.
        Contraception. 2013; 87: 101-106
        • Godfrey E.M.
        • Memmel L.M.
        • Neustadt A.
        • et al.
        Intrauterine contraception for adolescents aged 14-18 years: a multicenter randomized pilot study of levonorgestrel-releasing intrauterine system compared to the copper T 380A.
        Contraception. 2010; 81: 123-127
        • Guazzelli C.A.F.
        • de Queiroz F.T.
        • Barbieri M.
        • Torloni M.R.
        • de Araujo F.F.
        Etonogestrel implant in postpartum adolescents: bleeding pattern, efficacy and discontinuation rate.
        Contraception. 2010; 82: 256-259
        • Rosenstock J.R.
        • Peipert J.F.
        • Madden T.
        • Zhao Q.
        • Secura G.M.
        Continuation of reversible contraception in teenagers and young women.
        Obstet Gynecol. 2012; 120: 1298-1305
        • Teal S.B.
        • Sheeder J.
        IUD use in adolescent mothers: retention, failure and reasons for discontinuation.
        Contraception. 2012; 85: 270-274
        • Cohen R.
        • Sheeder J.
        • Arango N.
        • Teal S.B.
        • Tocce K.
        Twelve-month contraceptive continuation and repeat pregnancy among young mothers choosing post-delivery contraceptive implants or postplacental intrauterine devices.
        Contraception. 2016; 93: 178-183
        • Teal S.B.
        • Romer S.E.
        • Goldthwaite L.M.
        • Peters M.G.
        • Kaplan D.W.
        • Sheeder J.
        Insertion characteristics of intrauterine devices in adolescents and young women: success, ancillary measures, and complications.
        Am J Obstet Gynecol. 2015; 213: 515.e1-515.e5
        • Tocce K.M.
        • Sheeder J.L.
        • Teal S.B.
        Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?.
        Am J Obstet Gynecol. 2012; 206: 481.e1-481.e7
        • Berlan E.
        • Mizraji K.
        • Bonny A.E.
        Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting.
        Contraception. 2016; 94: 81-86
        • Gemzell-Danielsson K.
        • Buhling K.J.
        • Dermout S.M.
        • Lukkari-Lax E.
        • Montegriffo E.
        • Apter D.
        A phase III, single-arm study of LNG-IUS 8, a low-dose levonorgestrel intrauterine contraceptive system (total content 13.5 mg) in postmenarcheal adolescents.
        Contraception. 2016; 93: 507-512
        • Tocce K.
        • Sheeder J.
        • Python J.
        • Teal S.B.
        Long acting reversible contraception in postpartum adolescents: early initiation of etonogestrel implant is superior to IUDs in the outpatient setting.
        J Pediatr Adolesc Gynecol. 2012; 25: 59-63
        • Madden T.
        • McNicholas C.
        • Zhao Q.
        • Secura G.M.
        • Eisenberg D.L.
        • Peipert J.F.
        Association of age and parity with intrauterine device expulsion.
        Obstet Gynecol. 2014; 124: 718-726
        • Frieden T.R.
        • Jaffe H.W.
        • Richards C.L.
        • et al.
        Providing quality family planning services. Centers for Disease Control and Prevention; MMWR Editorial and Production Staff (Serials) MMWR Editorial Board.
        Recomm Reports. 2014; 63
        • Krashin J.
        • Tang J.H.
        • Mody S.
        • Lopez L.M.
        Hormonal and intrauterine methods for contraception for women aged 25 years and younger.
        Cochrane Database Syst Rev. 2015; 8: CD009805
        • Deans E.I.
        • Grimes D.A.
        Intrauterine devices for adolescents: a systematic review.
        Contraception. 2009; 79: 418-423
        • Usinger K.M.
        • Gola S.B.
        • Salas M.
        • Smaldone A.
        Intrauterine contraception continuation in adolescents and young women: a systematic review.
        J Pediatr Adolesc Gynecol. 2016; 29: 659-667
        • Sivin I.
        • el Mahgoub S.
        • McCarthy T.
        • et al.
        Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study.
        Contraception. 1990; 42: 361-378
        • Goldman J.A.
        • Dekel A.
        • Reichman J.
        Immediate postabortion intrauterine contraception in nulliparous adolescents.
        Isr J Med Sci. 1979; 15: 522-525
        • Chiles D.P.
        • Roberts T.A.
        • Klein D.A.
        Initiation and continuation of long-acting reversible contraception in the United States military healthcare system.
        Am J Obstet Gynecol. 2016; 215: 328.e1-328.e9
        • Berenson A.B.
        • Tan A.
        • Hirth J.M.
        • Wilkinson G.S.
        Complications and continuation of intrauterine device use among commercially insured teenagers.
        Obstet Gynecol. 2013; 121: 951-958