Most women prefer delayed vs. immediate postpartum IUD placement

Key takeaways:

• Most women preferred delayed postpartum IUD placement and not immediate placement.
• Women reported malposition, IUD type and 1-year pregnancy risk as the most highly ranked attributes affecting decision-making.

More women prefer delayed postpartum IUD placement, citing higher efficacy and lower complication rates compared with immediate postpartum IUD placement, according to study results published in Obstetrics & Gynecology.

“While it’s safe to insert an IUD for contraception immediately after delivery of a child, or some weeks later, this study found that slightly more patients preferred insertion at a later time when taking into account the risks and benefits of both time frames,” Sarita Sonalkar, MD, MPH, associate professor of obstetrics and gynecology at the University of Pennsylvania, told Healio. “While clinicians may feel that patients with lower access to care are better suited to receive an IUD immediately after a delivery, counseling about IUD placement timing should not vary by demographic characteristics of patients.”

Sonalkar and colleagues conducted a cross-sectional study surveying 190 nonpregnant, parous women on preference of postpartum IUD timing. All women hypothetically chose their postpartum IUDs with options for hormonal or nonhormonal types, placement timing, 1-year efficacy, expulsion risk, risk of lost strings and malposition risk, the researchers wrote.

Primary outcome was preference for immediate or delayed postpartum IUD placement and importance of placement timing compared with other attributes. Secondary outcomes included demographic and neighborhood characteristics and whether they were linked to timing preferences and attribute importance.

Overall, most women (62.6%) preferred the option of delayed postpartum IUD placement.

Researchers observed no significant difference in timing preference by race or block-level Area Deprivation Index score. Women who preferred immediate postpartum IUD placement were more likely to have public insurance vs. private insurance (70.4% vs. 29.6%; P = .04). More than half (55.1%) of women with public insurance preferred delayed postpartum IUD placement, the researchers reported.

IUD type, malposition risk, 1-year efficacy and expulsion risk attributes affected patient decision-making more than IUD placement timing. Researchers observed no difference in importance of attributes by race, Area Deprivation Index score, insurance type or other demographic characteristics.

Women reported malposition (67.9%), IUD type (47.4%) and 1-year pregnancy risk (40%) as the most highly ranked attributes affecting decision-making, the researchers reported.

“Additional research is needed in how patients would like information about contraception to be delivered to them in order for them to feel most healthy and empowered,” Sonalkar said.

For more information:

Sarita Sonalkar, MD, MPH, can be reached at sarita.sonalkar@pennmedicine.upenn.edu.