Skip to main content

Conference Program

Subpage Hero

Loading

The use of postpartum long-acting reversible contraceptives among women with genetic conditions 

Prenatal Genetics
  • Primary Categories:
    • Prenatal Genetics
  • Secondary Categories:
    • Prenatal Genetics
Introduction:
Interpregnancy intervals shorter than 6 months are associated with increased maternal and fetal risks. Studies have shown that women with genetic conditions are at a higher risk for pregnancy complications. Additionally, national databases indicate that medically complex women are at an increased risk for unintended pregnancy. Long-acting reversible contraception (LARC) is a strong recommendation for women at higher risk for adverse health events resulting from a future pregnancy. Understanding the use of LARC amongst this population is imperative for preventing complications associated with unintended pregnancies, short interpregnancy intervals, and maternal genetic conditions. This study aims to assess the utilization of LARC and counseling for LARC in the post-partum encounter in patients with genetic disorders.

Methods:
We retrospectively analyzed maternal and fetal outcomes for pregnancies of patients with genetic disorders who delivered at a single institution with two delivery sites between 2013-2024. Only the first delivery was included in the analysis if a patient delivered more than once. The primary outcome measures were the rate of women with genetic conditions who received LARC and/or consultation about LARC. Non-parametric statistical methods were employed.

Results:
106 patients with genetic disorders were included in the analysis. There was a wide range of genetic disorders represented including chromosomal (18, most commonly mosaic Turner syndrome), renal (18), inborn errors of metabolism (16), connective tissue (10) , skeletal (9), multi-system disorders (8), neurocutaneous (6), endocrine (6), RASopathies (4), neuromuscular (3), albinism (3), vascular (3), hematologic (1), and oncologic (1). Of these cases, 14 patients were excluded due to lack of information regarding contraception, and 1 patient was excluded for gonadal dysgenesis. Of the 91 cases analyzed, contraceptive counseling was documented in 87.9% of cases. None of the patients without contraceptive counseling received LARC or permanent sterilization. Among patients receiving contraception counseling, 40% of patients received LARC or permanent sterilization. Of those who received LARC or permanent sterilization, 40.6% received a BTL, 21.9% received an implant, and 37.5% received an IUD. Those who did not receive LARC or permanent sterilization (60%) elected for alternate methods including the barrier method (9.89%), DMPA (8.79), vaginal ring/patch (1.1%), oral contraceptives (21.98%), or declined contraception entirely (23.08%). There was a significant increase in the rate of postpartum disease progression in patients who received LARC versus those who did not (p = 0.043). There was no difference in the rate of pregnancy complications or antepartum disease progression between the two groups.

Conclusion:
Women with genetic conditions have an increased risk of adverse pregnancy outcomes, as well as disease progression. Adequate inter-pregnancy intervals are imperative for the optimization of health status prior to subsequent pregnancies. Therefore, it is essential to provide counseling on the use of LARC to avoid maternal and fetal complications in women with genetic conditions. Further studies are needed to evaluate barriers to LARC in this population and decision making around contraception.

Agenda

Sponsors