LAUSR

OBJECTIVE To evaluate the effects of offering immediate postpartum long-acting reversible contraception to pregnant patients with heart disease. STUDY DESIGN Retrospective cohort of pregnant patients with cardiac disease managed by a Comprehensive Pregnancy & Heart Program. Patients were divided into two cohorts: pre-immediate postpartum LARC Program implementation (3/2015-1/2017) and post-implementation (2/2017-6/2019). The primary outcome was LARC (intrauterine device (IUD) or etonogestrel implant) use postpartum, defined as LARC either immediately postpartum or at the postpartum visit. Secondary outcomes included contraception intent at delivery and IUD expulsion rate of IUDs placed immediately postpartum. RESULTS Of 159 included patients, 96 (60%) delivered during the post-implementation period. LARC use tripled after program implementation, 11% vs 35%, p<0.01. Specifically, immediate postpartum IUD use increased from 1 (1.6%) to 10 (10.4%), p = 0.05, and use of immediate postpartum implant increased from 0 to 14 (14.6%), p = 0.002. Rates of women without contraception plans at delivery decreased from 32% to 14%, p<0.01, as did the number of women using medroxyprogesterone acetate: 16% vs 4%, p=0.01. Female sterilization rates were not different before and after program implementation: 24% and 29%, p=0.46. Postpartum visit rates were similar between Pre and Post groups: 70% and 72%, p=0.78, respectively. One immediate postpartum IUD expulsion occurred. CONCLUSION LARC use tripled in pregnant patients in an obstetric heart disease program after implementation of an immediate postpartum LARC Program. Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality.