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Within-cycle variation in coagulation factors seen with patch and oral contraception: a randomized crossover study
218
Abstracts / Contraception 80 (2009) 194–226
Results: Of the 721 IUDs that were ordered, only 398 were placed (55.2%). The median time between the initial visit and insertion was 43 days (range 0– 610 days). Single women were significantly less likely to return for IUD insertion, as were women who requested IUDs at pregnancy-related visits as compared to gynecologic visits. Race, age, type of IUD ordered and distance of residence from the clinic did not significantly affect the probability of insertion. Conclusions: Many women who requested IUD insertion, particularly those who had never been married, did not receive the device. Two-visit placement protocols for IUD insertion may place women at risk of unintended pregnancy. P69
percent were currently using contraception. More than half (61%) did not use contraception in the last year, yet 19% of these women wanted to use it. This group reported greater difficulty with payment (p=.004), finding a clinic (p=.01) and transportation to clinic (p=.01), when compared to women who had used contraception. Moreover, 88% of the women who wanted to use contraception but had not, and 60% of all women in the sample would accept contraception from Jail Health Services if offered. Conclusions: A substantial proportion of incarcerated women have not accessed reversible contraception in the year prior to arrest. They also reported significant structural and logistical barriers to accessing these services. The majority of women would accept contraception from Jail Health Services if offered. Jail is thus a potentially important and acceptable point of access to contraception for these traditionally marginalized women.
ASSOCIATION BETWEEN INTRAUTERINE CONTRACEPTION AND PELVIC INFLAMMATORY DISEASE: AN ANALYSIS OF THE 2002 NATIONAL SURVEY OF FAMILY GROWTH Bell J University of Michigan, Ann Arbor, MI, USA
P71
Vahratian A, Harris L
WITHIN-CYCLE VARIATION IN COAGULATION FACTORS SEEN WITH PATCH AND ORAL CONTRACEPTION: A RANDOMIZED CROSSOVER STUDY
Objectives: IUDs are the most effective method of long acting reversible contraception available. However, US IUD use rates are low, in part because clinicians and/or patients fear infectious complications. We assessed the association between IUD use and pelvic inflammatory disease (PID) in a representative sample of US women. Method: Using data from the 2002 National Survey for Family Growth (NSFG) female respondent file (n=7643), we identified all respondents that have ever had heterosexual vaginal intercourse (n=6781). Among this sub-sample, we examined the association between ever use of an IUD and having ever been treated for PID. We abstracted respondent demographic data, details of sexual history and practices and obstetrical history. We used multivariate logistic regression to generate adjusted odds ratios and 95% confidence intervals. Results: IUD usage was more common in non-Hispanic whites, women N25 years old, women ever married, those with some college and income N$50,000. The association between IUD use and PID treatment had an unadjusted OR of 2.37 (1.41–3.99). After adjustment for race, gravidity, fecundity, age at first intercourse and number of lifetime sexual partners, the association remained statistically significant 1.93 (1.12–3.32). Conclusions: Women with a history of IUD use are more likely than women without IUD use to have been treated for PID. As the NSFG is a crosssectional study, it is impossible to determine temporality between IUD and PID but this study points to the need for prospective data on the relationship of IUD use and pelvic infection. P70 ACCESS AND BARRIERS TO REVERSIBLE CONTRACEPTION AMONG RECENTLY ARRESTED WOMEN IN SAN FRANCISCO
Prager S University of Washington, Seattle, WA, USA Krieger E, Chan E, Fish B, Paramsothy B, Knopp R Objectives: Patch contraception (PC) results in 60% greater systemic estrogen levels than oral contraception (OC). This study evaluates changes in coagulation factor values throughout a 28-day OC or PC cycle. Method: In a randomized crossover trial, 31 healthy women received each of three treatments for 2 months: monophasic OC [35 mcg ethinyl estradiol (EE), 0.25 mg norgestimate], PC (EE 20 mcg, norelgestromin 150 mcg) or extended patch (XPC). PC consisted of 3 weeks on, 1 week off; XPC of 7 weeks on, 1 week off. A 1–2-month OC phase-in preceded randomization. Measurements on each treatment (Days 1, 7, 21 and 28 of the second month) included: fibrinogen, protein C and S, and Factors V and VIII. Paired t tests were used to compare within-treatment changes; linear regression to compare between-treatment differences. Results: The mean percent change (MPC) in factor VIII from Day 1–21 on OC and PC, respectively [16.7⁎⁎; 18.8⁎ (⁎pb.05; ⁎⁎pb.001)], is greater than the Day 21 mean percent difference (MPD) between PC and OC (3.2). MPC in free and total protein S within OC (−11.0⁎⁎; −11.2⁎⁎) and PC (−16.1⁎⁎; −13.4⁎⁎) are also greater than MPD between PC and OC (−14⁎⁎; −9.9⁎⁎). Within-cycle MPC for protein C, factor V and fibrinogen on OC or PC is less dramatic. XPC minimized any MPC. Conclusions: OC and PC use demonstrate more within-cycle variation in the levels of certain prothrombotic factors than when comparing Day 21 values between treatments. XPC shows less within-cycle variation, having achieved a steady state from continuous use. P72
LaRochelle F Stanford University School of Medicine, Stanford, CA, USA Castro C, Winter K, Goldenson J, Tulsky J, Sufrin C Objectives: Incarcerated women typically have had limited access to health care as well as high rates of prior unintended pregnancies and low contraceptive use prior to incarceration. This study aimed to describe access to and use of reversible contraception prior to women's arrest and evaluate barriers to access among this population. Method: Over a 4-month period, we administered a 63-item computerbased, cross-sectional survey of women between 18–44 years old who were arrested in San Francisco. Results: Our sample of 221 nonpregnant, nonsterilized respondents had an average age of 28.8 (S.D.=7.5); 83% were an ethnic minority. Twenty-one
A RANDOMIZED CONTROLLED TRIAL OF THE IMPACT OF ADVANCED SUPPLY OF EMERGENCY CONTRACEPTION ON POSTPARTUM TEENS Schreiber C University of Pennsylvania School of Medicine, Philadelphia, PA, USA Ratcliffe S Objectives: The United States continues to have an intractable teenage pregnancy rate. The prevention of a second pregnancy can improve maternal and child health. We studied the impact of advanced supply of emergency contraception (EC) on teen pregnancy recidivism in the first year postpartum.
Abstracts / Contraception 80 (2009) 194–226
Results: Of the 721 IUDs that were ordered, only 398 were placed (55.2%). The median time between the initial visit and insertion was 43 days (range 0– 610 days). Single women were significantly less likely to return for IUD insertion, as were women who requested IUDs at pregnancy-related visits as compared to gynecologic visits. Race, age, type of IUD ordered and distance of residence from the clinic did not significantly affect the probability of insertion. Conclusions: Many women who requested IUD insertion, particularly those who had never been married, did not receive the device. Two-visit placement protocols for IUD insertion may place women at risk of unintended pregnancy. P69
percent were currently using contraception. More than half (61%) did not use contraception in the last year, yet 19% of these women wanted to use it. This group reported greater difficulty with payment (p=.004), finding a clinic (p=.01) and transportation to clinic (p=.01), when compared to women who had used contraception. Moreover, 88% of the women who wanted to use contraception but had not, and 60% of all women in the sample would accept contraception from Jail Health Services if offered. Conclusions: A substantial proportion of incarcerated women have not accessed reversible contraception in the year prior to arrest. They also reported significant structural and logistical barriers to accessing these services. The majority of women would accept contraception from Jail Health Services if offered. Jail is thus a potentially important and acceptable point of access to contraception for these traditionally marginalized women.
ASSOCIATION BETWEEN INTRAUTERINE CONTRACEPTION AND PELVIC INFLAMMATORY DISEASE: AN ANALYSIS OF THE 2002 NATIONAL SURVEY OF FAMILY GROWTH Bell J University of Michigan, Ann Arbor, MI, USA
P71
Vahratian A, Harris L
WITHIN-CYCLE VARIATION IN COAGULATION FACTORS SEEN WITH PATCH AND ORAL CONTRACEPTION: A RANDOMIZED CROSSOVER STUDY
Objectives: IUDs are the most effective method of long acting reversible contraception available. However, US IUD use rates are low, in part because clinicians and/or patients fear infectious complications. We assessed the association between IUD use and pelvic inflammatory disease (PID) in a representative sample of US women. Method: Using data from the 2002 National Survey for Family Growth (NSFG) female respondent file (n=7643), we identified all respondents that have ever had heterosexual vaginal intercourse (n=6781). Among this sub-sample, we examined the association between ever use of an IUD and having ever been treated for PID. We abstracted respondent demographic data, details of sexual history and practices and obstetrical history. We used multivariate logistic regression to generate adjusted odds ratios and 95% confidence intervals. Results: IUD usage was more common in non-Hispanic whites, women N25 years old, women ever married, those with some college and income N$50,000. The association between IUD use and PID treatment had an unadjusted OR of 2.37 (1.41–3.99). After adjustment for race, gravidity, fecundity, age at first intercourse and number of lifetime sexual partners, the association remained statistically significant 1.93 (1.12–3.32). Conclusions: Women with a history of IUD use are more likely than women without IUD use to have been treated for PID. As the NSFG is a crosssectional study, it is impossible to determine temporality between IUD and PID but this study points to the need for prospective data on the relationship of IUD use and pelvic infection. P70 ACCESS AND BARRIERS TO REVERSIBLE CONTRACEPTION AMONG RECENTLY ARRESTED WOMEN IN SAN FRANCISCO
Prager S University of Washington, Seattle, WA, USA Krieger E, Chan E, Fish B, Paramsothy B, Knopp R Objectives: Patch contraception (PC) results in 60% greater systemic estrogen levels than oral contraception (OC). This study evaluates changes in coagulation factor values throughout a 28-day OC or PC cycle. Method: In a randomized crossover trial, 31 healthy women received each of three treatments for 2 months: monophasic OC [35 mcg ethinyl estradiol (EE), 0.25 mg norgestimate], PC (EE 20 mcg, norelgestromin 150 mcg) or extended patch (XPC). PC consisted of 3 weeks on, 1 week off; XPC of 7 weeks on, 1 week off. A 1–2-month OC phase-in preceded randomization. Measurements on each treatment (Days 1, 7, 21 and 28 of the second month) included: fibrinogen, protein C and S, and Factors V and VIII. Paired t tests were used to compare within-treatment changes; linear regression to compare between-treatment differences. Results: The mean percent change (MPC) in factor VIII from Day 1–21 on OC and PC, respectively [16.7⁎⁎; 18.8⁎ (⁎pb.05; ⁎⁎pb.001)], is greater than the Day 21 mean percent difference (MPD) between PC and OC (3.2). MPC in free and total protein S within OC (−11.0⁎⁎; −11.2⁎⁎) and PC (−16.1⁎⁎; −13.4⁎⁎) are also greater than MPD between PC and OC (−14⁎⁎; −9.9⁎⁎). Within-cycle MPC for protein C, factor V and fibrinogen on OC or PC is less dramatic. XPC minimized any MPC. Conclusions: OC and PC use demonstrate more within-cycle variation in the levels of certain prothrombotic factors than when comparing Day 21 values between treatments. XPC shows less within-cycle variation, having achieved a steady state from continuous use. P72
LaRochelle F Stanford University School of Medicine, Stanford, CA, USA Castro C, Winter K, Goldenson J, Tulsky J, Sufrin C Objectives: Incarcerated women typically have had limited access to health care as well as high rates of prior unintended pregnancies and low contraceptive use prior to incarceration. This study aimed to describe access to and use of reversible contraception prior to women's arrest and evaluate barriers to access among this population. Method: Over a 4-month period, we administered a 63-item computerbased, cross-sectional survey of women between 18–44 years old who were arrested in San Francisco. Results: Our sample of 221 nonpregnant, nonsterilized respondents had an average age of 28.8 (S.D.=7.5); 83% were an ethnic minority. Twenty-one
A RANDOMIZED CONTROLLED TRIAL OF THE IMPACT OF ADVANCED SUPPLY OF EMERGENCY CONTRACEPTION ON POSTPARTUM TEENS Schreiber C University of Pennsylvania School of Medicine, Philadelphia, PA, USA Ratcliffe S Objectives: The United States continues to have an intractable teenage pregnancy rate. The prevention of a second pregnancy can improve maternal and child health. We studied the impact of advanced supply of emergency contraception (EC) on teen pregnancy recidivism in the first year postpartum.