(436) LARC Uptake in High-Risk Pregnancies with Decision Aid versus Routine Care: One-Year Postpartum Follow-Up

Education is a critical component of comprehensive patient-centered care and improves reproductive autonomy. Previously we reported the results of a trial (NCT04291040) which randomized high-risk pregnancies to an intervention with a multimedia based educational tool (MET) compared to routine care (RC) to assess the use of long-acting reversible contraception (LARC) at 12 weeks postpartum (Qureshey EJ et al Obstet Gynecol;2022:139;571-8). Herein, we aimed to report a priori pre-planned 1-year follow-up of the cohorts.


Study Design: In the parent trial, 380 individuals were randomized (190 to MET and 190 to RC group). Individuals in MET received a multimedia based educational intervention. Electronic surveys were scheduled and automatically sent to all participants at 3-month intervals following delivery. Data from the 12-month postpartum survey were analyzed. The primary purpose of this analysis was to ascertain use of LARC at 1-year; secondary outcomes were satisfaction with method of contraception and repeat pregnancies within a year. Relative risk (RR), number needed to treat (NNT) and 95% confidence intervals (CI) were calculated.

Results: Overall, one-year follow-up was obtained in 309 (81%) individuals—152 (80%) in MET and 157 (83%) in RC—who enrolled in the parent trial. Participants who followed up were more likely to have previously used LARC as contraception (24% vs. 11% P= 0.017) and to be privately insured (17.8% vs. 5.6% P= 0.033), compared to those who did not follow up. At the 1-year follow-up, contraceptive usage was significantly higher in the MET compared to the RC (81.6% vs. 70.7% P=0.025 RR 1.15 95% CI 1.02-1.31 NNT 9; Table 1). Satisfaction with the method of contraception was similar between the groups (80.3% vs 79.6%; P=0.887; Table 1). There was a trend towards decreased short interval pregnancy in the MET group compared to RC (7.2% vs 11.4% RR 0.64 95% CI 0.31-1.30; Table 2).

Conclusion: Compared to routine care, the use of a multimedia-based education tool increased the overall use of contraception at 1 year postpartum in patients with an antecedent high-risk pregnancy.