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Intrauterine device use and the risk of pre-eclampsia: a case-control study
S E Parker1, S S Jick2, M M Werler1
1Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Objective:
To determine the association between intrauterine device (IUD) use, timing of removal prior to pregnancy, and the risk of pre-eclampsia.
Design:
A case-control study within the Clinical Practice Research Datalink, UK.
Setting:
Medical record database in the UK.
Sample:
Cases of pre-eclampsia (n = 2744) were identified among pregnancies resulting in singleton deliveries from 1993 to 2010. Four controls, or pregnancies unaffected by pre-eclampsia, were matched to each case on maternal age, general practice, and year of delivery.
Methods:
Data on IUD use were obtained from patient records. The odds ratios (ORs) for the association between IUD and pre-eclampsia were adjusted for covariates identified a priori, and analyses were stratified by BMI and number of prior deliveries.
Main Outcome Measures:
Odds ratios (95% confidence intervals, 95% CIs) of pre-eclampsia in pregnancies among women with a history of IUD use, compared with women without a history of IUD use.
Results:
Prior IUD use was associated with a reduced risk of pre-eclampsia (OR 0.76; 95% CI 0.58-0.98). The timing of removal in relation to the start of pregnancy showed an inverse association, with shorter intervals associated with a larger decrease in risk of pre-eclampsia. IUD removal within a year prior to pregnancy had an OR of 0.68 (95% CI 0.46-1.00). Among women with a prior delivery, the association between IUD use and pre-eclampsia was null.
Conclusions:
Intrauterine device use is associated with a small decreased risk of pre-eclampsia, specifically if removed within the year prior to conception.
Tweetable Abstract:
A case-control study of pregnancies in the UK suggests a reduced risk of pre-eclampsia for former IUD users.
