Association Between Comorbidities and Inpatient Postpartum Permanent Contraception Completion

To evaluate whether comorbidities (defined as both medical conditions and peripartum complications) are associated with inpatient postpartum permanent contraception by tubal surgery completion.

This is a secondary analysis of a multisite retrospective cohort study of patients who had documented plans for permanent contraception. Our primary outcome was inpatient completion of postpartum permanent contraception by tubal surgery. We used univariable and multivariable logistic regression analyses to examine associations between aggregate and individual comorbidities and the attainment of inpatient postpartum permanent contraception.

In this study of 2,226 pregnant people, 53.4% of patients received postpartum permanent contraception by the time of hospital discharge, and 70.8% of patients had documented comorbidities. Although patients with medical conditions initially had lower odds of permanent contraception completion compared with those without any comorbidities (adjusted odds ratio [aOR] 0.77, 95% CI, 0.64-0.93), this association was no longer significant after adjusting for multiple comparisons (adjusted P =.06). This association also was not significant for patients with peripartum complications (aOR 0.86, 95% CI, 0.64-1.16, adjusted P =.42). Similarly, when individual comorbidities were assessed, patients with hypertension (aOR 0.80, 95% CI, 0.65-0.97, adjusted P =.06), mental health diagnoses (aOR 0.80, 95% CI, 0.66-0.96, adjusted P =.06), and elevated body mass index (BMI, 40 or higher) (aOR 0.77, 95% CI, 0.63-0.95, adjusted P =.06) had no significant differences in odds of immediate permanent contraception attainment after adjusting for multiple comparisons.

Though the balance of risks and benefits is imperative for surgical care, it is imperative that modifiable barriers to desired permanent contraception are mitigated. There were no statistically significant differences in inpatient postpartum permanent contraception attainment for patients with medical conditions in our study; however, further study is needed to better elucidate the complex relationships between medical comorbidities and contraception.