Postpartum Long-Acting Reversible Contraception Use Among People With Sickle Cell Disease in the United States

To assess trends in the uptake of immediate postpartum long-acting reversible contraception (LARC) among deliveries among people with and without sickle cell disease (SCD).

Using 2012-2019 National Inpatient Sample data, we conducted a cross-sectional study comparing rates of immediate postpartum LARC uptake (intrauterine device or contraceptive implant) among all delivery hospitalizations (live-born and stillbirth deliveries) for people with SCD and people without SCD. We included analyses of all deliveries and a subanalysis limited to individuals of Black race as per dataset coding. We calculated the rates of immediate postpartum LARC uptake among people with and without SCD per 1,000 deliveries. We used univariate and multivariate logistic regression to evaluate the odds of immediate postpartum LARC uptake by SCD status, adjusting for covariates including clinical characteristics (ie, delivery mode and presence of severe maternal morbidity [SMM]), and demographic factors (ie, maternal age, insurance, household income, region, hospital type, and calendar year).

We analyzed 29,822,518 deliveries between 2012 and 2019: 18,860 among people with SCD and 29,803,658 among people without SCD. Overall, people with SCD had higher rates of SMM and were more likely to deliver at an urban hospital, to use public insurance, and to deliver in the South compared with those without SCD. Compared to people without SCD, people with SCD had a threefold higher uptake of immediate postpartum LARC (16.4 per 1,000 deliveries vs 4.7 per 1,000 deliveries, P<.001) and a steeper increase in rate of immediate postpartum LARC uptake during the study period (differences in trends, P<.0001). In our unadjusted regression model, people with SCD had a 3.51 higher odds of immediate postpartum LARC use compared with people without SCD (95% CI, 2.72-4.54). After adjustment for clinical and demographic factors, people with SCD still had significantly higher odds of receiving immediate postpartum LARC compared with people without SCD (adjusted odds ratio 1.82, 95% CI, 1.40-2.32). Results were consistent in our subanalysis of deliveries limited to Black individuals.

After adjustment for clinical and demographic factors, immediate postpartum LARC use was higher among people with SCD compared with people without SCD. These results reflect nuanced patterns of contraception use for people who experience high-acuity outcomes in pregnancy and invite further inquiry on drivers for immediate postpartum contraception decision making in medically complex patients.