Postpartum LARC Use in Adolescents Linked to Lower Rates of Short Interpregnancy Intervals

Adolescent mothers in a high-risk inner-city population who selected long-acting reversible contraception (LARC) after delivery were significantly less likely to experience a short interpregnancy interval (SIP) and duration between pregnancies was longer for them compared to peers choosing other contraceptive methods, according to findings presented at the 2025 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting in Minneapolis. May 16-18, 2025, in Minneapolis, MN.

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In this retrospective cohort study, presenting author Olivia Fehrmann, from the Duke University School of Medicine and colleagues examined postpartum contraceptive (PPC) choices and their relationship to recurrent adolescent pregnancy (RAP) among 395 adolescents aged 10 to 17 years who delivered after 20 weeks gestation within a single health system between May 1, 2013, and April 30, 2023. The study compared outcomes across three PPC categories: LARC (intrauterine devices and Nexplanon), hormonal contraception (HC, including combined hormonal methods, depot injections, and progesterone-only pills), and nonhormonal contraception (NHC, including condoms, abstinence, or no method).

• LARC users had significantly fewer SIPs (23.8%) compared to HC (79.4%) and NHC (66.7%) users (P <.001).
• Median interpregnancy interval (MIPI) was also longer among LARC users (32.5 months) vs HC (24.0 months) and NHC (32.0 months) (P = .007).
• Among adolescents who did experience a recurrent pregnancy before age 18 (n = 61, 15%), LARC users still had longer MIPIs (21.0 months) compared to HC (10.5 months) and NHC (14.5 months) users (P <.001).

Although overall RAP rates did not differ significantly by PPC method after adjusting for race and ethnicity, regression analysis revealed HC users were 17.7 times more likely to experience a SIP than LARC users (95% CI, 2.86–109) and had a 9.3-month shorter MIPI (95% CI, –16.0 to –2.69), the authors wrote.

Fehrmann et al reported that race and ethnicity influenced PPC selection: Black adolescents were more likely to choose HC, followed by LARC, then NHC (P = .009), while Latinx adolescents most often selected NHC, followed by LARC, then HC (P =.006). No other demographic, obstetric, or intrapartum factors were associated with contraceptive choice, according to the study abstract.

The findings underscore the importance of offering postpartum LARC to adolescent patients to reduce rapid repeat pregnancies and extend the time between births, the authors emphasized. They call for further research to improve PPC counseling strategies and address barriers to LARC use among adolescents.

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Reference
Fehrmann O, Nisky GR, White SA, Adkins L, Wood R, Dotters-Katz SK. Tackling recurrent pregnancy in adolescents through postpartum contraception counseling. Abstract presented at: 2025 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting; May 16-18, 2025; Minneapolis, MN.