IUDs likelier to be expelled if placed right after childbirth
A multiyear study of intrauterine devices (IUDs) shows that the popular birth-control device is five times more likely be expelled if it is inserted right after childbirth. The study was published in the JAMA Network Open.
The study included the examination of more than 326,000 IUD insertions between 2001 and 2018. The Association of Perforation and Expulsion of Intrauterine Devices (APEX-IUD) cohort study included women ages 50 years or younger. Only the first IUD insertion during the study period for each individual was included in this analysis.
"The first goal of this analysis was to see if there was a higher risk of IUD expulsions in the year following a delivery, while the second goal was to see if breastfeeding increased or decreased the risk of expulsion," said Dr. Susan Reed, one of the study authors and an OB-GYN with the University of Washington School of Medicine.
The study identified nearly 9,000 IUD expulsions. Average age of individuals in the study was 32. The population was diverse – about 60% were Hispanic or nonwhite. When an IUD was inserted immediately after childbirth or within three days of delivery, the cumulative risk of expulsion over five years was about 11%. This risk was five times greater than that among women who had an IUD placed more than a year after delivery or who had never been pregnant. If an IUD was inserted six weeks to 14 weeks after childbirth, the cumulative five-year expulsion rate dropped to 3%.
Breastfeeding also decreased the risk of expulsion by about 30%, the study found.
APEX-IUD is the largest study to date to examine postpartum timing of IUD insertion and breastfeeding with risk of IUD expulsion, Reed said. The findings confirmed smaller prior studies, she added.
An important reason for IUD failure and unwanted pregnancy, the study noted, is unrecognized expulsion of the IUD. Primary care providers should talk with their patients about rates of IUD failure, and engage in individualized shared decision-making about timing of an IUD placement. Expulsion rates should be part of these pre-delivery conversations.
In general, Seattle area providers are good about broaching this caution and discussing IUD risks and benefits, but other areas may differ, Reed noted.
Funding for this research was provided by Bayer AG, Berlin, Germany; RTI Health Solutions; Kaiser Permanente Northern California; Kaiser Permanente Washington (where Reed is an affiliate investigator), and the Regenstrief Institute. The cohort studys compiled data from three healthcare systems—Kaiser Permanente Northern California, Kaiser Permanente Southern California, and Kaiser Permanente Washington —and the Regenstrief Institute, an Indiana research site that accesses data from a healthcare information exchange.
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.