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  • Immediate postpartum...

Immediate postpartum long-acting reversible contraception can improve QoL and reduce Severe Maternal Morbidity: Study

Written By : Dr.Niharika Harsha B |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2025-01-15T20:30:17+05:30  |  Updated On 16 Jan 2025 11:37 AM IST
Immediate postpartum long-acting reversible contraception can improve QoL and reduce Severe Maternal Morbidity: Study
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A recent study revealed that quality of life can be improved, and health care costs can be reduced at the time of index delivery by immediate postpartum long-acting reversible contraception (LARC). The study results were published in the journal Obstetrics & Gynecology.

Postpartum contraception is a safe and effective method to reduce severe maternal morbidity (SMM) by preventing unintended pregnancy and reducing short-interval pregnancy births. Short-interval pregnancy births are those that are less than 18 months from prior birth to subsequent conception. Hence, researchers conducted a study to assess the cost-effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce short interpregnancy intervals (IPI), severe maternal morbidity (SMM), and preterm birth rates by developing a decision analytic model.

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By employing the TreeAge software, a decision-analytic model was built to compare maternal health and cost outcomes in two scenarios. One where immediate postpartum LARC was a Medicaid-covered option and the other where it was not. The study focused on a hypothetical cohort of 100,000 postpartum individuals on Medicaid who had not opted for permanent contraception. The primary outcome of measurement was the incremental cost-effectiveness ratio (ICER), which indicates the cost increase required per additional quality-adjusted life year (QALY) gained from one health intervention over another. Secondary outcomes of interest included the rate of short IPI (defined as an interpregnancy interval of less than 18 months), the occurrence of SMM, preterm births, overall costs, and QALYs. Sensitivity analyses were conducted to account for variations in costs, probabilities, and utilities in the model.

Findings:

  • The analysis found that providing immediate postpartum LARC was a cost-effective strategy.
  • The ICER was calculated at -$11,880,220,102, indicating significant cost savings.
  • Immediate postpartum LARC coverage led to 299 fewer repeat births, 178 fewer short IPIs, two fewer cases of SMM, and 34 fewer preterm births.
  • The intervention also resulted in 25 additional QALYs and a total cost saving of $2,968,796 for Medicaid.

Thus, the study concluded that providing Medicaid coverage for immediate postpartum LARC at the time of delivery is both a cost-saving and life-quality-enhancing strategy. By reducing short IPIs, SMM, and preterm birth rates, this policy can improve overall maternal and neonatal health outcomes while also reducing healthcare costs for Medicaid. Expanding Medicaid coverage to include immediate postpartum LARC could help achieve optimal interpregnancy intervals and decrease the risks associated with SMM and preterm birth.

Also Read: Longer Labor Duration During Second-Trimester Medication Abortions Raises Risk of Adverse Maternal Outcomes: Study

TAKE-HOME MESSAGE

  • This study evaluated the cost-effectiveness of immediate postpartum long-acting reversible contraception (LARC) coverage by Medicaid to reduce the rates of short interpregnancy intervals, preterm birth, and severe maternal morbidity.
  • A model was created comparing maternal health and cost outcomes in a setting where immediate postpartum LARC was covered by Medicaid and one where LARC was not covered.
  • Immediate postpartum LARC coverage was more cost-effective and saved approximately 3 million dollars. The use of immediate postpartum LARC led to reductions in the rates of repeat births, short-interval pregnancy births, severe maternal morbidity, and preterm births.
  • Clinicians should counsel patients on the option of immediate postpartum LARC and the potential benefits, such as reductions in the rates of short interpregnancy interval births, severe maternal morbidity, and preterm births.

Further reading: Bullard, Kimberley A et al. “Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis.” Obstetrics and gynecology vol. 144,3 (2024): 294-303. doi:10.1097/AOG.0000000000005679

Obstetrics & GynecologyKimberley A Bullardlong-acting reversible contraceptionSevere Maternal Morbidity
Source : Obstetrics & Gynecology
Dr.Niharika Harsha B
Dr.Niharika Harsha B

    BDS, MDS

    Dr.Niharika Harsha B (BDS,MDS) completed her BDS from Govt Dental College, Hyderabad and MDS from Dr.NTR University of health sciences(Now Kaloji Rao University). She has 4 years of private dental practice and worked for 2 years as Consultant Oral Radiologist at a Dental Imaging Centre in Hyderabad. She worked as Research Assistant and scientific writer in the development of Oral Anti cancer screening device with her seniors. She has a deep intriguing wish in writing highly engaging, captivating and informative medical content for a wider audience. She can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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