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Abstract #153768

Carla W. Picardo, MD, MPH, St. Vincent Health Center, 2314 Sassafras Street, Third Floor, Erie, PA 16502, 814-217-9207, picardoc@yahoo.com, Joanne Garrett, PhD, Department of Obstetrics and Gynecology, University of North Carolina, 725 Martin Luther King Boulevard, CB 7521, Chapel Hill, NC 27599, David Hubacher, PhD, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, and Katherine Hartmann, MD, PhD, Institute of Medicine and Public Health, Vanderbilt University School of Medicine, 1161 21st Avenue South, Suite 6000, Medical Center East, North Tower, Nashville, TN 37232.

Background: IUD expulsion complicates 2.6-24% of insertions. Expulsions often occur within one month after insertion. Other risks include younger age, nulliparity, increased menstrual flow, severe dysmenorrhea, and immediate postpartum placement. Approximately 20% of expulsions go undetected, increasing the risk of unintended pregnancy. This study was designed to calculate the odds of early Cu-380A IUD expulsion by lactation status, adjusting for measured confounders and interaction terms.

Methods: Using data from a prospective study of 969 parous women who had a TCu-380A inserted in/near Mexico City and returned one month later, a logistic regression model was created comparing the odds of expulsion in women breastfeeding or not at one month. Interaction terms for lactation-menstrual status at insertion and lactation-bleeding complaints at follow-up were assessed for significance using likelihood ratio tests. Using backwards elimination, demographic and reproductive factors were deemed confounders if removing them changed the fully-adjusted odds ratios by >10%.

Results: Among women cycling within 5 weeks of insertion who reported bleeding complaints at follow-up, the OR of IUD expulsion was 16.49 (95% CI:2.52, 108.12) for breastfeeding versus non-breastfeeding women, adjusted for age, history of abortion, ease of insertion, and parity. Other ORs: among women amenorrheic at insertion with bleeding complaints, 3.03 (95% CI: 0.32, 28.88), among cycling women without bleeding complaints, 2.35 (95% CI: 0.64, 8.61), and among amenorrheic women without bleeding complaints, 0.43 (95% CI: 0.08, 2.42).

Conclusions: TCu-380A IUD insertion in breastfeeding women while still amenorrheic may decrease the frequency of early expulsion.

Learning Objectives:

• Describe risk factors for early TCu-380A IUD expulsion.
• Recognize that a complex relationship may exist between lactation status and early TCu-380A IUD expulsion.

Keywords: Breast Feeding, Contraception

Presenting author's disclosure statement:

Any relevant financial relationships? Yes

Name of Organization	Clinical/Research Area	Type of relationship
Pfizer, Inc.	Depo-Provera	received investigator-initiated grant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.