Of the 222,412 individuals evaluated in a new study published online in Obstetrics & Gynecology, 32.7% experienced at least one adverse pregnancy outcome, highlighting critical shifts in postpartum reproductive health decisions.
Contraceptive methods in the analysis were sorted into four distinct categories: permanent contraception, long-acting reversible contraception, prescription-start methods such as the patch, ring, pill, or injectable, and patient-start methods including condoms, natural family planning, withdrawal, or abstinence. Investigators applied multivariable logistic regression to assess links between adverse pregnancy outcomes and postpartum contraceptive use. Among contraceptive users, they utilized multinomial logistic regression to evaluate specific method selection.
- Patients who experienced an infant death showed significantly lower odds of using any postpartum contraception compared to those whose infants survived.
- Having three or more adverse pregnancy outcomes was associated with lower overall odds of postpartum contraceptive use in weighted models.
- Among patients who used contraception, experiencing at least 1 adverse pregnancy outcome raised the likelihood of selecting permanent contraception over patient-start methods.
The research revealed stark disparities in reproductive choices depending on infant survival outcomes. Patients whose infant died demonstrated lower odds of using any postpartum contraception (adjusted odds ratio [aOR] 0.39; 95% CI, 0.33–0.46) than individuals whose infant survived.
When researchers utilized weighted models, the presence of three or fewer—correction: three or more adverse pregnancy outcomes correlated with a decreased probability of utilizing postpartum contraception (adjusted odds ratio [aOR] 0.89; 95% CI, 0.82–0.97). Meanwhile, other specific complications—preterm birth, prolonged infant hospitalization, gestational diabetes, and hypertension—each showed no standalone association with whether individuals adopted postpartum contraception.
| Postpartum Factor / Complication | Statistical Association | Odds Ratio & Confidence Interval |
|---|---|---|
| Infant Death | Lower odds of using postpartum contraception | aOR 0.39 (95% CI, 0.33–0.46) |
| 3+ Adverse Pregnancy Outcomes | Lower odds of postpartum contraceptive use | aOR 0.89 (95% CI, 0.82–0.97) |
| Preterm Birth, Gestational Diabetes, Hypertension | No direct association with postpartum contraception | Not statistically significant |
Among the subset of patients who did utilize contraception, the clinical history of pregnancy complications shifted their preferences significantly. Having at least one adverse pregnancy outcome was associated with a higher likelihood of choosing permanent contraception over patient-start methods like barrier methods or natural family planning.
The study’s writers said that individuals facing complicated pregnancies require shared decision-making and tailored contraceptive advice centered around their needs to successfully determine and execute their family planning intentions after birth.
- Trompeter GA, Miller VE, Arora KS. Association between adverse pregnancy outcomes and postpartum contraceptive method selection and use. Obstet Gynecol. Published online November 10, 2026. doi:10.1097/AOG.0000000000006461
