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History of IUD utilization and the risk of preterm birth: a cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To explore whether a history of IUD use could increase the risk of subsequent preterm birth.

Methods

We performed a cohort study of 24,496 multipara aged 19–48 years in Dongguan City. Each subject was followed up for 1 year, and 12,508 women obtained pregnancy outcomes. They were divided into 2 groups: 2130 subjects with IUD use history (exposure group), and 10,378 subjects without IUD use history (control group). The exposure group will remove the IUD before pregnancy. The primary outcomes were preterm birth (less than 37 weeks of gestation) and early preterm birth (less than 34 weeks of gestation). We used log-binomial regression to estimate adjusted risk ratios (aRR) of preterm birth and early preterm birth for women with a history of IUD. According to the different adjusted baseline data, three regression models were established, and the propensity matching score method was also used to verify the stability of the results.

Results

The delivery rate of women with IUD history was 51.24%, and that of women without IUD was 51.03% (2 = 0.063, P = 0.802). Six hundred and eighty-five women had preterm birth (5.48%, 95% CI 5.08–5.88) and 133 women had early preterm birth (1.06%, 95% CI 0.83–1.24). Compared with the control group, the incidence of preterm birth and early preterm birth in the exposure group were significantly lower. The results are stable in all four models. Subgroup analysis also supported the result. This study also found that the longer the women used IUD before pregnancy, the younger the age of first using IUD, and the shorter the time from condom removal to pregnancy, the lower the incidence of premature birth.

Conclusion

The women with a history of IUD use are less likely to have premature birth after the IUD is removed. More prospective studies are needed to confirm it.

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Abbreviations

NFPHEP:

National Free Preconception Health Examination Project

IUD:

Intrauterine device

RR:

Risk ratios

PSM:

Propensity matching score method

References

  1. Buhling KJ, Zite NB, Lotke P, Black K (2014) Worldwide use of intrauterine contraception: a review. Contraception 89:162–173. https://doi.org/10.1016/j.contraception.2013.11.011

    Article  PubMed  Google Scholar 

  2. Wang Z et al (2019) Attitudes and practices related to intrauterine devices for nulliparous women among Chinese health care providers. Reprod Health 16:10. https://doi.org/10.1186/s12978-019-0678-9

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yuan X et al (2019) Induced abortion, birth control methods, and breast cancer risk: a case-control study in China. J Epidemiol 29:173–179. https://doi.org/10.2188/jea.JE20170318

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sonalkar S, Hunter T, Gurney EP, McAllister A, Schreiber CA (2018) A decision analysis model of 1-year effectiveness of intended postplacental compared with intended delayed postpartum intrauterine device insertion. Obstet Gynecol 132:1211–1221. https://doi.org/10.1097/aog.0000000000002926

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sundaram A et al (2017) Contraceptive failure in the United States: estimates from the 2006–2010 National Survey of Family Growth. Perspect Sex Reprod Health 49:7–16. https://doi.org/10.1363/psrh.12017

    Article  PubMed  PubMed Central  Google Scholar 

  6. Deveer R et al (2011) Comparison of C-reactive protein levels in pregnancies with retained and removed intrauterine device. J Matern Fetal Neonatal Med 24:1152–1154. https://doi.org/10.3109/14767058.2010.545925

    Article  CAS  PubMed  Google Scholar 

  7. Mansour D, Gemzell-Danielsson K, Inki P, Jensen JT (2011) Fertility after discontinuation of contraception: a comprehensive review of the literature. Contraception 84:465–477. https://doi.org/10.1016/j.contraception.2011.04.002

    Article  CAS  PubMed  Google Scholar 

  8. Skjeldestad FE (2008) The impact of intrauterine devices on subsequent fertility. Curr Opin Obstet Gynecol 20:275–280. https://doi.org/10.1097/GCO.0b013e3282fe7427

    Article  PubMed  Google Scholar 

  9. Lu R et al (2016) Neonatal mortality in the urban and rural China between 1996 and 2013: a retrospective study. Pediatr Res 79:689–696. https://doi.org/10.1038/pr.2016.6

    Article  PubMed  Google Scholar 

  10. Chawanpaiboon S et al (2019) Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health 7:e37–e46. https://doi.org/10.1016/s2214-109x(18)30451-0

    Article  PubMed  Google Scholar 

  11. Zeng Y, Hesketh T (2016) The effects of China’s universal two-child policy. Lancet 388:1930–1938. https://doi.org/10.1016/s0140-6736(16)31405-2

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tang J, Zhu X, Li M, Huang D, Zhao Q (2020) The impact of maternal prepregnancy impaired fasting glucose on preterm birth and large for gestational age: a large population-based cohort study. Am J Obstet Gynecol 222(265):e261-265.e219. https://doi.org/10.1016/j.ajog.2019.09.037

    Article  CAS  Google Scholar 

  13. Liu J et al (2017) Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth: a population-based cohort study. Lancet Glob Health 5:e624–e632. https://doi.org/10.1016/s2214-109x(17)30142-0

    Article  PubMed  Google Scholar 

  14. Zhou Q et al (2016) A new perspective on universal preconception care in China. Acta Obstet Gynecol Scand 95:377–381. https://doi.org/10.1111/aogs.12865

    Article  PubMed  Google Scholar 

  15. Li S, Zhang Y, Feldman MW (2010) Birth registration in China: practices, problems and policies. Popul Res Policy Rev 29:297–317. https://doi.org/10.1007/s11113-009-9141-x

    Article  PubMed  PubMed Central  Google Scholar 

  16. Di Renzo GC, Tosto V, Giardina I (2018) The biological basis and prevention of preterm birth. Best Pract Res Clin Obstet Gynaecol 52:13–22. https://doi.org/10.1016/j.bpobgyn.2018.01.022

    Article  PubMed  Google Scholar 

  17. Li J et al (2013) A review of contraceptive practices among married and unmarried women in China from 1982 to 2010. Eur J Contracept Reprod Health Care 18:148–158. https://doi.org/10.3109/13625187.2013.776673

    Article  PubMed  Google Scholar 

  18. Yoost J (2014) Understanding benefits and addressing misperceptions and barriers to intrauterine device access among populations in the United States. Patient Prefer Adherence 8:947–957. https://doi.org/10.2147/ppa.S45710

    Article  PubMed  PubMed Central  Google Scholar 

  19. Grimes DA (2000) Intrauterine device and upper-genital-tract infection. Lancet 356:1013–1019. https://doi.org/10.1016/s0140-6736(00)02699-4

    Article  CAS  PubMed  Google Scholar 

  20. Darney PD (2001) Time to pardon the IUD? N Engl J Med 345:608–610. https://doi.org/10.1056/nejm200108233450810

    Article  CAS  PubMed  Google Scholar 

  21. Adeyemi-Fowode OA, Bercaw-Pratt JL (2019) Intrauterine devices: effective contraception with noncontraceptive benefits for adolescents. J Pediatr Adolesc Gynecol 32:S2-s6. https://doi.org/10.1016/j.jpag.2019.07.001

    Article  PubMed  Google Scholar 

  22. Fraser IS (2013) Added health benefits of the levonorgestrel contraceptive intrauterine system and other hormonal contraceptive delivery systems. Contraception 87:273–279. https://doi.org/10.1016/j.contraception.2012.08.039

    Article  CAS  PubMed  Google Scholar 

  23. Johnson MJ, Morgan KW (2005) Intrauterine contraception benefits extend beyond birth control. Nurse Pract 30:50–55. https://doi.org/10.1097/00006205-200502000-00009

    Article  PubMed  Google Scholar 

  24. Madden T, Grentzer JM, Secura GM, Allsworth JE, Peipert JF (2012) Risk of bacterial vaginosis in users of the intrauterine device: a longitudinal study. Sex Transm Dis 39:217–222. https://doi.org/10.1097/OLQ.0b013e31823e68fe

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wang LY et al (2016) The effect of contraceptive methods on reproductive tract infections risk: a cross-sectional study having a sample of 52,481 women. Arch Gynecol Obstet 294:1249–1256. https://doi.org/10.1007/s00404-016-4172-0

    Article  PubMed  Google Scholar 

  26. Diedrich JT, Madden T, Zhao Q, Peipert JF (2015) Long-term utilization and continuation of intrauterine devices. Am J Obstet Gynecol 213(822):e821-826. https://doi.org/10.1016/j.ajog.2015.08.077

    Article  Google Scholar 

  27. Sergison JE, Maldonado LY, Gao X, Hubacher D (2019) Levonorgestrel intrauterine system associated amenorrhea: a systematic review and metaanalysis. Am J Obstet Gynecol 220:440-448.e448. https://doi.org/10.1016/j.ajog.2018.12.008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Baldaszti E, Wimmer-Puchinger B, Löschke K (2003) Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 67:87–91. https://doi.org/10.1016/s0010-7824(02)00482-1

    Article  CAS  PubMed  Google Scholar 

  29. Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F (2018) Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 46:3–11. https://doi.org/10.1016/j.bpobgyn.2017.09.004

    Article  PubMed  Google Scholar 

  30. Andersson K, Batar I, Rybo G (1992) Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception 46:575–584. https://doi.org/10.1016/0010-7824(92)90122-a

    Article  CAS  PubMed  Google Scholar 

  31. Girault A, Le Ray C, Chapron C, Goffinet F, Marcellin L (2018) Leiomyomatous uterus and preterm birth: an exposed/unexposed monocentric cohort study. Am J Obstet Gynecol 219(410):e411-410.e417. https://doi.org/10.1016/j.ajog.2018.08.033

    Article  Google Scholar 

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Acknowledgements

The authors thank all the obstetricians, pediatricians, pathologists and other participants involved in the birth defects monitoring program and pre-pregnancy examination project in Dongguan City. The author thanks Mr. Ri-Hui Liu for his great support and help in the statistical analysis and writing of their papers.

Funding

This is not a funded research project so “not applicable”.

Author information

Authors and Affiliations

  1. Dongguan Maternal and Child Health Care Hospital, No.99 Zhenxing Road, Dongcheng District, Dongguan City, 523112, Guangdong Province, China

    Bi Jiang, Wei-Chao He, Jing-Yun Yu, Si-Si Wei & Xin-Jian Zhang

Authors
  1. Bi Jiang
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  2. Wei-Chao He
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  3. Jing-Yun Yu
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  4. Si-Si Wei
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  5. Xin-Jian Zhang
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Contributions

All the authors contributed a lot to this research: BJ: protocol/project development, data collection or management, and manuscript writing/editing; W-CH: data collection or management and data analysis; J-YY: data collection or management and data analysis; S–SW: data collection or management; X-JZ: protocol/project development and data collection or management.

Corresponding author

Correspondence to Xin-Jian Zhang.

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Conflict of interest

The authors declare that they have no competing interests, including: the authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethics approval

This study was approved by the ethics committee of Dongguan Maternal and Child Health Hospital on September 30, 2018 (No. [23] 2018).

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All the participants signed informed consent before the examination.

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Jiang, B., He, WC., Yu, JY. et al. History of IUD utilization and the risk of preterm birth: a cohort study. Arch Gynecol Obstet 305, 349–358 (2022). https://doi.org/10.1007/s00404-021-06158-9

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  • DOI: https://doi.org/10.1007/s00404-021-06158-9

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