1187: Immediate postpartum long-acting reversible contraception in women with heart disease

To compare postpartum (PP) contraception in women with heart disease before and after implementation of an immediate postpartum LARC (IPP LARC) program. Retrospective cohort of women with cardiac disease managed by the UAB Comprehensive Pregnancy & Heart Program who delivered at UAB between 3/1/2015 – 6/30/2019. Women were pre-implementation (Pre) if they delivered before IPP LARC implementation (3/1/2015 – 1/31/2017) and post-implementation (Post) if they delivered after (2/1/2017 – 6/30/2019). Primary outcome was LARC (intrauterine device (IUD) or etonogestrel implant) use PP, defined as IPP LARC or LARC at PP visit. Secondary outcomes included contraception intent at delivery, IPP IUD expulsion rate, and subsequent pregnancy data. Parametric and non-parametric tests were used to compare characteristics between groups. Of 159 women included, 96 (60%) were Post. Age, race, payor, parity, BMI, mode of delivery and modified World Health Organization maternal cardiovascular risk classification were similar over time. Total LARC use tripled after IPP LARC implementation, 10% vs 35%, p < 0.01, despite similar LARC intent at delivery: 33% vs 43%, p=0.21. Rates of women without contraception plans at delivery decreased from 32% to 14%, p < 0.01, as did the number of women using medroxyprogesterone acetate: 16% vs 4%, p=0.01. Female sterilization rates remained similar before and after IPP LARC implementation: 24% and 29%, p = 0.46. PP visit rates were similar between Pre and Post groups: 70% and 72%, p=0.78, respectively, and 1 IPP IUD expulsion occurred. As expected given longer follow-up duration, more Pre women had subsequent pregnancies in our system compared to Post: 20 (32%) vs 7 (7%), p< 0.01. LARC use in women with heart disease tripled after implementing IPP LARC. Since LARC is the most effective way to prevent unintended pregnancies, IPP LARC should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality.