Contraception counseling, pregnancy intention and contraception use in women with medical problems: An analysis of data from the Maryland pregnancy risk assessment monitoring system (PRAMS)

Background: Data from the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) were used to evaluate whether women with selected medical comorbidities are less likely than healthier women to report receiving contraceptive counseling during pregnancy and to report using contraception postpartum. Methods: We analyzed de-identified data from the 2004-2007 Maryland PRAMS using logistic regression to evaluate these outcomes: undesired pregnancy, self-reported antepartum contraceptive counseling and postpartum contraceptive use for women with and without hypertension, diabetes or heart disease. Survey data were used to estimate response frequency within the Maryland birth population. Results: Patient self-report of contraceptive use increased overall during the postpartum period as compared to the antepartum period, from 44.3%-90.1% (p<.001). Almost one fourth (23%) of 6361 respondents reported receiving no contraceptive counseling. There was no difference in reported contraceptive counseling in women with selected medical comorbidities as compared to those without, and only women with preconception diabetes mellitus were significantly less likely than healthier women to report postpartum contraceptive use. Conclusions: Overall, there was no difference in the report of receiving contraceptive counseling in women with selected medical comorbidities as compared to than those without. In addition, they were not more likely to report receiving contraceptive counseling either despite higher risk of pregnancy complications. These results indicate lost opportunities for effective counseling that could improve health outcomes.