Redmond JJ, Jensen ET, Stanford JB, Greene ME, Kennedy E, Urrutia RP. Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention During the Postpartum Period.
Contraception 2022;
114:32-40. [PMID:
35716805 DOI:
10.1016/j.contraception.2022.06.007]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES
To summarize the evidence on typical and perfect-use effectiveness of fertility awareness-based methods for avoiding pregnancy during the postpartum period, whether breastfeeding or not.
STUDY
Design We conducted a systematic review of studies published in English, Spanish, French, or German by November 2021 in MEDLINE, EMBASE, CINAHL, Web of Science, and ClinicalTrials.gov. Abstract and full text review were completed by two independent reviewers. Study inclusion: at least 50 subjects who enrolled prior to experiencing three cycles after childbirth and were using a specific fertility awareness-based method to avoid pregnancy; unintended pregnancy rate or probability calculated; postpartum amenorrheic and postpartum cycling individuals analyzed separately; and prospectively measured pregnancy intentions and outcomes. Outcomes were abstracted and study quality was systematically assessed by two independent investigators.
RESULTS
Four studies provided effectiveness data for one specific fertility awareness-based method among postpartum individuals. Of these, there were zero high quality, one moderate quality, and three low quality for our question of interest. Typical-use pregnancy probability for the first six cycles postpartum for Marquette Method users was 12.0 per 100 women years (standard error [SE] not reported) and for Billings Ovulation Method users ranged from 9.1 (SE 3.9) for non-lactating women <30 years old to 26.8 (SE 4.6) for lactating women <30 years old. Typical-use pregnancy probabilities for the first six months post-first menses for the Postpartum Bridge to Standard Days Method users was 11.8 (95% confidence interval 6.01-17.16) and for Billings Ovulation Method users was 8.5 per 100 women (SE 1.7).
CONCLUSIONS
The current evidence on the effectiveness of each fertility awareness-based method for postpartum persons is very limited and of mostly low quality. More high quality studies on the effectiveness of fertility awareness-based method in postpartum persons are needed to inform clinical counseling and patient-centered decision-making.
Collapse