Study Objective

There is growing advocacy for use of long-acting reversible contraception among sexually active adolescents. Our primary aims were to evaluate the etonogestrel subdermal contraceptive implant (SCI) insertion trends among adolescents, as well as SCI retention at 1, 2, and 3 years, indications for removal, and to identify pregnancies that occurred during SCI use.

Design, Setting, Participants, Interventions, and Main Outcome Measures

A retrospective cohort study was conducted of adolescents aged 13-19 years with SCI insertions in 2008-2014 within a large integrated health care system. Demographic and clinical characteristics included age, race/ethnicity, body mass index, gravidity, parity, insertions, reinsertions, indications for removal, and pregnancy. Electronic medical record review was conducted on a randomized sample of 540 adolescents with insertions during 2008-2011 for the retention objective to validate electronically extracted variables. Analyses included descriptive statistics, survival analysis with Kaplan-Meier estimates for implant retention and Cochran-Armitage trend test for insertions according to year during 2008-2014.

Results

Most adolescent SCI users were non-Hispanic white (43%), or Hispanic (34.2%) and 16 years or older (84.2%) at the time of insertion. Overall, 1-, 2-, and 3-year retention rates were 78.6%, 59.4%, and 26.2%, respectively, with retention at 44.3% at 2 years 9 months (indicative of removal of method for near expiration of 3-year device). The insertion rate trend showed statistically significant increases annually, from 0.14% in 2008 to 0.91% in 2014; P < .0001. No pregnancies were documented during implant use. The most common indication for SCI removal was device expiration.

Conclusion

SCI insertions increased annually among adolescents, with more than a sixfold increase over the 6-year study period, and more than half of the SCIs were retained through 2 years of use. The most common indication of SCI removal was completion of Food and Drug Administration-approved duration.

中文翻译：

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青少年皮下避孕药的植入趋势和保留率

研究目的

在性活跃的青少年中，越来越多的人主张使用长效可逆避孕。我们的主要目的是评估青少年中的依托孕酮皮下避孕植入物（SCI）的插入趋势，以及在1、2和3年时的SCI保留，去除的迹象，并确定在使用SCI期间发生的怀孕。

设计，设置，参与者，干预措施和主要结果指标

进行了一项回顾性队列研究，研究对象是2008-2014年在大型综合医疗保健系统中插入SCI的13-19岁青少年。人口统计学和临床​​特征包括年龄，种族/民族，体重指数，妊娠率，胎次，插入，重新插入，摘除指征和怀孕。电子病历审查是对随机抽取的540名青少年的样本进行的，这些样本在2008-2011年期间有保留，目的是验证电子提取的变量。分析包括描述性统计数据，根据Kaplan-Meier估计的种植体保留率进行的生存分析以及根据2008-2014年的插入情况进行的Cochran-Armitage趋势测试。

结果

插入时，大多数青春期SCI用户为非西班牙裔白人（43％）或西班牙裔（34.2％）和16岁以上（84.2％）。总体而言，1年，2年和3年保留率分别为78.6％，59.4％和26.2％，在2年9个月时的保留率为44.3％（指示将3年期满的方法取消）设备）。插入率趋势显示出统计上的每年显着增长，从2008年的0.14％到2014年的0.91％；P  <.0001。植入期间没有怀孕记录。清除SCI的最常见指示是设备到期。

结论

青少年的SCI插入量逐年增加，在6年的研究期内，其插入量增加了六倍以上，并且通过使用2年，保留了一半以上的SCI。清除SCI的最常见迹象是食品和药物管理局批准的工期完成。