The use of long acting reversible contraception among women with a history of solid organ transplant
Awarded 2012
Complex Family Planning Fellowship Research
Colleen Krajewski, MD
Johns Hopkins University

Background: Little is known about contraceptive counseling and practices among women with solid organ transplant.
Objectives: To determine the knowledge, attitudes, and practices of transplant care providers regarding contraceptive methods; study contraceptive practices among women who have undergone solid organ transplantation and describe the use of LARC methods in a cohort of transplant recipients.
Methods: A survey was circulated via email among transplant care providers at our institution, and among interested subgroups of the American Society of Transplantation (AST). All women who were of reproductive age at the time of transplant in the past 10 years at our institution were invited via mail to complete our survey and to participate in a prospective cohort study of LARC use. Women were offered Paragard Mirena, or Nexplanon in accordance with USMEC guidelines, then followed prospectively for one year.
Results: Provider survey: Surveys were sent via email to physicians, nurses, and coordinators of the Comprehensive Transplantation Center at Johns Hopkins University (36), the AST Women’s Health Community of Practice (COP) (129), the AST transplant pharmacy COP (232); the total was 397, and the response rate was 36% (N= 144). Among this group of motivated providers, 22% reported knowledge of the USMEC and 96.8% reported at least one misconception about LARC methods. 18% reported non-pharmacologic methods (barrier, NFP, abstinence) to be optimal contraception post-transplant. In multiple logistic regression analysis, only knowledge of the USMEC was predictive of provision of contraceptive counseling (OR 6.5, p=0.015).
Patient survey: Of 363 patients identified from the JH transplant database, 54 responded (14%). The most common forms of current contraception reported were condoms (30%), withdrawal (20%), OCPs (11%), and none (11%). 53% of women reported contraceptive counseling by their transplant team, usually the transplant coordinator. Of women who had ever been pregnant, 54% reported unplanned pregnancy, and 29% reported one or more abortions. Three of five reported post-transplant pregnancies were unplanned, and none of these women received contraceptive counseling from their transplant team. Both women with planned pregnancy post-transplant reported contraceptive counseling.
Conclusions: These surveys show broad misconceptions regarding contraceptive safety, leading to incorrect or absent patient counseling. The most effective methods are underutilized in this population that must avoid unintended pregnancy.