UC study finds low rates of contraceptive use in women with kidney transplant

The study evaluated 13,150 women of childbearing age with kidney transplantation for each calendar year between Jan. 1, 2005, and Dec. 31, 2013, who were aged 15-44 years with Medicare as the primary payer and linked data from the United Network for Organ Sharing, for up to three entire years after the date of transplantation.

Overall, the rate of contraceptive use was 9.5%. The mean age at study entry was 29 plus or minus 7 years for women with any contraceptive use. The contraceptive use was highest among women aged 15-24 years (14.6%) and lowest among women aged 40-44 years (4.1%). The study showed that a younger age and Native American and Black ethnicities were associated with a higher likelihood of contraceptive use. Second- and third-year post-transplant were associated with a lower likelihood of contraceptive use. Interestingly, the socioeconomic status and donor type did not impact the likelihood of contraceptive use.

Shah says the study is unique in that it addresses a comprehensive group of all women with a history of kidney transplants of all racial and ethnic groups in the United States to better understand the incidence of contraceptive use and factors associated with it. The study further took into account patients with complete Medicare coverage, thus avoiding the potential shortfalls of registries dependent on voluntary reporting or patient recall. This study shows for the first time that contraceptive rates in women with kidney transplants remain low in the United States.  

“We were not able to account for use of natural methods or use of condoms by men in our study, which remains a limitation. However, our results highlight that contraceptive use among women with kidney transplants is low,” says Shah.

“The low rate may be attributed to lack of awareness about the return of fertility and inadequate counseling regarding contraception to prevent unplanned pregnancies. Therefore, we need to include contraceptive counseling for women with kidney transplants in routine clinical care.

“Additionally, the present study emphasizes the importance of formulating policies that promote awareness of reproductive health and contraception among women with kidney transplants.”

Assisting her in the research were Annette Christianson, research associate in the UC Department of Environmental Health; Shalini Bumb, MD, in the UC Division of Nephrology Kidney/CARE Program; and Prasoon Verma, MD, in the UC Department of Pediatrics. Shah is supported by the National Institutes of Health K23 career development award, under award number 1K23HL151816-01A1 and intramural funds.