Perinatal outcomes including long-term neuropsychiatric hospitalizations of offspring conceived during intrauterine contraceptive device use

Objective: To investigate short-term adverse perinatal outcomes and long-term neuropsychiatric hospitalizations through 18 years of age in offspring conceived during copper intrauterine device (IUD) use. Study design: We conducted a population-based cohort study comparing the pregnancy outcomes after 22 weeks of women who conceived with a copper IUD that was removed, women with a retained IUD and pregnancies without an IUD. Deliveries occurred between the years 1991 and 2014. We used a multivariable generalized estimating equation (GEE) logistic regression model analysis to control for confounders and for maternal clusters, a Kaplan–Meier survival curve to compare cumulative neuropsychiatric hospitalizations incidence and a Cox proportional-hazards model to evaluate long-term neuropsychiatric hospitalizations. Results: During the study period there were 221,805 deliveries, of which 203 (0.09%) and 149 (0.06%) occurred in patients with removed or retained copper IUD, respectively. Using GEE models, preterm delivery was independently associated with copper IUD use [odds ratio (OR) 2.1, 95% confidence interval (CI) 1.4–3.2 and OR 2.3, 95% CI 1.4–3.7 for removed and retained IUD, respectively]. We did not find an association between copper IUD presence or removal and the offspring's long-term neuropsychiatric hospitalizations (total long-term neuropsychiatric hospitalizations: 2.5%, 4.4% and 3.2% for removed, retained and no IUD, respectively, p=.71). Long-term neuropsychiatric hospitalization rate was comparable between the groups (Kaplan–Meier survival curve log rank p=.23). Conclusion: Pregnancies in women who conceive with a removed or retained copper IUD are at an increased risk for short-term adverse perinatal outcomes, especially preterm delivery. For pregnancies that continued to at least 22 weeks, we found no benefit in IUD removal. However, the risk of long-term neuropsychiatric hospitalizations is not increased among offspring of these women. Implications: Our data are insufficient to make a recommendation as to whether removal or retention of a copper IUD during pregnancy is best, as after 22 weeks’ gestation we have found no benefit in IUD removal. Careful surveillance and categorization of the pregnancy as “high risk” are warranted.