Hormonal contraception use and pregnancy in adolescents with sickle cell disease: analysis of Michigan Medicaid claims

Background: Access to effective family planning is of great importance for women with sickle cell disease (SCD) due to the increased frequency of pregnancy complications. However, little is known regarding use of hormonal contraception, complications of contraception, and pregnancy in young women with SCD. Study Design: We abstracted diagnostic codes, procedure codes and pharmacy claims from women with SCD, aged 13-21 years, enrolled in Michigan Medicaid between 1/1/2000 and 12/31/2003 with >= 9 months of continuous eligibility. Results: We identified 250 women with SCD with an average period of continuous Medicaid enrollment of 20 months. Claims for hormonal contraception could be identified in only 20 patients (8%, 95% CI 5-12%). The most commonly prescribed method (n=12) was depot medroxyprogesterone (DMPA) acetate. Venous thromboembolism and osteopenia were rarely identified (n <= 10) and occurred only in women with no recorded use of hormonal contraception. In the total population, 64 patients had one pregnancy and 16 had >= 2 pregnancies during the 4-year study period. Among adolescents (13-18 years), 49 (30%) of 195 patients (95% CI 24-37%) had 59 pregnancies. By 12 weeks postpartum, few patients (n <= 10) with a record of delivery had hormonal contraception claims. Conclusions: In a publicly insured population of young women with SCD, pregnancy was more commonly identified than hormonal contraception use. Our work suggests that significant gaps may exist in family planning care for young women with SCD. (C) 2011 Elsevier Inc. All rights reserved.