CDC Updates Eligibility Criteria for Contraceptive Use
Am Fam Physician. 2016 Dec 1;94(11):942-944.
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Key Points for Practice
• The use of IUDs in postpartum women is safe and does not increase IUD-associated risks.
• Combined hormonal contraceptives present an unacceptable health risk, or category 4, for breastfeeding women fewer than 21 days postpartum.
• For women with a history of or acute superficial venous thrombosis, combined hormonal contraceptives are a category 3, whereas other forms of contraception are category 1.
• STI screening at the time of IUD insertion is not necessary in most women.
From the AFP Editors
Almost one-half of pregnancies in the United States are unintentional. These pregnancies are linked to increased risks of adverse outcomes for the mother and infant, and greater health care costs. Many safe and effective methods for contraception exist, all of which require evidence-based guidance for health care professionals.
The Centers for Disease Control and Prevention (CDC) first published the U.S. Medical Eligibility Criteria for Contraceptive Use, which is a companion document to the U.S. Selected Practice Recommendations for Contraceptive Use, in 2010 to provide guidelines on safely using a variety of contraceptive methods. These guidelines update the 2010 report.
Using the Guidelines
These guidelines, which discuss the use of contraceptives in persons with certain characteristics (e.g., age) or known medical conditions (e.g., diabetes mellitus), can be used when discussing different methods with patients. The recommendations do not consider the use of these methods for other medical conditions.
The conditions that affect the eligibility for each method are categorized as follows: 1 = condition for which there is no restriction for the use of the method, 2 = condition for which the advantages of using the method generally outweigh the theoretical or proven risks, 3 = condition for which the theoretical or proven risks usually outweigh the advantages of using the method, and 4 = condition that represents an unacceptable health risk if the method is used.
Updates and Changes
The full guidelines provide categorizations for all contraceptive methods across a variety of conditions. Some of the changes and updates are highlighted in this summary (http://www.cdc.gov/mmwr/volumes/65/rr/rr6503a1_appendix.htm#modalIdString_CDCTable_0).
A few things should be kept in mind when evaluating postpartum women for contraceptive use, including the benefits of breast-feeding for women and their infants. Public health goals from the U.S. Department of Health and Human Services include increasing the number of infants who are breastfed initially, solely breastfeeding for at least six months, and continuing to breastfeed for at least a year.
In postpartum women, the presence of additional risk factors for
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
Copyright © 2016 by the American Academy of Family Physicians.
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