Pregnancies complicated by an intrauterine device in situ are
associated with a greater risk of adverse outcomes.
Conclusion
Women conceiving with an intrauterine device are at increased risk for adverse
obstetric outcomes. The risk is higher with a retained intrauterine device compared
with an early intrauterine device removal. Pregnancies continuing with the IUD
retained are more likely to result in a spontaneous abortion than those for whom the
device was removed or expelled. Thus, early removal reduces the risk of an adverse
pregnancy outcome. Even with an early removal, however, the risk of a spontaneous
is higher than pregnancies not resulting from an IUD failure.
Clinical Question
Does a pregnancy with an intrauterine device in situ increase the risk of adverse
pregnancy outcomes?
Search Terms
IUD, pregnancy outcome, birth defects.
Citations
Brahmi D, Steenland MW, Renner RM, et al. Pregnancy outcomes with an IUD in
situ: a systematic review. Contraception 2012;85:131-139.
Object of Research
Intrauterine device
Research Outcome
Birth defects
Study Features
This is a review article which includes information from studies comparing the IUD
retained versus removed, three studies comparing the IUD retained versus removed
versus pregnancies conceived without an IUD, and one of the IUD retained versus
pregnancies conceived without an IUD.
The studies include:
Canada, Puerto Rico, USA: This is a retrospective cohort study from 1970 – 1976. Of
918 pregnancies with an IUD in situ at conception, 275 continued their pregnancies
with 157 retaining their IUD and 118 having it removed or it was expelled.
Turkey [1]: This is a retrospective cohort study from 1994-1999. Of 618 pregnancies
with an IUD in situ at conception, 89 continued their pregnancies with 26 retaining
their IUDs and 56 having it removed or it was expelled.
Turkey [2]: This is a retrospective cohort study from 2009-2010. Of 48 pregnancies
with an IUD in situ at conception, 30 retained their IUDs and 18 had it removed or it
was expelled.
France [1]: This is a retrospective cohort study from 1979 -1985. Of 157 pregnancies
with an IUD in situ at conception, 29 retained their IUDs and 38 had it removed or it
was expelled.
France [2]: This is a retrospective cohort study from 1985 -1988. Of pregnancies with
an IUD in situ at conception, 12 retained their IUDs and 41 had it removed or it was
expelled.
Israel [1]: This is a retrospective cohort study from 1988 -2007. Of pregnancies with
an IUD in situ at conception, 98 retained their IUDs and 191 had it removed or it was
expelled.
Israel [2]: This is a retrospective cohort study. Of pregnancies with an IUD in situ at
conception, 16 had their IUDs removed. These outcomes were compared with 48
pregnancies without an IUD matched for age, parity, and gravidity.
Chile: This is a retrospective cohort study from 1997-2007. Of pregnancies with an
IUD in situ at conception, 196 retained their IUDs and these were compared to
121,101 pregnant women with no IUD.
Evidence Grade: Level 3
The Evidence
The following is a summary of outcomes from these studies.
Canada, Puerto Rico, USA
IUD retained (n=157)
Spontaneous Abortion
54%
Preterm Delivery
17%
Live birth
44%
Still birth/neonatal death
2%
IUD removed/expelled (n=118)
20%
4%
79%
1%
Turkey [1]
IUD retained (n=26)
Spontaneous Abortion
77%
Preterm Delivery
23%
Still birth/neonatal death
-
IUD removed/expelled (n=56)
27%
7%
-
The Evidence (continued)
Turkey [2]
IUD retained (n=30)
Spontaneous Abortion
53%
Preterm Delivery
23%
Live birth
Stillbirth/neonatal death
Vaginal bleeding
40%
Placental abruption
7%
Premature rupture (PROM) 40%
Small for gestational age
7%
IUD removed/expelled (n=18)
17%
6%
28%
0%
0%
11%
Chile
IUD retained (n=196)
Spontaneous abortion
16%
Preterm Delivery
56%
Premature rupture (PROM) 35%
Placental previa
2%
Placental abruption
8%
Chorioamnionitis
8%
Malformations
8%
Small for gestational age
5%
No IUD (n=121,101)
< 1%
< 1%
< 1%
< 1%
< 1%
< 1%
< 1%
< 1%
France [1]
IUD retained (n=29)
Spontaneous Abortion
48%
Septic abortion
7%
Preterm Delivery
*
Live birth
*
Vaginal bleeding
*
Premature rupture (PROM)
*
*Combined categories
90%
IUD removed/expelled (n=38)
8%
0%
*
*
*
*
34%
Note: A comparison group of pregnancies with no IUD reported vaginal bleeding in
10% of all cases; 13 percent of all pregnancies conceived with an IUD in situ resulted
in a congenital malformation.
France [2]
IUD retained (n=12)
Preterm Delivery
Vaginal bleeding
Premature rupture (PROM)
Malformations
25%
16%
9%
9%
IUD removed/
expelled (n=41)
17%
8%
12%
2%
No IUD
(n=14,442)
7%
10%
3%
7
The Evidence (continued)
Israel [1]
IUD retained (n=98)
Preterm Delivery
Birth weight < 2.5 kg
Premature rupture (PROM)
Placental previa
Placental abruption
Chorioamnionitis
Malformations
18%
11%
10%
4%
4%
7%
10%
IUD removed/
expelled (n=194)
14%
13%
8%
4%
2%
4%
6%
No IUD
(n=141,191)
7%
7%
6%
4%
1%
1%
5%
Israel [2]
Preterm Delivery
IUD retained (n=16)
19%
No IUD (n=48)
2%
Appraised by: The Jordan Evidence Based Medicine Reproductive Health Group
Update by: 25 March 2016