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  • Title: Current use of an intrauterine device and risk of tubal pregnancy.
    Author: Rossing MA, Daling JR, Voigt LF, Stergachis AS, Weiss NS.
    Journal: Epidemiology; 1993 May; 4(3):252-8. PubMed ID: 8512989.
    Abstract:
    Using data from a population-based, case-control study, we assessed risk of tubal pregnancy associated with use of an intrauterine device (IUD) at the time of conception. Cases were 249 members of Group Health Cooperative of Puget Sound who experienced a tubal pregnancy between 1981 and 1986. Controls were 831 members at risk of ectopic pregnancy who were similar to cases with respect to age and county of residence, but otherwise selected at random. Risk of tubal pregnancy associated with current IUD use was compared separately to that among users of various other (or no) contraceptive methods. Tubal pregnancy was more likely to occur among IUD users than among women using oral contraceptives [relative risk (RR) = 3.8, 95% confidence interval (CI) = 1.5-9.9] or barrier methods (RR = 3.6, 95% CI = 1.6-8.1), or, to a lesser extent, among women who had been surgically sterilized (RR = 1.6, 95% CI = 0.8-3.5). In contrast, IUD users were much less likely to experience a tubal pregnancy (RR = 0.2, 95% CI = 0.1-0.4) than were women who were currently not contracepting. For most women, the decision to use an IUD occurs within the context of choosing among various contraceptive methods. Our results indicate that, for these women, the decision to use an IUD results in increased risk of ectopic pregnancy while the device is in use. In King County, Washington, health workers interviewed 249 members of Group Health Cooperative of Puget Sound who had had an ectopic pregnancy between October 1981 and September 1986 and 831 randomly selected, age- and county-matched controls who were at risk of ectopic pregnancy. Researchers wanted to examine the risk of ectopic pregnancy associated with IUD use at time of conception. The Copper 7 IUD was the most common IUD used (66.7% of cases and 65% of controls). Cases were more likely to have a positive titer for C. trachomatis than controls (33.8% vs. 17.6%). In comparison with users of oral contraceptives, barrier methods, and tubal sterilization, IUD use increased the risk of ectopic pregnancy (relative risk [RR] = 3.8, 3.6, and 1.6, respectively). On other hand, IUD users were less likely to experience ectopic pregnancy than women not using any contraception or using other contraceptive methods (RR = 0.2 and 0.6, respectively). All the aforementioned results did not change when the researchers only considered women using the Copper 7 IUD. The risk of ectopic pregnancy fell with increasing duration of IUD use among current users, but the numbers of women were small (e.g., odds ratio for 36-72 months = 0.6 and for 72 months = 0.4). These findings suggest that, for women in the midst of choosing a contraceptive, the risk of ectopic pregnancy is high when an IUD is in situ.
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