bluuebunny/crossref_metadata_2025 huggingface dataset:
Venous Thromboembolism Prophylaxis Prescribing Patterns in Minimally Invasive Gynecologic Surgery After Implementation of Caprini Score Risk Assessment [ID 2683387]
Authors: Norton Taylor J. , Strouse Isabel M. , Galloway Emily , Barba Nelson Brandon
Published: May 2024

INTRODUCTION:

Venous thromboembolism (VTE) is a significant cause of postoperative morbidity, mortality, and cost. Although the risk is low in minimally invasive gynecologic surgery, risk-based prophylaxis is recommended. The modifed Caprini score (CS) can assess risk of VTE and inform preoperative and postoperative prophylaxis. We assessed whether formal implementation of the CS in the Department of Minimally Invasive Gynecologic Surgery at a large academic center affected preoperative and postoperative VTE prophylaxis prescribing patterns.

METHODS:

Institutional review board exemption was obtained. A sample of 356 patients (156 in pre-implementation group and 190 in post-implementation group) undergoing presumed benign minimally invasive hysterectomy or myomectomy between October 2021 and September 2022 was retrospectively analyzed. The primary outcome investigated was adherence to recommended preoperative prophylaxis before and after implementation. Secondary outcomes included incidence of VTE and concern for bleeding.

RESULTS:

Patient demographics, VTE risk factors, CS, and surgical details were determined to be statistically comparable between the groups. The implementation of CS significantly improved preoperative VTE prophylaxis recommendation adherence from 65.4% to 85.2% (P<.001). This was due to both an increase in indicated pharmacologic prophylaxis, as well as a decrease in nonindicated usage in low-risk patients (from 22.4% to 2.6%). VTE risk was similarly low in both groups, occurring in only one patient from the pre-implementation group. There was no significant difference in estimated blood loss.

CONCLUSION:

These results suggest that CS use in patients undergoing minimally invasive gynecologic surgery can improve adherence to recommended preoperative prophylaxis for VTE, while decreasing unnecessary overtreatment in low-risk patients.
Demographic Disparities in Brachial Plexus Birth Injury [ID 2683383]
Authors: Manske Mary Claire B. , Wilson Machelle D. , Wise Barton , Hedriana Herman L. , Tancredi Daniel J.
Published: May 2024

INTRODUCTION:

Black and Hispanic birthing individuals are at increased risk of delivering an infant with a brachial plexus birth injury (BPBI), but the reasons for these disparities are unclear. We evaluated the association of maternal race/ethnicity with established and suspected risk factors for BPBI to determine if these factors mediate these disparities.

METHODS:

Institutional review board approval was obtained for this retrospective cohort study of all live births occurring in California-licensed hospitals from 1996 to 2012. Multiple logistic regression was used to model adjusted associations of maternal race and ethnicity with an infant born with BPBI. Causal mediation analyses evaluated established and suspected risk factors for BPBI (obesity, diabetes, gestational diabetes, shoulder dystocia, macrosomia, prolonged second stage of labor, gestational age, post-term, vaginal delivery, insurance status, inadequate prenatal care) as potential mediators of the BPBI–maternal race/ethnicity relationship.

RESULTS:

The cohort included 6,278,562 births, with 7,762 BPBI. Although Black birthing individuals had an increased risk of obesity (adjusted odds ratio [aOR] 2.48) and diabetes (aOR 1.59) compared to non-Blacks, they had a lower risk of shoulder dystocia (aOR 0.76), macrosomia (aOR 0.60), prolonged second-stage labor (aOR 0.33), precipitous labor (aOR 0.88), and vaginal delivery (aOR 0.79). Blacks had an increased risk of inadequate prenatal care (aOR 1.26) and being underinsured (aOR 1.30). The combination of these factors explained only 16.3% of the increased risk for BPBI in Black people. Findings were similar in Hispanic individuals.

CONCLUSION:

The increased risk of BPBI in Black and Hispanic individuals is only modestly explained by known risk factors. Prenatal care utilization and socioeconomic factors may play a role.
RNA-Seq Analysis of Blastocoel Fluid-Conditioned Media From Euploid Embryos Reveals Higher Expression of Specific Mitochondrial Genes in Media From Embryos Associated With Positive Implantation Outcomes [ID 2683525]
Authors: Chosed Renee J. , Clay-Gilmour Alyssa , Earle Angel , Conry Alexandra , Green Lisa , Magwood Krystal
Published: May 2024

INTRODUCTION:

This retrospective study measured gene expression using RNA-seq of blastocoel fluid-conditioned media from euploid embryos with known implantation status to identify genes associated with implantation outcomes.

METHODS:

Blastocoel fluid-conditioned media was obtained after biopsy (ploidy status via NextGen sequencing) of intracytoplasmic sperm injection-generated day 5 blastocysts. Media used for RNA-seq were from 10 euploid blastocysts with known implantation outcomes. RNA was extracted, libraries were prepared, NextSeq500 sequencing was performed, and then sequences were aligned to the human genome. After quality control, the total gene count was 15,284. DESeq2 was used to test for differential gene expression. Raw read counts were normalized and variance stabilizing transformations were applied across samples. Log fold change shrinkage methods were used for gene visualization and rankings. Wald test statistic was used to compare implantation outcomes. Adjusted false-discovery rate P value of <.05 was considered statistically significant for differential expressed genes.

RESULTS:

Several genes were identified in this analysis revealing differential expression when comparing implantation outcomes. Of interest were two mitochondrial genes (DNAJC19 and MT-TK) and the NOA1 (required for mitochondrial function) with higher expression in media from embryos resulting in successful implantation.

CONCLUSION:

This study implicates mitochondrial function as a key player during preimplantation development that may affect implantation outcomes. DNAJC19 acts to bring proteins into the mitochondrial matrix, MT-TK encodes a mitochondrial tRNA, and NOA1 is a GTP binding protein residing in the mitochondria. The media samples in this study were collected from euploid blastocysts; therefore, gene expression differences detected represent potential molecular markers for predicting implantation success.
Neonatal and Maternal Outcomes of mRNA Compared With Non-mRNA Vaccinations in Pregnant Patients With COVID-19: A Systematic Review and Meta-Analysis [ID 2683437]
Authors: Queiroz Almeida Juliana Vieira , Silva Eloisa Gonçalves , Silva Anelise Maria , Alves Lívia , Gokmen Karasu Ayse Filiz , Philip Chris E.
Published: May 2024

INTRODUCTION:

COVID-19 infection in pregnancy poses risks such as preeclampsia, preterm birth, and stillbirth, even when asymptomatic. Vaccination is recommended, but hesitancy exists because of limited pregnancy-related data. Notable vaccines in the United States considered safe in pregnancy are Pfizer and Moderna, two mRNA vaccines, and Johnson & Johnson, an adenovirus vaccine. We aimed to investigate the safety profile of mRNA versus non-mRNA vaccines, and if a particular vaccine type offered superior care.

METHODS:

We systematically searched Pubmed, Embase, and Cochrane Central for studies comparing mRNA and non-mRNA vaccines. RevMan5 and RStudio were used for statistical analyses.

RESULTS:

We included eight observational studies, with a total of 32,153 patients assessed for maternal and neonatal outcomes. Overall, mRNA vaccines had lower incidence of fetal death outcomes (P<.00001), and non-mRNA vaccines had lower incidence of fever (P<.00001). In subgroup analyses, the J&J vaccine (Ad26.COV2.S) was less associated with premature labor/delivery (P=.09) and missed/spontaneous abortion (P=.02) when compared to Pfizer. Leave-one-out analysis favored mRNA vaccines in reducing the risk of fetal or neonatal death and still favored non-mRNA vaccines for minimizing pyrexia, expressing low heterogeneity.

CONCLUSION:

This meta-analysis changes our current perspective on the safety profile of mRNA vaccines, providing insightful information, because the use of certain vaccine classes may benefit women prone to certain events, such as recurrent pregnancy loss or with a history of premature labor/delivery.
SARS-CoV-2 Variants in Pregnancy [ID 2683546]
Authors: Asirwatham Alison , Hillman Michelle , Khan Lyba , Sangermano Lisa M. , Leung Katherine , Leftwich Heidi K.
Published: May 2024

INTRODUCTION:

We examined the effect of infection with each of the most common SARS-CoV-2 variants during pregnancy on the development of preeclampsia.

METHODS:

This was an IRB-approved retrospective cohort study of patients at our academic hospital from January 1, 2019 to December 30, 2022. Primary outcomes were rates of preeclampsia among those with and without SARS-CoV-2 infection during pregnancy, specifically comparing the periods when the most common SARS-CoV-2 variants (Alpha, March 15 to June 21, 2021; Delta, June 21 to December 20, 2021; and Omicron, December 20, 2021 to December 30, 2022) were the most frequently diagnosed variant. The secondary outcome was characteristics of placental pathology.

RESULTS:

Six thousand three hundred fifty-eight charts were reviewed, 6,182 met inclusion criteria, and 657 tested positive for SARS-CoV-2 during pregnancy. There were 109 cases prior to the identification of the Alpha variant, 14 Alpha, 72 Delta, and 462 Omicron cases. All variants were associated with an increase in preeclampsia (P=.006). In adjusted models, the pre-Alpha infection was associated with a 2.12-fold increase in preeclampsia (P=.003), and Omicron infection was associated with 2.11-fold increase in severe preeclampsia (P=.01). Infections with Omicron and Delta were associated with an increase in placental intervillous thrombi (30.8% and 16.5% versus 12.5% in no infection; P=.014). Intervillous thrombi was seen 3.25 times more after Delta infection in adjusted models (P=.001).

CONCLUSION:

Adjusted models showed an increase in preeclampsia rates with pre-Alpha and severe preeclampsia with Omicron variant infections. Delta infection was associated with an increase in thrombotic vasculopathy within the placenta. These findings suggest differing levels of concern by viral variant and may help direct counseling should additional variants emerge.
Effect of SARS-CoV-2 Infection on Preeclampsia Rates in a Single Academic Center [ID 2683570]
Authors: Hillman Michelle , Khan Lyba , Patel Jenna , Long Kylie C. , Leung Katherine , Leftwich Heidi K.
Published: May 2024

INTRODUCTION:

Given the rise in preeclampsia during the COVID-19 pandemic, we aim to describe the effect of SARS-CoV-2 positivity during pregnancy on rates of preeclampsia with and without severe features.

METHODS:

This was an IRB-approved retrospective cohort study of patients receiving prenatal care and delivering at our academic hospital from January 1, 2019 to December 30, 2022. Primary outcomes were rates of preeclampsia and severe preeclampsia among those with and without SARS-CoV-2 infection during pregnancy. The secondary outcomes were placental pathology.

RESULTS:

Six thousand three hundred fifty-eight total charts were reviewed, and 5,525 patients met inclusion criteria. Of these, 12.1% tested positive for SARS-CoV-2 during pregnancy. Significantly more SARS-CoV-2-positive patients developed preeclampsia (16.1% versus 11.7%; P=.001). Of these, significantly more SARS-CoV-2-positive patients developed severe features (68.2% versus 55.0%; P=.011). Adjusted analysis showed SARS-CoV-2-positive patients 31% more likely to develop preeclampsia (95% CI, 1.03–1.67; P=.030) and 79% more likely to have severe features (95% CI, 1.14–2.80; P=.011). Placental pathology for 2,124 patients revealed SARS-CoV-2-positive patients 43% more likely to have intervillous thrombi than those without (95% CI, 1.02–2.01; P=.038). No other studied placental pathology differed.

CONCLUSION:

SARS-CoV-2 infection during pregnancy was associated with an increase in preeclampsia and severity compared to uninfected patients. Placental pathology from SARS-CoV-2-positive patients was more likely to show some vascular malperfusion, as evidenced by higher rates of intervillous thrombi. As COVID-19 becomes more endemic, these risks are important to note and discuss.
Rates of Female Sterilization, Vasectomy, and LARC Placement Before and After the Dobbs Decision: A Retrospective Cohort Study [ID 2683404]
Authors: Mitchell Jameson A. , Yao Meng , Maeda Rie , Lappen Justin R. , Brant Ashley R.
Published: May 2024

INTRODUCTION:

Immediately after the Dobbs decision in Ohio, abortion was restricted after detection of a fetal heartbeat. The objective of this study was to characterize changes in utilization of long-acting reversible contraception (LARC) and permanent sterilization (PS) after the abrupt enactment of restrictive abortion legislation.

METHODS:

We conducted a retrospective cohort study of female and male patients aged 15–55 who underwent permanent sterilization (tubal ligation, salpingectomy, vasectomy) or LARC placement (IUD, contraceptive implant) at a large Northeast Ohio hospital system from January 1, 2022 to December 31, 2022; 6 months before and after Dobbs. Contraception procedure volumes were compared, and patient characteristics were assessed.

RESULTS:

Pre-Dobbs, 4,247 procedures were identified among females, including 725 (17.1%) PS and 7,449 (81.3%) LARC. Post-Dobbs, the total number of female procedures increased by 15.5% (4,916) and there was a significant increase in the proportion of PS procedures, representing 20.1% of all female procedures (P<.001). Males showed a similar trend, with vasectomies rising from 1,193 to 1,590 procedures. Post-Dobbs, patients undergoing procedures were younger (women, 30.9 years [24.5, 36.8] versus 31.5 [25.2, 36.9]; P=.011; men, 36.6 years [32.9, 39.6] versus 37.2 [34.2, 40.4]; P<.001). Among patients undergoing procedures post-Dobbs, the proportion that reported single relationship status significantly increased for women (57.4% versus 55.9%; P=.028) and men (23.0% versus 18.1%; P=.002).

CONCLUSION:

This study demonstrates increased utilization of LARC and PS following the Dobbs decision. This rise in PS and demographic changes implies concerns about abortion access, especially among younger reproductive-aged patients. Further research is warranted to understand the driving factors behind these trends.
Estrogen-Containing Contraceptive Use and Blood Lead Concentrations in a Cohort of Young Women [ID 2683459]
Authors: Chapman Lauren E. , Upson Kristen , Hall Mandy S. , Harmon Quaker E. , Wise Lauren A. , Wegienka Ganesa
Published: May 2024

INTRODUCTION:

Toxic metal lead is stored in the skeleton and, with increased bone turnover, is mobilized to systemic circulation. Given the bone-conserving properties of estrogens, we hypothesized that current users of estrogen-containing contraception would have lower blood lead concentrations.

METHODS:

We conducted a cross-sectional analysis using baseline data from the Study of Environment, Lifestyle & Fibroids (SELF). During 2010–2012 (baseline), 1,693 self-identified Black women, ages 23–35, enrolled. Data on contraceptive use were ascertained by interview. We quantified lead concentrations in whole blood using inductively coupled plasma mass spectrometry (ICP-MS). Among 1,555 participants, we estimated the percent difference in blood lead concentrations and 95% CIs between current users and nonusers of estrogen-containing contraception using multivariable linear regression, adjusting for potential confounders.

RESULTS:

The geometric mean blood lead concentrations for estrogen-containing contraceptive users and nonusers were 0.41 micrograms/dL (95% CI: 0.39, 0.43) and 0.51 micrograms/dL (95% CI: 0.50, 0.52), respectively. After adjustment, current use of estrogen-containing contraception was associated with 10% lower blood lead concentrations (95% CI: −15%, −4%). Considering estrogen-containing contraceptive type, compared to nonusers, combined oral contraceptive users (n=187) had 9% lower blood lead concentrations (95% CI: −15%, −2%) and vaginal ring/transdermal patch users (n=33) had 17% lower blood lead concentrations (95% CI: −29%, −4%).

CONCLUSION:

As hypothesized, we observed lower blood lead concentrations with current use of estrogen-containing contraception. Further research is warranted to confirm the results and to understand the relationship between lead exposure, hormonal contraception, and bone health to limit systemic lead exposure.
Is Women's Knowledge About Oral Contraception Affected by Social Media? [ID 2683506]
Authors: Yu Vivian , Southard Rachel A. , Nelson Anita L.
Published: May 2024

INTRODUCTION:

This study sought to investigate a possible association between use of social media for women’s health and individuals’ knowledge regarding oral contraception.

METHODS:

This IRB-approved, anonymous study surveyed English-speaking, female followers of two of the authors’ (V.Y., R.A.S.) well-known platforms on Instagram and YouTube about their oral contraception knowledge and the sources of that knowledge. The 14-question survey collected demographic information and personal experiences with hormonal contraception. It then asked for agreement on a 5-point Likert scale with factual and nonfactual statements about oral contraceptive pills. The sources of information were compared between high- versus low-scoring participants.

RESULTS:

Two thousand fifty-four women responded. The majority (72.3%) were 25 years or younger; 57.6% were Caucasian; 67.5% had at least college degrees. Nearly 50% were students; the remainder were employed. Incomes were well distributed. Two-thirds had used oral contraceptives but nearly 80% reported searching online prior to filling a prescription. Most frequently missed questions were related to mood disorders, weight gain, and infertility. Comparing those who had less than or equal to two questions correct (42.3%) versus greater than or equal to five questions correct (11.1%), more of the former (56.6%) acquired information from friends and social media than did the latter (28.1%) (P<.001).

CONCLUSION:

This survey of young, highly educated, frequent consumers of social media harbored many myths about oral contraceptive use, often originating from friends and social media sources. Recognizing the effect that online influences have on women’s oral contraceptive knowledge may assist providers in their counseling.
Do Rates of Obtaining Desired IPP LARC Differ by Maternal Care Access Levels and Demographics? [ID 2683528]
Authors: Young Megan Lacy , Mastronardi Alicia , Shelton Zachary , Maples Jill M. , Zite Nikki
Published: May 2024

INTRODUCTION:

This analysis aimed to determine whether rates of obtaining desired immediate postpartum long-acting reversible contraception (IPP LARC) differed by maternity care access level or maternal demographic characteristics to identify gaps in practice, specific to health equity among Tennessee Medicaid recipients.

METHODS:

Data were obtained from deliveries March 2018 to December 2022 at our institution. Only deliveries insured by TennCare Medicaid were included in the analysis. Maternal care access level was defined by March of Dimes 2022 designations based on location of maternal residence. Variables included contraception counseling, desired and obtained contraception type, late/limited prenatal care designation, and demographics including race, ethnicity, age, gravida, and maternity care access level.

RESULTS:

Of the 10,623 publicly insured deliveries from March 2018 to December 2022, 2,251 patients desired IPP LARC, and 84.5% obtained it. Among those who did not (15.5%), 4.9% lived in a designated maternity care desert (MCD); 15.6% had late, limited, or no prenatal care; 21.7% were Hispanic; and 14.2% were Black, non-Hispanic. There were no statistically significant differences in IPP LARC obtainment between maternal care access levels or the other maternal demographics considered.

CONCLUSION:

When individuals are unable to obtain their desired contraceptive option immediately following delivery, assessing factors that may prevent access, including systemic barriers and potential bias, should be important in the organization. Bias may be identified as gaps in rates of obtainment stratified by maternal characteristics. Although we do not currently see statistically significant differences in rates of obtaining desired IPP LARC based on maternal characteristics, ongoing assessment will continue.
Association Between Contraceptive Efficacy Knowledge and Method Choice: A Behavioral Economics Lens [ID 2683608]
Authors: Schaefer Kimberly M. , Liberty Abigail
Published: May 2024

INTRODUCTION:

Patients often use less effective contraception despite desire to avoid pregnancy, a decision considered “irrational” by neoclassical economic theory. “Bounded rationality,” a behavioral economics principle encompassing information failure, may underlie such decisions. We assess the role of bounded rationality on contraceptive decision-making by evaluating the relationship between contraceptive efficacy knowledge and contraceptive choice.

METHODS:

We used the Guttmacher’s publicly available “Continuity and Change in Contraceptive Use” dataset, a survey administered 2012–2014. Contraceptive effectiveness was grouped into Tier 1, Tier 2, “Other,” and “No Method” based on survey options and CDC classification. Contraceptive knowledge was assessed by two questions comparing effectiveness of oral contraceptive pills (OCPs) versus condoms and OCPs versus intrauterine devices (IUDs). We used logistic regression to calculate odds ratios (ORs) for the association between contraceptive tier used and contraceptive knowledge, adjusted for race/ethnicity and age, with each regression restricted to users of the two methods compared.

RESULTS:

Our sample included 4,634 respondents. 43.8% accurately compared OCPs and condoms; 30.1% accurately compared OCPs and IUDs. Answering that condoms are more effective than OCPs was associated with seven times greater odds of using other methods (OR 7.1; 95% CI, 4.5–11.1). Answering that OCPs are more effective than IUDs was associated with 0.01 odds of using Tier 1 over Tier 2 (95% CI, 0.005–0.05).

CONCLUSION:

Consistent with bounded rationality, respondents who incorrectly compared contraceptive efficacy were far more likely to use the less effective method. Contraception misconceptions, particularly regarding relative efficacy, should be assessed and addressed when offering patient-centered counseling.
Comparative Readability Assessment of Four Large Language Models in Answers to Common Contraception Questions [ID 2683638]
Authors: Patel Anisha V. , Panakam Aisvarya , Amin Kanhai , Doshi Rushabh H. , Patil Ankita , Sheth Sangini S.
Published: May 2024

INTRODUCTION:

Large language models (LLMs) have the potential to revolutionize reproductive health education by offering accessible contraception counseling. The CDC, NIH, and AMA recommend presenting patient educational materials at or below a sixth-grade reading level. In this study, we present a comparative analysis of the readability of responses generated by LLMs, including OpenAI's ChatGPT 4.0, OpenAI's ChatGPT 3.5, Google Bard, and Microsoft Bing, to common contraception questions.

METHODS:

Referencing common contraception questions outlined in a recent review, we presented GPT-4.0, GPT-3.5, Google Bard, and Microsoft Bing with six common contraception questions on June 10, 2023, ensuring no prior chat bias. The readability of LLM outputs was evaluated using Flesch–Kincaid Grade Level (FK), Gunning Fog (GF), Automated Readability Index (ARI), and Coleman–Liau (CL) indices. All index score outputs correspond to a reading grade level (RGL), eg, RGL of 6 represents a sixth-grade level.

RESULTS:

Of the four LLMs, Google Bard demonstrated the highest readability with an average RGL of 10.6 (GF 10.1, FK 9.6, ARI 11.4, CL 11.4), followed by GPT-3.5 at an average RGL of 13.6 (GF 13.3, FK 12.6, ARI 15.2, CL 16.5). Microsoft Bing and GPT-4.0 yielded responses with higher average RGLs of 14.2 and 15.4, respectively.

CONCLUSION:

Google Bard and GPT-3.5 offered the most readable responses to contraception questions; however, these models still provided responses significantly above the recommended sixth-grade reading level (RGL of 6). Large language models should undergo evaluation to ensure alignment with established readability standards to optimize patient comprehension in reproductive counseling applications.
Disparities in Overall Survival Within AANHPI Subpopulations With Cervical Cancer [ID 2683427]
Authors: Mishra Anjali , Hu Robert , Silberstein Peter
Published: May 2024

INTRODUCTION:

The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) community is a diverse group, including over 21 ethnic groups, but is often misrepresented as one cohort. Differences in human papillomavirus prevalence and access to care lead to varying cervical cancer incidences and outcomes within the AANHPI community. Here, we compare overall survival (OS) of cervical cancer patients within the AANHPI subpopulations.

METHODS:

The National Cancer Database identified 84,395 women with cervical squamous cell carcinoma (ICD-O-3-code 8070). Races listed as “unknown/other” or “Other Asian” were excluded. Kaplan–Meier and Cox regression model were performed.

RESULTS:

This study identified 985 East Asian (EA), 395 South Asian (SA), 1,073 Southeast Asian (SEA), and 290 NHPI patients with cervical cancer. Mean OS was 144.0 months for EA, 137.0 months for SA, 132.6 months for SEA, and 116.1 months for NHPI. Kaplan–Meier revealed worse OS for SEA and NHPI compared to SA (P=.011, P<.001, respectively) and EA (P=.002, P<.001, respectively). EA (hazard ratio [HR] 0.522; P<.001), SA (HR 0.490; P<.001), and SEA (HR 0.633; P<.001) had lower survival hazard ratios compared to NHPI.

CONCLUSION:

Survival disparities exist among AANHPI subgroups with cervical cancer. Disaggregation of AANHPI subpopulations revealed that SEA and NHPI patients had worse OS. Native Hawaiian and Pacific Islander patients had greater survival hazard ratios after controlling for socioeconomic variables. This study highlights the need to disaggregate AANHPI data so that disparities among subpopulations can be identified, investigated, and addressed.
Ethnicity and In Vitro Fertilization Outcomes in an Equal Access to Care Setting [ID 2683634]
Authors: Molina Ruben , Simpson Samantha , Saunders Rhiana , Ugoanusi Fauziat T.
Published: May 2024

INTRODUCTION:

Many studies report racial disparities in assisted reproductive technology (ART) outcomes, specifically, lower pregnancy rates and higher miscarriage rates in Black women. In an equal access to care setting, we wanted to delineate causes of this ongoing racial disparity.

METHODS:

This is a retrospective review of ART cycles at Brooke Army Medical Center (BAMC) from 2013 to 2021 via the Society for Assisted Reproductive Technology database. This study received a nonresearch designation from the BAMC IRB.

RESULTS:

A total of 1,211 in vitro fertilization (IVF) cycles were reviewed, comparing outcomes by race from first-time embryo transfers, fresh or frozen after “freeze-all” IVF cycles. Black women (19% of all cycles) experienced a lower live birth rate (27.3% versus 34.6%; risk ratio [RR] 0.75; 95% CI 0.6–0.94), but did not experience a statistically significant increase in pregnancy loss (36.8% versus 30.6%; RR 1.26; 95% CI, 0.94–1.68] compared to all other patients. Black women were found to have a higher prevalence of uterine factor infertility (RR 2.87; 95% CI, 2.24–3.66) and tubal factor infertility (RR 1.79; 95% CI, 1.51–2.12). When controlling for uterine factor infertility, Black racial identity was no longer a risk factor for decreased live birth rate (adjusted RR 0.85; 95% CI, 0.69–1.07).

CONCLUSION:

Recent literature demonstrates poorer ART outcomes for Black women. Our study suggests that this may be attributable to uterine fibroids, and an increased research focus on uterine fibroid treatment in patients desiring fertility may improve ART outcomes in Black women.
Changes in Language Used for Ultrasound Reports in Early Pregnancy Loss After Initiation of Restrictive Abortion Laws [ID 2683508]
Authors: Taper Gabrielle , Gonzaga Maria , Tristan Sigrid , Alvarez Miriam J. , Thaxton Lauren D.
Published: May 2024

INTRODUCTION:

This study compared language used to describe early pregnancy loss (EPL) in ultrasound reports at a single teaching hospital before and after the passage of Texas Senate Bill 8 (SB8) in September 2021.

METHODS:

We conducted a retrospective cohort study of pregnant patients presenting to the emergency department (ED) between January 2020 and March 2023. Charts were screened using ICD-10 codes for pregnancy and first-trimester diagnoses and included if diagnosis of EPL was present. Abstracted data from ultrasound reports included the following: diagnosis assigned by radiology and confidence of qualifying language (“diagnostic of,” “suggestive of,” or omitted diagnosis). Evidence-based diagnosis was assigned based upon ultrasound review by two independent ob-gyn providers using established ultrasound criteria for EPL. This protocol was approved for IRB exemption by the University of Texas at Austin Dell Medical School.

RESULTS:

A total of 185 charts were identified, N=103 prior to SB8 versus 82 after. After SB8, radiology-assigned diagnosis was discordant with evidence-based diagnosis more often (55% versus 45%; P=.08) and radiology impressions used less confident qualifying language (61% versus 47%; P=.03).

CONCLUSION:

Restrictive abortion laws like SB8, compounded by the Dobbs decision, may affect the diagnostic accuracy and confidence of qualifying language for diagnosis used in ultrasound reports for EPL. Language in ultrasound reports became significantly less confident after SB8 with a decrease in correct diagnosis despite clear diagnostic criteria. Failure to correctly diagnose EPL on radiology reports may delay recognition and treatment of EPL.
Treatment Goals and Symptoms of Patients Presenting to a Center for Fibroid Care [ID 2683523]
Authors: Dahiya Asha K. , Hamer Dina , Friedman Steven , Hade Erinn , Shirazian Taraneh
Published: May 2024

INTRODUCTION:

Multidisciplinary fibroid centers represent a new model of fibroid care. We evaluated the goals and symptoms of patients presenting to our center.

METHODS:

This is a retrospective cohort study of patients presenting between June 2022 and June 2023. Patients were sent the Uterine Fibroid Symptom Quality of Life (UFS-QOL) survey and a goals questionnaire prior to first appointment. Patients who completed both were included. We obtained age, race, most recent hemoglobin level (Hgb), largest fibroid type on most recent imaging, composite symptom severity score (SS), and health-related QOL score (HRQL). This study met IRB exemption criteria.

RESULTS:

Of 581 patients, 326 (56%) completed both surveys. Mean age was 43.0 years (SD 8.0). Patients identified as Black (35.3%), White (24.8%), Asian (8.9%), and other/multiple race (7.7%). Most patients' largest fibroid was subserosal (37%), followed by intramural (28.7%), submucosal (5.9%), and combined type (28.3%). There was no difference in SS (P=.307) or HRQL (P=.504) between these groups. Most patients (60.7%) selected a top goal of symptom elimination, followed by treating anemia (21.2%) and becoming pregnant (18.1%). Almost a quarter (26.4%) reported difficulty conceiving, and they had higher SS (mean difference [MD] −6.1; 95% CI, −12.1, −0.6) and lower HRQL (MD 7.2; 95% CI, 0.4, 14.0). Patients with Hgb below 12 had higher SS (MD −8.6; 95% CI, −14.6, −2.7) and lower HRQL (MD 8.0; 95% CI, 1.1, 15.0).

CONCLUSION:

Most patients reported a primary goal of symptom elimination. Difficulty conceiving and low Hgb were associated with worse symptoms, yielding insight into treatment opportunities affecting QOL.
Is Concentrated Urine PCR Test Valuable to Detect Genital HPV Infection [ID 2683587]
Authors: Aksakal Boran , Acar Osman , Nadirova Narmin , Apa Alara , Ozturk Harika Bodur
Published: May 2024

INTRODUCTION:

Human papillomavirus (HPV) is the leading cause of cervical cancer and early detection is crucial for effective prevention. The standard HPV detection method, cervical smear PCR, entails discomfort and deters many women. Therefore, it is challenging to screen large populations for HPV from cervical smear samples. In this study, we investigated the sensitivity of detecting HPV by PCR in concentrated urine samples.

METHODS:

Urine and cervical smear samples were collected from 126 patients (ages 20–35) at Acibadem Altunizade Hospital. Urine samples were concentrated by a tool (MyMagiCon). The presence of HPV DNA in cervical smear and urine samples was determined by PCR.

RESULTS:

Among 126 patients, HPV was detected in 57 either in at least one of the sample types (cervical smear, urine, and concentrated urine). Among all HPV-positive patients, HPV was identified in 87.7% of swab samples, 86% of concentrated urine samples, and only 73.7% of unconcentrated urine samples. The χ2 test comparing cervical smear and concentrated urine samples yielded a Kappa value of 0.78 (95% confidence), indicating strong statistical correlation within this study. Additionally, PCR from concentrated urine samples, identified six HPV-positive samples that were HPV negative in cervical smear samples of the same patients.

CONCLUSION:

It was possible to identify HPV in concentrated urine samples by PCR with a sensitivity almost equal to cervical smear sampling. Since obtaining urine is much easier than obtaining cervical smear samples, this may enable easy screening of large populations for HPV. This may have a big effect in the prevention of cervical cancer.
Do Structured Radiology Reports to Describe Uterine Fibroids Provide Adequate Information for Clinical Decision Making? [ID 2683615]
Authors: Alvarez Alexandra L. , Tordjman Laura A. , Alessandrino Francesco , Delgado Stephanie
Published: May 2024

INTRODUCTION:

This study evaluated whether structured radiology reports for uterine fibroids can affect clinical decision-making when compared to narrative reports.

METHODS:

Three templates were developed by gynecology and radiology departments to interpret MRI reports in women with uterine fibroids. These included the following: structured report using FIGO classification (SR-FIGO), structured report without FIGO classification (SR), and narrative report (NR). Twenty reports in each group were reviewed and evaluated for presence of 19 key features deemed relevant for management of fibroids. One-way ANOVA was used to evaluate the distribution of key features. Reports were also evaluated for 1) presence of sufficient information to decide on treatment; 2) surgical approach; 3) type of surgery; 4) necessity to review the MRIs; and 5) time spent reviewing the MRIs.

RESULTS:

Eighty MRI reports for patients with uterine fibroids were reviewed. Average number of key features in each report type was significantly different (P<.001); SR-FIGO had highest number (16.95±0.19), followed by SR (16.15±0.29), and NR (9.8±0.58). A significant difference was observed between NR and SR (P=.001), NR and SR-FIGO (P=.001), whereas no significant difference was observed between SR and SR-FIGO (P=.063). No significant difference was found in answers to questions 1–5 among the three different reports (P-value range: 0.05–0.34).

CONCLUSION:

Structured MRI reports for uterine fibroids provide more information than narrative reports. Including the FIGO classification does not significantly alter clinical decision making. Further studies may help clarify whether SR-FIGO can alter treatment and surgical planning for patients with uterine fibroids.
Physician and Adolescent Hirsutism Score Ratings and Their Concordance to Androgen Levels [ID 2683618]
Authors: Reddy Sireesha Y. , Dubey Pallavi , Kim Sophie Y. , Sangha Hareena , Ramirez Paulina , Sanchez Sheralyn
Published: May 2024

INTRODUCTION:

Hirsutism affects 5–15% of reproductive-aged women. The gold standard for quantifying hirsutism is the modified Ferriman–Gallwey (mFG) score. This study explores whether adolescent and physician ratings of hirsutism using the mFG score, correlate with androgen levels in the setting of confounders like depilation.

METHODS:

Hispanic adolescent females with irregular menstruation and suspected polycystic ovary syndrome (PCOS) were recruited from obstetrics and gynecology clinics at TTUHSC El Paso between September 2021 and May 2023. Patients completed an intake questionnaire, completed PCOS laboratory testing, and rated their hair growth using the mFG visual scoring method. Providers used same the methods for rating hirsutism during the same visit. We estimated Lin’s concordance correlation and Bland–Altman agreement between patient and provider mFG ratings. Linear regression explored factors affecting score changes. Statistical analysis was done by STATA 17.0.

RESULTS:

Forty females participated in this study. The average age at enrollment was 16.19 with a mean (SD) mFG score of 10.55 (5.95) (physicians) and 18.29 (5.78) (adolescents). Adolescents reported higher mean mFG scores than physicians. There is a low level of agreement between the two groups (−7.95; 95% CI: −23.02, 7.12). Specifically, physicians underrated hirsutism scores for arm hair. Using unadjusted linear regression, DHEAS and 17-hydroxyprogesterone levels demonstrate the hormonal influence on hirsutism.

CONCLUSION:

Preliminary findings indicate discordance between physicians’ and patients’ mFG scores, possibly influenced by examination precision and patient perception. Physician-scored mFG, and evaluation of androgen levels, may serve as precise hirsutism markers for Hispanic adolescents.
Fezolinetant Compared With Placebo for Vasomotor Symptoms in Menopause: A Systematic Review and Meta-Analysis [ID 2683665]
Authors: Meirelles Dias Yasmin Jardim , Queiroz Almeida Juliana Vieira , Mora de Marco Novellino Andrea , Eskandar Karine , de Araujo Zotti Ana Isabela
Published: May 2024

INTRODUCTION:

Although menopausal hormone therapy is the most effective choice for vasomotor symptoms (VMS), it is not appropriate for everyone. Therefore, fezolinetant, a nonhormonal, selective neurokinin 3 receptor antagonist has been proposed as an alternative therapy. We aimed to perform a meta-analysis of the clinical outcomes comparing fezolinetant and placebo for vasomotor symptoms in menopause.

METHODS:

PubMed, Embase, and Cochrane databases were searched for studies comparing 30 mg of fezolinetant with placebo in menopausal women. Outcomes assessed were frequency of moderate/severe VMS and change from baseline to week 12 in total VMS score. Our secondary outcomes were headache, bone fracture, and treatment-emergent adverse events (TEAEs) leading to discontinuation of the drug and TEAEs leading to death. We only included randomize control trials. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics and random-risk effect was used if 𝐼2>50%.

RESULTS:

Seven studies met inclusion criteria, with 3,678 patients included, of whom 1,067 were randomized to fenzolinetant. No statistical difference was found in frequency of moderate/severe VMS or TEAEs leading to death, TEAEs leading to drug discontinuation. However, severity of moderate and severe VMS comparing to baseline VMS (MPR) was significantly lower with fezolinetant 30 mg BID (odds ratio [OR] −0.22; 95% CI, −0.30, −0.13; P=.00001; I
2=89%). In addition, headache and bone fractures (OR −6.98; 95% CI, −6.98 to −6.73; P=.03; I
2=100%) were lower with fezolinetant compared to placebo.

CONCLUSION:

Our findings suggest that 30 mg of fezolinetant is a well-tolerated nonhormone therapy that improves vasomotor symptoms with menopause. The safety and efficacy demonstrated in our study support the potential use of fezolinetant as an effective nonhormonal treatment option and may reduce bone fractures and headaches in menopausal women.
Effect of the Affordable Care Act on Cervical Cancer Survival Rates in Californian Women [ID 2683402]
Authors: Akinyemi Oluwasegun A. , Nwokolo Vania
Published: May 2024

INTRODUCTION:

Following the Affordable Care Act (ACA), insurance coverage among women in California surged. While ACA aimed to boost health care access and utilization, whether this has improved cancer-specific survival rates for cervical cancer patients remains questioned. In the present study, we evaluate the effect of the Affordable Care Act (ACA) on cancer-specific survival rates among women with cervical cancer by comparing pre-ACA (2000–2009) and post-ACA (2010–2020) periods.

METHODS:

This study utilized data from the Surveillance, Epidemiology, and End Results (SEER) Registry from 2000 to 2020. We bifurcated the study duration into pre-ACA (2000–2009) and post-ACA (2010–2020). The primary outcome investigated was cancer-specific survival between these periods. Our objective was to assess the effect of ACA's implementation on cancer-specific survival among women diagnosed with cervical cancer. Analytical adjustments were made for patient age, race/ethnicity, disease stage at presentation, income, marital status, and metropolitan residence status. We also considered whether cervical cancer was the primary site and incorporated treatment modalities such as curative surgery, radiotherapy, and chemotherapy into our analysis.

RESULTS:

Of 29,402 cervical cancer patients, 15,962 were diagnosed pre-ACA and 13,440 post-ACA. More women over 50 were diagnosed post-ACA (49.4%) than pre-ACA (44.9%). Late-stage diagnoses rose slightly post-ACA (42.7% versus 40.8%). Curative surgery decreased post-ACA (53.7% from 62.7%), but chemotherapy increased (48.6% from 39.9%). After adjusting for treatment modalities, post-ACA survival rates in California mirrored those of the pre-ACA period (hazard ratio [HR] 1.06; 95% CI, 0.98–1.15).

CONCLUSION:

The implementation of the ACA led to notable changes in treatment patterns and demographics for cervical cancer patients in California. Although health care access increased, cancer-specific survival rates were similar to the pre-ACA period when adjusting for treatment modalities.
The Role of Social Determinants of Health in Seeking Cancer-Related Information and Influencing Cancer Screening Behaviors Among U.S. Adult Women Aged 40–65 Years [ID 2683457]
Authors: Sacca Lea , Okawaraji Goodness , Marciniak Adeife , Zerrouki Yasmine
Published: May 2024

INTRODUCTION:

Social determinants of health (SDOH) influence patients’ breast health and their decision and ability to screen for breast cancer. Our study aims to provide a general overview of SDOH acting as significant predictors of mammogram completion across different timeline categories (1–5 years ago, >5 years ago, and never had a mammogram) compared to having a mammogram a year ago or less.

METHODS:

The data were obtained from the 2020 Health Information National Trends Survey 5 (HINTS 5) Cycle 4, which was administered from February through June 2020 to a total of 2,204 females. Multinomial logistic regression was carried out to identify SDOH acting as predictors of mammogram completion for three different timeline categories (1–5 years ago, >5 years ago, and never had a mammogram) compared to having a mammogram a year ago or less.

RESULTS:

The SDOH predictor variables varied as predictors of mammogram completion across the three timeline categories. For the “mammogram 1–5 years ago” category, being Black, not having a full-time job, being single, and not having health insurance were seen as significant predictors of the screening behavior. For the “mammogram >5 years ago” category, identifying as widowed and not having health insurance showed significance as predictors of breast cancer screening. For the “never had a mammogram” category, all age categories >25 years of age, identifying as Black, being single, and not having health insurance were recorded as significant predictors of mammography. Health insurance was consistently seen as a significant predictor of mammogram completion across the different timeline categories.

CONCLUSION:

Future interventions should consider insurance status as an important factor influencing a woman’s decision to seek breast cancer screening. However, a holistic approach integrating the diverse aspects of the SDOH will be more effective in understanding the different barriers hindering at-risk women from seeking annual mammography.
Medicaid Expansion and Cervical Cancer Survival: A Comparative Analysis of Expansion Compared With Non-expansion States Using the SEER Registry [ID 2683647]
Authors: Akinyemi Oluwasegun A. , Nwokolo Vania , Weldeslase Terhas A. , Colon-Santos Lyanne , Luo Guoyang
Published: May 2024

INTRODUCTION:

Medicaid expansion under the Affordable Care Act sought to improve access to care for millions of uninsured Americans. The implications of this policy change on patients with cervical cancer, a condition disproportionately affecting socioeconomically disadvantaged women, remains underinvestigated. This study explores the effect of Medicaid expansion on cancer-specific survival.

METHODS:

Using the SEER registry, we retrospectively analyzed cervical cancer patients from a non-expansion state (Georgia), and states that experienced Medicaid expansion (California, Connecticut, Louisiana, etc.). The study spans from 2000 to 2020. We divided the data into pre-ACA (before 2010) and post-ACA (after 2010) periods. Cancer-specific survival was our primary outcome. A difference-in-differences analysis was conducted, adjusting for age, race, income, disease stage, marital status, and regional characteristics.

RESULTS:

Among 63,796 cervical cancer patients, 55,683 (87.3%) were from Medicaid expansion states and 8,184 (12.7%) from non-expansion Georgia. The 5-year survival was 68.5% in expansion states versus 68.4% in Georgia (P>.05). Difference-in-differences analysis revealed no significant effect of policy implementation on cancer-specific survival (hazard ratio [HR] 1.01; 95% CI, 0.90–1.13). Surgical treatment significantly predicted improved survival (HR 0.46; 95% CI, 0.44–0.49). Black women had lower survival than White women (HR 1.18; 95% CI, 1.12–1.25).

CONCLUSION:

Medicaid expansion under the Affordable Care Act showed no significant effect on cervical cancer-specific survival. Surgical treatment improved survival, while Black women experienced comparatively lower survival rates.