bluuebunny/crossref_metadata_2025 huggingface dataset:
Food Deserts and Gestational Weight Gain: An Urban Problem? [24R]
Authors: Braightmeyer Kelli , Beausang Jasjit
Published: April 2018

INTRODUCTION:

Over 48% of women in the United States gain more than the recommended amount of weight in pregnancy, and poor access to healthy foods has been proposed to contribute to this. Philadelphia has many food deserts, neighborhoods with poor access to affordable healthy food. These areas have been studied before; however, no studies have focused on pregnant women. The purpose of this study was to identify whether food access impacts gestational weight gain.

METHODS:

A survey detailing food access was administered to 197 postpartum women. Electronic medical record data was collected regarding gestational weight gain and basic demographic data. Primary analysis looked at gestational weight gain as influenced by the frequency of produce shopping. We also analyzed gestational weight gain based on distance to the nearest grocery store. Data was analyzed using chi-square tests, chi-square for linear associations, and Spearman’s correlations.

RESULTS:

Mean BMI of participants was 27.86, with 32.5% having a BMI of 30 or greater, and 59.3% gaining appropriate gestational weight. Produce shopping frequency did not significantly impact gestational weight gain, P=0.08. Participants who shopped for produce less frequently were least likely to gain excess weight; however, this trend is not a significant, rho=-0.09. There was no significant correlation of appropriate weight gain and distance to the nearest grocery store, (p=0.97).

CONCLUSION:

Sixty percent of participants in this study gained the recommended amount of weight during pregnancy. Residency within a food desert and frequency of produce shopping had no impact on weight gain during pregnancy.
Weight Self-Awareness in Women with Gestational Diabetes Mellitus [28R]
Authors: Theva Meena , Has Phinnara , Werner Erica
Published: April 2018

INTRODUCTION:

Excess gestational weight gain (GWG) is particularly important in gestational diabetes mellitus (GDM) where it increases risks of pregnancy and post-partum complications. We sought to assess self-awareness of body mass index (BMI) and GWG among women with GDM and the association between self-awareness and adherence to Institute of Medicine (IOM) GWG guidelines.

METHODS:

Cross-sectional study of women >18 years of age, fluent in English or Spanish, who were diagnosed with GDM (by Carpenter-Coustan criteria or Glucose Challenge Test >200mg/dl), delivered at term and received postpartum inpatient care at Women and Infants Hospital between in 2016. Post-partum day 2 surveys asked participants to assess their BMI, BMI classification, and GWG category (not enough, appropriate, or too much). Chart abstraction was used to obtain actual BMI, GWG, demographic data and pregnancy outcomes. Women who appropriately categorized their BMI and GWG were compared to those who did not with respect to GWG that was within or exceeded IOM guidelines (<40 lb if BMI <25 kg/m2; <25 lb if BMI 25-29.9 kg/m2; <20 lb if BMI >30 kg/m2).

RESULTS:

Of 220 women approached, 146 (66%) women met study criteria and consented; 98/146 (67%) exceeded IOM GWG guidelines. Women who exceeded guidelines compared to those who did not had similar baseline characteristics except with regard to first prenatal BMI (32.9 v. 30 kg/m2; p<0.04- Table). The two groups did not differ with regard to BMI self-awareness; 41.8% of those who gained excess GWG correctly categorized their BMI compared to 56.3% of those who limited their GWG; (p=0.11). However, women who exceeded GWG guidelines were more likely to lack self-awareness of their GWG. Only 18.4% of women who gained excess weight correctly classified their GWG, compared to 91.7% of the women who limited their GWG; (p<0.001).

CONCLUSION:

A majority of women with GDM exceed GWG IOM guidelines and are unaware of this excess weight gain. We must work to better educate women on GWG not only to help them adhere to the IOM goals but also to mitigate the associated pregnancy and post-partum risks.
Neonatal Outcomes After Hypertension in Twin Gestations: Potentially Protective? [29R]
Authors: Roberts Nicole A. , Hoffman Matthew , Chichester Melanie , Shlossman Philip
Published: April 2018

INTRODUCTION:

To investigate whether and in what way neonatal outcomes vary in twin pregnancies affected by hypertension as compared with non-hypertensive twin pregnancies.

METHODS:

This was a retrospective cohort study of 1276 twin infants divided into four groups: non-hypertensives, chronic hypertensives, hypertensives developed during pregnancy without prior hypertension, prior hypertensives who developed pre-eclampsia in pregnancy. Outcomes assessed included gestational age at delivery, composite neonatal outcome, small for gestational age at less than the tenth percentile, 5 minute APGAR, and absolute birthweight.

RESULTS:

Chronic hypertensives were more likely to deliver prior to 34 weeks than non-hypertensives (OR 3.473; P=0.024) and were about 2.8 times more likely to have a low APGAR score (p = 0.0097) than women without hypertension. Women who developed hypertension in pregnancy were less likely than non-hypertensives to have one of the composite outcomes prior to adjustment (OR 0.6; p=0.008). This trend remained after adjustment for demographic variables but was not statistically significant (OR 0.679; p=0.090). Similarly, children of these women were less likely to have RDS (OR 0.89; p=0.025) prior to adjustment. Again, this became statistically non-significant after adjustment for demographic variation (OR 1.04; p=0.242).

CONCLUSION:

This study supports some trends toward improved neonatal outcomes with hypertensive disorders developed in pregnancy as compared with non-hypertensive twin pregnancies and poorer outcomes of chronic hypertensive relative to non-hypertensive twin gestations. Prospectively collected data allowing for differentiation between gestational hypertension and pre-eclampsia with severe features would help further clarify these findings.
Induction of Autophagy by Sera From Women With Ovarian Hyperstimulation Syndrome: Potential Predictive Marker [2OP]
Authors: Minis Evelyn , Irani Mohamad , Nasioudis Dimitrios , Witkin Steven S. , Spandorfer Steven D.
Published: April 2018

INTRODUCTION:

Ovarian Hyperstimulation Syndrome (OHSS) affects 3–10% of women undergoing IVF. Identifying predictive biomarkers of OHSS can help its prevention. Given that autophagy is implicated in the regulation of ovulation, we examined the differential induction of autophagy by sera from women with OHSS and controls.

METHODS:

Sera were obtained before stimulation from 75 women at risk for OHSS (AMH>2 ng/mL); 34 of whom subsequently developed OHSS. The remaining 41 women served as controls. Sera were incubated for 48 hours with peripheral blood mononuclear cells (PBMCs) from a healthy donor, the PBMCs lysed and the level of autophagy determined by measuring the p62 (sequestrome-1) level. Cytoplasmic p62 is consumed during autophagy and so the p62 concentration is inversely related to the extent of autophagy. The p62 values between groups were compared by the Mann-Whitney test.

RESULTS:

There were no differences in age (34±5.3 vs 33.05±3.8 years), body mass index (23.4±3.5 vs 23.84.6 kg/m2), parity (0.2±0.5 vs 0.2±0.5) or number of harvested oocytes (25.6±5 vs 25.9±10.67) (P>.05) between the two groups. Median PBMC p62 levels were lower (autophagy was higher) following incubation with sera from women who developed OHSS (5.85 ng/mL) than with sera from controls (7.31 ng/mL) (P=.03).

CONCLUSION:

Baseline sera from women who developed OHSS induced a higher level of autophagy in PBMCs than did at risk women who did not develop OHSS. Excessive autophagy induction in the ovary may increase susceptibility to OHSS. The extent of autophagy induction by sera obtained prior to undergoing IVF could be a predictive marker of OHSS.
Effect of Removal of Pregnancy Category on Prescribing in Pregnancy: A Randomized [5OP]
Authors: Robinson Angela , Atallah Fouad , Weedon Jeremy , Chen Yi-Ju Amy , Apostol Radu , Minkoff Howard
Published: April 2018

INTRODUCTION:

To assess the degree to which the removal of pregnancy drug categories (A, B, C, and D) from labeling information affects the likelihood that providers will prescribe medications.

METHODS:

From October 2015 through October 2016, a convenience sample of providers was recruited into a randomized, survey-based, study. The survey instrument described four clinical vignettes, one each for pregnancy categories A, B, C, and D. Each vignette described a pregnant woman with an indication for the drug in question, and provided detailed drug information. Two forms of the survey were randomly distributed; one presented the clinical vignette, drug information along, and the pregnancy category. The other presented the identical vignette and drug information but did the pregnancy category. Using a 5-point Likert scale the respondents were asked to estimate their likelihood of prescribing the drug.

RESULTS:

One hundred and sixty-two surveys were included in the analysis. In the model without covariates there was a significant form type (with or without letter categories) by drug category interaction (P=.003); simple effects analysis showed that provision of a letter significantly affected the decision to prescribe the category B (P<.001) and C drugs (P=.008) but not the A or D. Participants were significantly less likely to prescribe the B and C drugs when the letters were not available for review. After adding covariates (eg, age, gender, specialization, years of experience) to the model the interaction persisted (P<.001).

CONCLUSION:

Without the pregnancy category physicians are less likely to use category B and C drugs, the most common medications prescribed in pregnancy. Therefore, it is possible that in the absence of a letter, pregnant women's access to medications may become more restrictive, and further research is needed to address that concern and monitor for trends as the new system is well-established.
Development of a Risk Score to Predict Obstetric Anal Sphincter Injuries in Laboring Patients [8OP]
Authors: Woo Victoria G. , Hung Yun-Yi , Ritterman Weintraub Miranda M. L. , Wilson-Hannay Sarah , Ramm Olga
Published: April 2018

INTRODUCTION:

We piloted the utility of a scoring system to predict patient risk of obstetric anal sphincter injury (OASIs) during labor.

METHODS:

Among the 9,800 women with singleton term cephalic vaginal deliveries within Kaiser Permanente Northern California between January and December 2013 with complete study data, 8.5% (n=833) of the nullipara and 3.5% (n=343) of the multipara incurred OASIs. Multivariable logistic regression and classification and regression tree analyses were used to identify risk factors. Maternal and gestational age, race/ethnicity, duration of second stage of labor, vacuum delivery, and history of OASIs were associated with OASIs. Stratified by parity, points were assigned to each risk factor as an integer on a 10-point scale based on effect size and impact in the regression analyses, and were externally validated within a similar separate patient cohort using multivariable logistic regression.

RESULTS:

Different OASIs risk score cut-offs were assessed. Among nulliparous women, a score ≥6 had 40% sensitivity and 91% specificity, whereas a score ≥4 had 51% sensitivity and 84% specificity. Among multiparous women, a score ≥7 had 89% sensitivity and 60% specificity compared to a score ≥10, which had 74% sensitivity and 72% specificity.

CONCLUSION:

These pilot scores, demonstrating a reasonable predictor of OASIs risk, illustrate the utility of a clinical risk score to inform providers of patients' risk of OASIs prior to delivery and facilitate a shared decision-making approach to labor management.
Long-Term Safety and Efficacy of Elagolix Treatment in Women With Endometriosis-Associated Pain [11OP]
Authors: Surrey Eric , Taylor Hugh S. , Duan W. Rachel , Peloso Paul , Schwefel Brittany , Chwalisz Kristof
Published: April 2018

INTRODUCTION:

Long-term safety and efficacy of elagolix, an oral, non-peptide GnRH antagonist for the management of endometriosis-associated pain, was evaluated in two 6-month (M) extension studies (Elaris EM-III and IV) of the pivotal, 6M, phase 3 studies (12M-overall treatment with 150 mg once daily [QD] or 200 mg twice daily [BID]).

METHODS:

Women with moderate/severe endometriosis-associated pain, randomized to receive elagolix in the pivotal studies, continued treatment during the extension studies (treated: Elaris EM-III, n=287; Elaris EM-IV, n=282). Baseline was before dosing in pivotal studies. Dysmenorrhea (DYS), non-menstrual pelvic pain (NMPP), and dyspareunia (DYSP) scores were recorded in a daily electronic-diary. Adverse events (AE), bone mineral density (BMD), and endometrium were assessed.

RESULTS:

DYS, NMPP and DYSP scores across dose groups were significantly decreased compared to placebo at M6 in the pivotal studies (P<.05; exception-DYSP 150 mg), and improvements in scores were maintained after 12M of treatment in Elaris EM-III (Extension-M6 mean percent change from baseline: DYS, 150 mg QD=−49%, 95% CI [−57,−41], 200 mg BID=−82%, 95% CI [−88,−76], NMPP, 150 mg QD=−49, 95% CI [−57,−41], 200 mg BID=−57%, 95% CI [−64,−49]; DYSP, 150 mg QD=−31%, 95% CI [−46,−16], 200 mg BID=−42%, 95% CI [−58,−25]). Hot flush was the most common AE over 12M of treatment (150 mg QD=29.5%; 200 mg BID=52.2%). At extension M6, there was a dose-dependent decrease in BMD from baseline, while mean lumbar spine BMD Z-score was within normal range (−2.0–+2.0). Mean change in endometrial thickness ranged 0.6 to −0.8 mm across doses. Elaris EM-IV results were generally similar.

CONCLUSION:

In women with endometriosis-associated pain, long-term elagolix treatment was associated with reductions in DYS, NMPP, and DYSP. No new safety concerns were identified with long-term elagolix use.
Barriers to LARC Training in OB-GYN Residencies [14OP]
Authors: Evans Megan L. , Espey Eve , Ogburn Tony , Breeze Janis , Zite Nikki
Published: April 2018

INTRODUCTION:

Widespread provision of LARC relies on adequate provider training. Although LARC education and insertion techniques are required in the OB-GYN residency curriculum, barriers may negatively affect the quality of training.

METHODS:

This anonymous survey used structured questions about residents' experience with LARC training, including number of LARC insertions. The survey questions were administered electronically in conjunction with the 2016 resident CREOG in-service exam; de-identified data were categorized for analysis by US census regions (Northeast, West, Midwest, South).

RESULTS:

The response rate for questions about number of LARC insertion was 99%. As of January 2016, 32% of all residents inserted 1–10 IUDs and 31.7% inserted 11–25 IUDs; 39.6% of residents inserted 1–10 contraceptive implants. In total, 8% of chief residents had never inserted an implant and 10% had inserted between 1–10 IUDs Nearly a third of all residents and 40% of Southern residents identified financial barriers, including cost of the device and inadequate insurance coverage, to LARC training. Twenty percent of residents reported institutional policy and 27% reported lack of patient demand as additional barriers. Religious affiliation was reported as a significant barrier only by residents in the Midwest (27%, P<.001) compared to all other residents (6.4%). Residents with low insertion numbers identified institutional religious affiliation as a greater barrier to LARC training than residents with higher insertion rates.

CONCLUSION:

Residents face a variety of barriers to LARC insertion training and many residents insert fewer than 10 devices during residency.
The Postpartum Challenge: Best Practices to Improve Return Rates in Los Angeles County Hospitals [21OP]
Authors: Celaya Anna K. , Jaque Jenny , Katzir Lirona , Garcia Erika , Jackson Ashaki , Saleeby Erin
Published: April 2018

INTRODUCTION:

Nearly 40% of women do not attend their postpartum visits. Attendance rates are even lower in underserved populations. Increasing patient participation, especially in communities of low resources, involves a multi-faceted approach in care coordination. We highlight a bundle of systems changes implemented by three Los Angeles County Department of Health Services (LAC DHS) hospitals to improve the rates of postpartum visits.

METHODS:

We collected baseline data on postpartum visits for women who delivered in the LAC DHS from July 2016 to June 2017. A bundle of interventions were implemented throughout the health system including: 3rd trimester scheduling of postpartum visits, appointment confirmation on day of discharge after delivery for both 3-week and 6-week visits, congratulations calls with appointment reminders at 1 week post-delivery, reminder calls the day before appointments, and coordinating pediatric visits at discharge with existing maternal appointments. During the bundle implementation year, data collection continued and performance improvement was assessed at 6 months and 1 year after baseline assessment. Services were identified by CPT, ICD-9-CM and ICD-10-CM codes.

RESULTS:

Six months following baseline, 47% (n=753) of patients attended postpartum visits. One year following baseline, 58% (n=954) of patients attended. There was a statistically significant difference chi-square (1, N=3,251)=36.11, P<.001, with a 60% improvement in follow-up rates.

CONCLUSION:

Increased postpartum return rates in resource-limited setting can be achieved through coordinated efforts. Performance improvement teams can utilize a bundle of structured activities and track change through rapid cycle improvement initiatives.
Breaking Down Barriers to Transgender Health Care: Would a Transgender-Only Clinic Help? [22OP]
Authors: Abern Lauren , Maguire Karla
Published: April 2018

INTRODUCTION:

The transgender community faces many barriers to care. As a result, they can be reluctant to seek health care and often have under-addressed medical needs. The aim of this study is to determine the type and frequency of barriers to care, how they find competent providers, and if they prefer a transgender-only clinic.

METHODS:

Transgender patients ages 18–65 participated in an online survey which included demographics, medical history, and perceptions of the healthcare system.

RESULTS:

120 surveys were collected. Mean age was 23.4 (SD 6.5, range 18–53), and majority was white (101, 84%). 119 (89%) had insurance with most (65, 54%) through a family member or employer. 34 (28%) had a minimum of a college degree, and 70 (58%) of people surveyed made less than $24,000 a year. Of the respondents, 83 (69%) experienced barriers to care. The majority (70, 84%) reported cost as a factor while 47 (57%) had problems with access to care. 33 (40%) experienced stigma and 23 (28%) reported discrimination. 79 (77%) find competent providers through word of mouth and 17 (17%) search the internet. Only 25 (23%) desired care in a transgender-only clinic. Comments reflect that many are uncomfortable for fear of being identified as transgender.

CONCLUSION:

Most transgender patients surveyed face barriers to care. These must be acknowledged and addressed so that health care they receive can be accessible and improved. The majority did not prefer to receive care in a clinic exclusive to transgender individuals, which is important to consider when working towards decreasing these barriers.
Enhanced STI Retesting Services [23OP]
Authors: Diniz Clarissa P. , Witter Frank R. , Coleman Jenell S.
Published: April 2018

INTRODUCTION:

Chlamydia, gonorrhea, and trichomoniasis (CGT) retesting 3 months after treatment is recommended, however retesting rates are low. Untreated sexually transmitted infections (STI) can lead to adverse reproductive outcomes, and reinfections have even worse outcomes compared with the initial infection. To increase retests, we implemented alternative options of home-based self-testing and clinic-based “fast-track” appointments in a large academic practice.

METHODS:

OB/GYN patients who were CGT positive in 2016 and not retested were telephoned. We offered postage-paid home-test kits or fast-track appointments with medical assistants. Chi-squared and logistic regression were performed.

RESULTS:

Nine percent of STI tested patients were positive. The majority were black (92%) with median age 25 (IQR: 21–30). Younger women (<25) were more likely to be retested by their provider (P=.04). Among 61 (48%) patients not retested, 44 (72%) were reached and agreed to retest. Twenty (45%) patients elected home-testing, 12 (60%) kits were returned, and 2 (17%) were STI positive. Twenty-four (55%) patients elected fast-track appointments, 17 (71%) completed the appointment, and 3 (18%) were STI positive. Overall, 5/44 (11%) retests were positive, all had Medicaid insurance. The adjusted odds of home testing were 4.67 (95% CI: 1.07–20.33, P=.04) higher among older women (>24). There was no difference between older vs younger women on positive retest (AOR=0.932, 95% CI: 0.34–2.55, P=.891).

CONCLUSION:

A large proportion of women retested positive for an STI. Alternative retesting options like home-testing or fast-track visits should be widely used to increase retesting. Further examination of patients' decision-making about home-testing versus fast-track appointment may further improve care delivery.
Probability of Pregnancy after Intended Postplacental versus Interval Intrauterine Device Placement [3F]
Authors: Hunter Tegan , Gurney Elizabeth P. , Schreiber Courtney , McAllister Arden , Sonalkar Sarita
Published: April 2018

INTRODUCTION:

We sought to determine the one-year probability of pregnancy following intended postplacental intrauterine device (IUD) insertion compared with intended insertion at a postpartum visit (interval insertion), using decision analysis methodology.

METHODS:

We developed an evidence-based decision model comparing one-year probability of pregnancy following intended postplacental or intended interval IUD placement. We obtained proportion estimates from the literature for mode of delivery, successful IUD placement, IUD type, postpartum visit attendance, IUD expulsion and discontinuation, and contraceptive use, choice, and efficacy after IUD discontinuation. We performed a sensitivity analysis and a Monte Carlo simulation to account for variations in proportion estimates.

RESULTS:

The one-year probabilities of pregnancy among women intending to receive a postplacental IUD following vaginal or Cesarean delivery are 94/1,000 and 68/1,000 respectively; one-year probability of pregnancy is 174/1,000 for women intending to receive an interval IUD. For interval IUD placement to have effectiveness equal to postplacental placement, 94.0% of women delivering vaginally and 97.2% of women delivering by Cesarean would need to attend postpartum care. Once placed, postplacental IUDs have effectiveness lower than interval IUDs: one-year probabilities of pregnancy following IUD placement at a vaginal delivery, Cesarean delivery, and an interval visit are 88/1,000, 51/1,000, and 24/1,000, respectively.

CONCLUSION:

After accounting for barriers to successful placement and retention, intended postplacental IUD insertion results in a lower 1-year probability of pregnancy as compared with intended interval IUD insertion.
The Patch Wear Profile from SECURE: A Once-Weekly Low-Dose Contraceptive Patch Study [7F]
Authors: Nelson Anita L. , Kaunitz Andrew M. , Kroll Robin , Simon James A. , Castaño Paula M. , Garner Elizabeth I.O.
Published: April 2018

INTRODUCTION:

AG200-15 (Twirla®) is an investigational transdermal contraceptive delivery system (TCDS), which delivers daily exposure of levonorgestrel (LNG) and ethinyl estradiol (EE) similar to oral doses of 120 μg LNG and 30 μg EE. We examine various aspects of patch adhesion and wearability with AG200-15 TCDS.

METHODS:

SECURE was a single-arm, open-label, Phase 3 study conducted in US women 18 years or older, with no restrictions on body mass index or weight (NCT02158572). Subjects recorded patch-related characteristics daily in electronic diaries; irritation/itching and patch adhesion were also evaluated by the investigator at each visit. Irritation/itching scores were rated from 0 (none) to 3 (severe). Patch adhesion scores were rated from 0 (no/small amount of lifting off skin) to 4 (entire patch falling off).

RESULTS:

In 2,031 women across 13 cycles, 6.2% reported a local site reaction. The subject-rated mean skin irritation/itching score was 1.31, and most women reported their worst skin irritation as none, mild, or moderate (26.2%, 32.0%, and 26.6%, respectively). The investigator-reported mean skin irritation score was 0.18, and most women were determined by the investigator to have none or mild skin irritation (85.0% and 12.6%, respectively). The mean subject- and investigator-rated patch adhesion scores were 0.52 and 0.04, respectively. Treatment discontinuation due to application site irritation/itching occurred in 1.9% of women.

CONCLUSION:

Overall, results of various subject- and investigator-rated patch characteristics provide favorable support for patch adhesion and wearability of the AG200-15 TCDS.
Five-Year Efficacy and Safety of the Liletta® Levonorgestrel Intrauterine System [13F]
Authors: Teal Stephanie B. , Turok David K. , Jensen Jeffrey T. , Chen Beatrice A. , Kimble Thomas D. , Creinin Mitchell D.
Published: April 2018

INTRODUCTION:

Liletta is a levonorgestrel 52 mg contraceptive intrauterine system (IUS) currently approved for contraception for up to four years based on an ongoing multicenter trial currently planned to continue for up to eight years of use. We evaluated the five-year efficacy and safety data for Liletta.

METHODS:

Women aged 16-45 years were enrolled; those women aged 36-45 years received the IUS for safety evaluation only. We followed 1,568 women aged 16-35 years and 146 women aged 36-45 years after successful IUS placement. We assessed five-year pregnancy rates and safety outcomes.

RESULTS:

The 16-35 year old subjects included 1,011 (57.7%) nulliparous and 438 (25.1%) obese women. Among these women, nine pregnancies occurred including four in nulliparous women and one in an obese woman. One pregnancy occurred following perforation and one following expulsion. Six (67%) pregnancies were ectopic. The Pearl Index in the first year was .15 (95% CI .02-.55). Cumulative life-table pregnancy rates through years three and five were .59 (95% CI .28-1.25) and .92 (95% CI .46-1.82), respectively. Perforation following IUS placement occurred in two (0.1%) women; both were diagnosed within the first year. Expulsion occurred in 63 (3.7%) participants, most (50 [80.6%]) during the first year of use. Pelvic infection was diagnosed in 11 (.6%) women. Only 39 (2.3%) women discontinued due to bleeding complaints, primarily (n=29 [74.3%]) in the first year.

CONCLUSION:

Liletta is highly effective and has an excellent safety profile over five years of use; most expulsions and discontinuation for bleeding occur during the first year of use.
Contraceptive Usage in Female Survivors of Young Adult Cancers [17F]
Authors: Shandley Lisa M. , Spencer Jessica B. , McKenzie Laurie J. , Mertens Ann C. , Howards Penelope P.
Published: April 2018

INTRODUCTION:

Cancer survivors may be less likely than the general population to use effective methods of contraception, but prior studies were small.

METHODS:

In a population-based study, we recruited reproductive-aged (22-45 years) women, diagnosed with cancer between the ages of 20-35 years and at least 2 years post-diagnosis. Women with no cancer history were recruited for comparison. Exclusion criteria included having a hysterectomy or bilateral oophorectomy. Women reported on contraceptive use (pills, patch, ring, mini-pills, Depo Provera, implant, hormonal and non-hormonal intrauterine device, and tubal ligation) in the past year.

RESULTS:

Among survivors (n=960), 38.4% reported using a WHO Tier I/II contraceptive method in the past year compared to 47.5% of comparison women (n=992). Long-acting reversible contraceptive (LARC) was more common among contracepting survivors (30.9%) than among contracepting comparison women (23.4%). Among cancer survivors contraceptive use was associated with being younger than 35 years at interview (odds ratio [OR]: 2.04, 95% confidence interval [CI] 1.55, 2.67), being younger than 30 years at diagnosis (OR 1.81, 95% CI 1.38, 2.37), identifying as white (OR 1.54, 95% CI 1.13, 2.10), not having chemotherapy (OR 1.43, 95% CI 1.10, 1.86), and being nulligravid at cancer diagnosis (OR 1.31, 95% CI 1.01, 1.69). Breast cancer survivors were less likely to have used birth control in the past year (OR 0.46, 95% CI 0.34, 0.62) compared with all other cancer types.

CONCLUSION:

While the overall rate of contraceptive use was lower among cancer survivors than among comparison women, survivors using contraception were more likely to use LARC methods.
Cost-Effectiveness of Offering Contraceptives to Incarcerated Women Prior to Release from Prison [20F]
Authors: Toffey David E. , Allen Allison , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

Incarcerated women face numerous barriers to consistent and affordable contraception, and experience high rates of unintended pregnancy with associated individual, institutional, and societal costs. We sought to determine the benefits of providing contraceptive services to this high-risk patient population.

METHODS:

A decision-analytic model using TreeAge software was designed to compare offering contraceptive counseling and methods prior to release from prison with providing no such services. Our study included long- and short-acting reversible contraception methods and included rates of discontinuation and method switching. All probabilities and utilities were derived from the literature. Utilities were included with a discounted life expectancy rate of 3% to produce quality adjusted life years (QALYs). The cost-effectiveness threshold was set at $100,000 per QALY. Outcomes include unintended pregnancies, ectopic pregnancy, spontaneous and therapeutic abortion, and preterm and term births.

RESULTS:

Offering contraception prior to release is cost-effective for all methods assessed. In a theoretical cohort of 56,000 incarcerated women of reproductive age not intending to get pregnant over a 12-month interval, offering contraception would prevent 18,251 unintended pregnancies, 644 preterm births, 6,045 term births, 180 ectopic pregnancies, 8,310 therapeutic abortions, and save $85 million. Sensitivity analysis demonstrated cost-effectiveness when services are utilized at a rate 25% of that modeled based on reported rates. Additionally, these services are cost-saving up to 9-times the costs modeled for counseling and office visits, and cost-effective up to 32-times these costs.

CONCLUSION:

Offering incarcerated reproductive-age women contraception prior to release is cost-effective, cost-saving, and reduces the rate of unintended pregnancy and associated obstetric complications.
Maternal and Neonatal Outcomes Following Methadone Taper for Opiate Detoxification [24F]
Authors: Smallwood Pamela Tess , Williams Corrine M. , McQuerry Kristen J. , Critchfield Agatha S.
Published: April 2018

INTRODUCTION:

Several models have been studied for treatment of opioid dependence during pregnancy. The purpose of our study is to examine maternal and neonatal outcomes following a methadone taper for medication-assisted withdrawal (MAW) for opioid dependent pregnant women.

METHODS:

A retrospective chart review of pregnant women undergoing inpatient MAW using a methadone taper and delivering at the study institution was performed. At our institution, methadone taper is performed over approximately six days beginning with a total of 30mg of methadone on Day 1. As needed doses are available to the patient, however this does not affect the overall taper length. “Success” of MAW was defined as appropriate urine drug screen (UDS) on admission to Labor and Delivery (LDR).

RESULTS:

Among study participants (n=32) 47% had an appropriate UDS at admission to LDR. Among those who were successful vs those who were not, mean length of stay (6.20 vs. 4.18days p=0.0150) and the incidence of opiate maintenance at time of delivery (93% vs. 23%, p<.0001) were significantly different. Differences in neonatal outcomes included number of neonates treated for neonatal abstinence syndrome (33% vs. 47% p=0.4905) and mean maximum morphine dose (0.05 vs. 0.08mg p=0.3985), however none were significant.

CONCLUSION:

MAW (as performed at our institution) results in a less than 50% success rate. Success rates are higher when the taper is performed more slowly and when maintenance therapy is utilized. Therefore, if MAW is preferred by the patient, completion of the entire taper should be encouraged and maintenance therapy should be discussed following MAW completion.
Characteristics of Referred Patients With Twin-Twin Transfusion Syndrome (TTTS) Who Did Not Undergo Fetal Therapy [29F]
Authors: Sasso Elizabeth B. , Hardley Macy T. , Bottura Isabela , Korst Lisa M. , Ouzounian Joseph G. , Chmait Ramen H.
Published: April 2018

INTRODUCTION:

Abundant research has been conducted regarding patients with TTTS who underwent fetal therapy, i.e., laser surgery, amnioreduction, and umbilical cord occlusion. Here, we describe patients referred for TTTS who did not undergo fetal therapy.

METHODS:

TTTS gestations at 16-26 weeks referred between 1/2006 and 3/2017 were reviewed. Those who did not undergo fetal therapy comprised the final study population. Based on initial consultation data, patients were grouped as non-surgical vs. surgical candidates. TTTS progression and perinatal outcomes were assessed.

RESULTS:

734 TTTS patients were evaluated. Of these, 68 (9.3%) did not undergo intervention; 42 non-surgical candidates (62%) and 26 surgical candidates (38%). Of the non-surgical candidates, 21 were ineligible because of fetal demise and 21 were ineligible because of maternal factors (12: preterm labor or preterm premature rupture of membranes, 7: placental abruption, 2: severe membrane separation). Of the surgical candidates, 11 underwent expectant management without subsequent intervention, 8 elected pregnancy termination, and 7 planned fetal intervention but had a complication before the procedure. Of 66 untreated cases, 10 (15.2%) had TTTS disease progression. Neonatal outcomes were available in 64 untreated cases: 41 (64%) had no survivors, 11 (17.2%) had one survivor and 12 (18.8%) had two survivors.

CONCLUSION:

9% of referred TTTS patients did not undergo fetal therapy, with many ineligible because of the development of fetal demise or labor onset between referral and consultation. To avoid bias, studies tracking outcomes of TTTS should routinely acknowledge this subgroup and the circumstances leading to lack of treatment.
Fetal and Maternal Responses to Yoga in the Third Trimester [30F]
Authors: Gavin Nicole R. , Kogutt Benjamin K. , Fletcher William , Szymanski Linda M.
Published: April 2018

INTRODUCTION:

The goal is to examine the practical and real-time maternal and fetal responses to a moderate intensity yoga session in the third trimester of pregnancy. Unlike previous studies, our study examines a typical 1-hour, moderate intensity prenatal yoga session.

METHODS:

This is a prospective observational study in low-risk, pregnant participants. Exclusion criteria included hypertension, IUGR, preterm labor, or contraindications to exercise. Wireless fetal monitors were used to monitor fetal beat-to-beat variability, accelerations, and decelerations as well as maternal heart rate and uterine activity. For analysis, fetal and maternal heart rates were continuously recorded over the entire yoga session, and pre- and post NST tracings were analyzed for loss of fetal heart rate variability and decelerations.

RESULTS:

Twenty participants were enrolled; 19 completed the session. Mean gestational age was 35 weeks and 6 days with an average participant age of 32 years. While fetal heart rates fluctuated over the course of the yoga session, there were no significant fetal heart rate decelerations or changes in beat-to-beat variability to suggest deleterious fetal effects. The fetal heart rate averaged 135.3 bpm (SD±12.2) regardless of activity level . Maternal heart rate also fluctuated from a mean resting heart rate of 88.7 bpm (SD±9.7), increasing to an average heart rate of 104.8 bpm (SD±18.6) during the session, reaching a maximum of 154.9 bpm (SD±12.8), and subsequently decreasing to 88.7 bpm (SD±11.2) during meditation,.

CONCLUSION:

Yoga can be recommended for low-risk women during pregnancy as no adverse fetal heart rate effects were observed during a realistic, continuous yoga session.
Educating Patients on Preeclampsia and the Effect of Different Methods of Education on Patient Anxiety [33F]
Authors: Fisher Sarah M. , Strassberg Emmie R. , Mackeen Awathif , Paglia Michael J.
Published: April 2018

INTRODUCTION:

To determine whether the exposure to two different methods of patient education regarding preeclampsia increased anxiety.

METHODS:

A randomized controlled trial was conducted of singleton primigravid patients at a tertiary care center between 18-25 weeks gestation. Patients were randomized to preeclampsia education with a graphic card or an educational video. Patients completed the validated State Trait Anxiety Short version 6 (STAI-6) anxiety assessment tool before and after exposure to the assigned educational tool. The change in score was compared to evaluate if patient anxiety level changed after education.

RESULTS:

A total of 101 patients were randomized with 56 to graphic card and 45 to educational video. The average STAI-6 scores before and after intervention for all groups were nearly within normal range (34-36). There were no significant differences in anxiety score before and after the intervention for those exposed to either the graphic card (p = 0.739) or the video (p = 0.121).

CONCLUSION:

Patient anxiety does not appear to be impacted by preeclampsia education with a graphic card or an educational video on preeclampsia.
Cost-Effectiveness of Detoxification vs. Methadone in Pregnancy [36F]
Authors: Seymour-Willey Alicia , Sargent James , Toffey David E. , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

Management of opiate-dependence in pregnancy can include detoxification and maintenance therapy with methadone or buprenorphine. Traditionally, detoxification was associated with higher rates of fetal and neonatal death but recent studies have challenged this relationship. The purpose of this study is to assess the cost-effectiveness of detoxification compared to methadone maintenance therapy.

METHODS:

A decision-analytic model using TreeAge Pro was designed to compare detoxification with methadone maintenance therapy. All probabilities and utilities were derived from the literature. Utilities were included with a discounted life expectancy rate of 3% to produce quality adjusted life years (QALYs). The cost-effectiveness threshold was set at $100,000 per QALY. Prenatal outcomes examined included intrauterine fetal demise (IUFD), neonatal demise (NND), perinatal deaths, neonatal abstinence syndrome (NAS), major neurodevelopmental disorder (MNDD), and preterm delivery (PTD). The maternal outcome measured was opioid relapse rate.

RESULTS:

We found that that detoxification was the dominant methodology for all outcomes assessed. In a theoretical cohort of 10,000 opiate-dependent pregnant woman, detoxification resulted in 59 fewer treatment failures, 26 fewer perinatal deaths, 4282 fewer cases of NAS, 137 fewer cases of MNDD, 224 fewer PTDs, and savings of $3,363 per pregnancy. Sensitivity analysis demonstrated that detoxification was the dominant strategy up to a detoxification price of $14,750, and remained cost-effective to a detoxification price of $26,357.

CONCLUSION:

Detoxification in pregnancy results in improved maternal and fetal outcomes, and is the cost-effective strategy when compared to methadone maintenance therapy.
Are Women Aware of FDA-510K Lubricant Clearance? [40F]
Authors: Krychman Michael
Published: April 2018

INTRODUCTION:

Vaginal products have come under greater scrutiny with the consumer awareness campaign that has focused on additives and potential chemical irritants, acid base balance, chemicals or carcinogens in these products. Class II medical device 510(k) clearance is a premarket submission, made directly to the FDA that includes sufficient evidence to demonstrate that the lubricant/device is safe and effective.

METHODS:

An in office observational survey was completed to investigate whether lubricant consumers were aware if the lubricant they were using was 510(k) cleared. Fifty popular lubricant products were reviewed as to if they designated 510(k) clearance on their home page.

RESULTS:

Fifty women, (mean age 48) were assessed. Ninety six percent of the woman were not aware if their lubricant was 510(k) cleared. Ninety-six percent of the women did not have understanding of what the 510(k)-clearance specified. All women were unaware if their lubricant contained additives such as bactericides, or other caustic chemical. A total of 50 lubricants (30 water; 20 silicone products) were assessed. Fifty percent of (water based) were deemed to be 510(k) cleared by the FDA whereas only 14% of those mentioned this designation on their website. Fifty percent of the silicone lubes were 510(k) cleared and only 5% of them mentioned it on their websites.

CONCLUSION:

Most women are not aware of the 510(k) designations nor are they familiar with its significance and meaning. Companies are remiss in educating women about this important safety, efficacy and product designation.
The Association Between Depo-Provera and Postpartum Depressive Symptoms [2G]
Authors: Ross Carolyn , Shim Jessica , Stark Elisabeth , Miller Emily Stinnett
Published: April 2018

INTRODUCTION:

Prior studies investigating the effects of Depo-Provera (DMPA) on mood have demonstrated conflicting results. We hypothesize that receipt of DMPA during the immediate postpartum period is associated with the development of postpartum depressive symptomatology.

METHODS:

We conducted a retrospective cohort study of women who presented to an academic outpatient clinic associated with Northwestern University for prenatal care between January 1, 2008 and December 31, 2014 who underwent a routine postpartum depression screen using the Patient Health Questionnaire-9 (PHQ-9) at their 6-week postpartum visits. A score of at least 10 defined a positive screen. Bivariable and multivariable analyses were performed to examine the relationship between DMPA receipt and postpartum depressive symptomatology.

RESULTS:

Of the 5103 women that met inclusion criteria, 410 (8.0%) received DMPA prior to being discharged from the hospital after delivery. Receipt of DMPA was not associated with a difference in the frequency of a positive depression screen at the postpartum visit (4.5% vs 6.1%, P=.25). This remained true after controlling for potential confounders (positive antenatal depression screen, age, BMI at delivery, gestational diabetes, nulliparity, public insurance, race, and preterm birth). Using an alpha of .05 and a beta of .20, this study had 80% power to detect a two-fold increase in the frequency of postpartum depressive symptomatology.

CONCLUSION:

Receipt of DMPA immediately postpartum is not associated with increased postpartum depressive symptomatology at the 6-week postpartum visit.
Contraceptive Practices in Women With Medical Conditions in the Clinics at the University Hospital of the West Indies [3G]
Authors: Hunter-Greaves Tiffany , Tate Nastassia , Medley-Singh Natalie , Simms-Stewart Donnette
Published: April 2018

INTRODUCTION:

Women with medical comorbidities should optimize their health prior to conception with the consistent use of effective contraceptives. The objective of this study is to assess the contraceptive use among women with chronic diseases at the University Hospital.

METHODS:

A cross-sectional study was done among 260 participants identified from the medical clinics at the University Hospital, with an interviewer-administrated questionnaire. Candidates were recruited by convenience sampling and those who fit the inclusion criteria were enrolled. Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) was used for data management and statistical analysis.

RESULTS:

The majority of the patients (200, 76.9%) were between 25-45 years old, employed (114, 43.9%), single (107, 41.2%), nulliparous (24,12.3%) and sexually active (176, 67.7%). Ten persons were pregnant however, only 3 (30%) were planned. The largest representation were in women with Systemic Lupus Erythematous (50, 19.2%), Diabetes Mellitus (48, 18.5%) and Hypertension (45, 17.5%), with the least among those receiving chemotherapy (7, 2.7%). 161 (62%) of the participants were currently using contraceptives. The methods included barrier methods (117, 45%) and oral contraceptive methods (36, 14%). Individuals with sickle cell disease were more likely to be using contraceptives (r=8.14, p=.004). Only 26 (10%) of patients used long acting reversible contraceptives

CONCLUSION:

Most women with chronic medical illness at the clinics at the University hospital reported current contraceptive use. Mainly short-term methods were used compared to the preferred long acting reversible counterparts. Greater efforts should be made in offering long-term contraception to women with chronic medical disorders.
Contraception Counseling in College Student Health Centers: A Survey of Healthcare Providers [13G]
Authors: Carr Audrey V. , Raker Christina , Clark Melissa A. , Khan Unab , Allen Rebecca H.
Published: April 2018

INTRODUCTION:

Many of the 20 million college students in the U.S. access contraception through student health centers, but little is known about how college health providers approach contraceptive counseling and provision.

METHODS:

We surveyed 87 New England college health providers about contraceptive counseling practices and on site availability of contraceptives, especially intrauterine devices and subdermal implants (long-acting reversible contraception= LARC). Providers were also surveyed about their IUD/implant training and comfort level with insertion. Descriptive statistical analyses were conducted using STATA 13.2.

RESULTS:

Most respondents (57%) were nurse practitioners, 17% were registered nurses, and 11% were medical doctors. Providers ranked oral contraceptive methods as most popular with students and reported that students chose LARC methods less than 10% of the time. Providers felt that IUDs and implants were appropriate methods for this population, however few (<15%) provided LARC methods themselves. Most students had to be referred off-campus for further services. Providers had some experience with LARC training. 75% of providers reported classroom training with IUDs and implants, while 30-50% had hands-on insertion training. Despite these training experiences, nearly all providers reported they were uncomfortable with IUD and implant insertion. Barriers to LARC uptake included insufficient volume or experience, institutional policies, and student unfamiliarity with the methods.

CONCLUSION:

While college student healthcare providers are enthusiastic about LARC methods, few have insertion experience or are comfortable with follow-up care. Further research should address whether increased on-campus accessibility would increase student uptake as well as development of supplemental college healthcare provider training to increase comfort with LARC insertion.