bluuebunny/crossref_metadata_2025_split huggingface dataset:
Demographics and the Placebo Response in the REPLENISH TRIAL: A Study of Vasomotor Symptoms [16OP]
Authors: Constantine Ginger , Graham Shelli , Bernick Brian , Archer David 
Published: April 2018

INTRODUCTION:
High placebo responses (up to 61%) are reported in studies evaluating therapeutic agents for vasomotor symptoms (VMS). Placebo response rates by subgroups from a recently completed positive trial of an investigational combination of 17β-estradiol and progesterone capsule (TX-001HR) are presented.

METHODS:
REPLENISH was a phase 3, randomized, double-blind, placebo-controlled trial that evaluated safety/efficacy of TX-001HR in postmenopausal women, who had ≥50 moderate to severe hot flushes at baseline. 767 women received one of four TX-001HR daily doses or placebo; frequency and severity of VMS at baseline and weeks 4 and 12 were recorded by diary. Secondary endpoints were responder analyses and menopause-specific quality of life (MENQOL) questionnaire. Subgroup analysis of efficacy was performed on demographics.

RESULTS:
The placebo response rate was high (55%). Significant differences were observed in the placebo response rates between White (51%) and African American (65%) women at 12 weeks (P=.049). Mean age was similar; more African American women had BMI≥30 kg/m2 (32.4%) vs White (18.7%). More African American women were current smokers than White (41.5% vs 17.6%). Significant differences in responders (≥50% and ≥75%) and the MENQOL Vasomotor Domain were observed for all groups compared to placebo in the White population; no differences noted in African Americans due to high placebo rate. Baseline estradiol levels and compliance rates for African American and White women were similar.

CONCLUSION:
Large placebo responses occurred and more frequently in African Americans. Understanding factors that contribute to placebo responses are important in designing and assessing the efficacy of medications in clinical trials.
Effect of First Trimester Bleeding on Retained Placenta Requiring Dilatation and Curettage [20OP]
Authors: Le Gallee Marissa , Lee Seohyuk , Czuzoj-Shulman Nicholas , Klam Stephanie , Abenhaim Haim Arie A. 
Published: April 2018

INTRODUCTION:
It is hypothesized that development of early subchorionic hemorrhage may lead to disruption in the placental-uterine matrix resulting in an adherence of the placenta to the endometrium. We sought to evaluate the effect of a first trimester bleed on the need for a post-vaginal delivery D&C for removal of retained placenta.

METHODS:
We carried out a case-control study at a tertiary care centre in Montréal, Canada between 2012 and 2016. Women identified through medical records as having had a post vaginal delivery D&C for retained placenta were considered cases and matched 2:1 with women delivering vaginally the same day as the case who did not have a retained placenta requiring D&C. Logistic regression evaluated the adjusted effect of a first trimester bleed on the requirement for D&C for retained placenta.

RESULTS:
There were 68 cases of retained placenta requiring D&C for an estimated 3/1,000 deliveries. Women requiring a D&C for placental removal were slightly older than controls but otherwise comparable in baseline characteristics. First trimester bleeding was more common among women requiring a D&C for retained placenta 11.8% vs 1.5%, respectively. In adjusted analysis, first trimester bleeding was strongly associated with requiring a D&C for removal of retained placenta (OR 7.70, CI 1.37.5). As well, it was associated with a greater postpartum hemorrhage and requirement for blood transfusions.

CONCLUSION:
First trimester bleeding is associated with a greater risk of retained placenta requiring D&C and blood transfusions. Women with a first trimester bleed should be considered at increased risk of postpartum hemorrhage and retained placenta.
Increasing Access to Reproductive Health Care for Underserved Women: Lessons Learned from Student Advocates [4F]
Authors: Hellerstein Leah H. , Wong Adriana J. , Brosch Jessica , Mundy Lawren , Oldak Sean , Curry Christine 
Published: April 2018

INTRODUCTION:
The American College of Obstetricians and Gynecologists supports access to comprehensive contraceptive methods for all women. The most effective reversible birth control method is long acting reversible contraception (LARC), which includes intrauterine devices (IUD) and the birth control implant. Although LARC is used by 7.2% of all women ages 15-44 in the United States, access is limited for underserved women. This study evaluates a patient advocacy program for women with barriers to accessing LARC and abortions.

METHODS:
Senior medical students designed an 8-hour training program to educate first-year Student Reproductive Health Advocates in contraception, counseling, pregnancy options, and legal-financial concerns. Patients were referred to advocates for connection to LARC or abortions. Advocates reported progress with patients biweekly and completed a survey. Three years of data were collected.

RESULTS:
Over three years, 48 students advocated for a total of 196 patients, and students reported outcomes for 174 patients. Out of the 71% of patients that students successfully contacted, 37% were lost to follow up after counseling. Advocates made appointments for the remaining 34% of patients, out of which 58% received the service they requested (LARC or abortion). Students cited insurance restrictions, patient loss of interest in LARC, and LARC availability as barriers in 36% of the patients. Patients who had any of these barriers were less likely to receive LARC (p < 0.05).

CONCLUSION:
Student-reported patient outcomes revealed aspects of success and areas of improvement for the program. Overall, student advocates have the potential to positively impact women’s access to reproductive healthcare.
Postpartum Contraception use in Somali Women: A Population-Based Study [5F]
Authors: Cope Adela , Mara Kristin , Weaver Amy , Casey Petra 
Published: April 2018

INTRODUCTION:
Contraception is an important resource for Somali women as this population is at increased risk for adverse pregnancy outcomes. This study compares postpartum contraception use between Somali and non-Somali women.

METHODS:
A retrospective cohort study was performed utilizing the Rochester Epidemiology Project. All Somali women aged 18 and older who experienced liveborn, singleton births in Olmsted County, Minnesota, in 2009-2015 (n=317) and an age-matched non-Somali cohort (n=317) were identified. Postpartum contraception was defined as use of any method within 12 months after the first delivery in the time period of interest. Contraception use was compared using a chi-square test. Factors associated with contraception use were evaluated using multivariable logistic regression.

RESULTS:
Somali women were significantly less likely to use contraception than non-Somali women (62.1% versus 89.3%, p<0.001). Of those who used contraception, both Somali and non-Somali women reported comparable use of long-acting reversible contraception (LARC) (19.8% versus 23.7%, p=0.31) and non-LARC hormonal contraception (40.1% versus 45.2%, p=0.26). Somali women were more likely to use less reliable methods including natural family planning and barrier methods (57.3% versus 21.1%, p<0.001). Among Somali women, postpartum contraception use was less likely with older maternal age (OR 0.12 for oldest versus youngest quartile, 95% CI 0.04-0.37) and more likely with pre-pregnancy contraception use (OR 15.46, 95% CI 5.18-46.18).

CONCLUSION:
Our study represents the first assessment in the literature of contraception use in Somali women in the United States. Somali women are less likely to utilize postpartum contraception, highlighting an opportunity for improvement in counseling practices.
The Effect of Eliminating Cost Sharing on Adolescent IUD Utilization [6F]
Authors: Advani Raina , Kobernik Emily , Kolenic Giselle , Minadeo Leah , Heisel Erica , Dalton Vanessa K. 
Published: April 2018

INTRODUCTION:
The Affordable Care Act (ACA) removed major cost barriers by expanding coverage to dependents and eliminating out of pocket costs (OOPC) for IUD placement. Our objective was to characterize the effect of eliminating OOPCs on IUD cost and placement among commercially-insured young women

METHODS:
This study used de-identified data from The Clinformatics™ Data Mart Database to examine changes in cost sharing and IUD placement among commercially-insured women ages 15-26 between 2009 and 2014. IUD placement was identified using ICD-9 and CPT-4 codes. Plans were categorized by cost sharing patterns: $0 OOPC, low OOPCs, and high OOPCs. Multilevel models were used to estimate the effect of cost sharing on IUD placement.

RESULTS:
We identified 604 unique plans that were utilized for IUD services in 2009 and 2014. The 75th percentile of OOPCs in 2009 was $241 and dropped to $0 in 2014. Average plan utilization rate increased significantly from 7.4% in 2009 to 10.3% in 2014 (p<.001). When grouped by cost sharing patterns, significant increases in IUD utilization were observed for all groups. However, differences in plan utilization between 2009 and 2014 were not found. IUD plan utilization rate did not differ between plans with high OOPCs in 2009 and $0 in 2014 compared to plans that always had $0 OOPC (difference in slopes=.0115, p=.574).

CONCLUSION:
The elimination of cost sharing did not cause adolescents to increase IUD utilization beyond the general trend. Adolescents may be continuing to go outside their plans to access contraception despite the elimination of cost sharing.
Analysis of Personal Preferences Influencing Contraceptive Decision Making Using a Digital Women’s Health Advisor [8F]
Authors: Sridhar Aparna , Yoast Felicity , Witte Carolyn 
Published: April 2018

INTRODUCTION:
Tia is a mobile application that helps women make informed reproductive health decisions. A core feature of the app is a birth control recommendation algorithm that provides women personalized birth control recommendations. Users are able to select two preferences, indicating which is the most important preference. These include maximum effectiveness, non-daily method, acne reduction, amenorrhea, non-hormonal methods, avoiding a procedure, hidden method and having regular monthly cycles.

METHODS:
We analyzed anonymous data from 3,184 users who used Tia for contraception decision-making. The preferences were analyzed by age to identify the most and the least preferred personal preferences.

RESULTS:
The most common first preference was birth control effectiveness (33%) followed by non-daily method (13%) and acne reduction (12%). When segmented by age, the number one concern for users ages 14-25 remained birth control effectiveness (35%), however, for women over 25 the top preference shifted to a non-daily method. For young users the gap between the most common and the second most common top priority was 20 percentage points, for older women this variation was minimal. Hidden method (4% chose as their first preference, 6% as their second preference) was the least commonly desired benefit across all methods.

CONCLUSION:
Women hold differentiated preferences through their birth control choices. Women still view birth control effectiveness as a top priority, before being an option to help with secondary benefits. While younger women are less likely to have same preferences, older women have a wider array of preferences when choosing their contraceptive method.
Contraception Knowledge in Transgender Individuals: Are we Doing Enough? [9F]
Authors: Abern Lauren , Maguire Karla 
Published: April 2018

INTRODUCTION:
Transgender individuals are often reluctant to seek reproductive health care and have under-addressed needs. Our objective is to determine use and awareness of contraceptive methods and views on abortion in this population.

METHODS:
Transgender patients ages 18-65 participated in an online survey about reproductive history, contraceptive use and knowledge, and abortion views.

RESULTS:
100 transgender men and 20 transgender women completed the survey. The mean age of transgender men and women was 22.9 (SD 5.6) and 25.9 (SD 9.5) respectively. The majority was white (85%). 76/101 (75%) were at risk of unintended pregnancy. 30/97 (31%) transgender men and 12/18 (67%) transgender women believed or were unsure if testosterone or estrogen therapy prevents pregnancy. 1/18 (6%) transgender women and 9/93 (9%) transgender men indicated that a provider stated gender affirming hormones prevented pregnancy. Over 70% had knowledge of condoms, oral contraceptive pills, and sterilization. 70% of transgender men were also aware of the contraceptive ring and implant. However, only 18/89 (20%) transgender men and 4/11 (36%) transgender women used contraception. 8/17 (47%) transgender women and 44/87 (51%) transgender men stated a provider did not discuss contraception after initiating hormone therapy. There were no unplanned pregnancies (0/16, 0%) in partners of transgender women. 3/93 (3%) transgender men had unplanned pregnancies. 2/3 chose abortion. The vast majority (95%) identify as pro-choice.

CONCLUSION:
Although many transgender individuals in our cohort were at potential risk of pregnancy, contraceptive use was limited. This highlights need for educational interventions for patients and providers and increased access to contraceptive and reproductive services.
First Bluetooth Connected Ovulation Test with App to Predict and Track Cycles [10F]
Authors: Thomas Michael A. , Johnson Sarah , Grace Bola , Marriott Lorrae , Zinaman Michael 
Published: April 2018

INTRODUCTION:
Fertility Apps offer the convenience of cycle tracking and storage of data over multiple cycles. However, accuracy of ovulation prediction by most Apps is very poor. Therefore an App that uploads accurate ovulation test data would be of benefit to women seeking to conceive. This study examined women’s usage and experience of the new Clearblue Connected Ovulation Test System.

METHODS:
This home based study required volunteers to pair the Bluetooth connected ovulation test to their mobile phone using the associated App, then use the App and ovulation tests for 1 cycle. The tests measure both estrogen and luteinizing hormone to identify the wider fertile window and pinpoint ovulation. Test results are uploaded using the App enabling easy tracking of fertility data. Volunteers completed usability questionnaires when pairing App with holder and after 4 weeks usage. Qualitative feedback from volunteers and Cloud data usage was analysed.

RESULTS:
Of 164 Android users, 98% found the test and 93% found the App easy to use. For iOS users (n=23), 100% found the test and 95% found the App easy to use. Cloud data showed women conducted tests on the right days and chose to add additional data e.g. intercourse and menses. Volunteers also successfully uploaded their test results to the App, providing a central, concise record of data. Qualitative data indicated women found this very beneficial.

CONCLUSION:
Conclusions: This Clearblue Connected Ovulation Test System combines the convenience of an App with the accuracy and benefit of a home ovulation test.
Reproductive Coercion in the Perinatal Context [11F]
Authors: Fay Kathryn , Gomez Helen , Yee Lynn 
Published: April 2018

INTRODUCTION:
Reproductive coercion (RC), or behavior that interferes with contraception use and/or pregnancy autonomy, has been poorly assessed in the perinatal context. Our objective was to determine patient factors associated with RC and to explore associations between RC and pregnancy engagement.

METHODS:
This was a cross-sectional study utilizing an anonymous, self-administered, Spanish or English survey among women with at least one prior pregnancy. The RC questionnaire queried participants’ experience of birth control sabotage and/or pressure to become pregnant by a partner at the time of their most recent pregnancy. Surveys were distributed at a tertiary care center during routine outpatient visits. Descriptive and bivariable analyses were performed.

RESULTS:
In this sample of 93 women, 6.5% screened positive for RC. In the overall cohort, the mean age was 36.8 years, 79.6% were racial or ethnic minorities, and 41.9% were college graduates. Women reporting RC were younger (27.6vs.37.4 years, p=0.036) and reported more limited prenatal care (66.7%vs.25.3% with late/no prenatal care, p=0.049). There were trends demonstrating greater work insecurity, younger age at first pregnancy, poorer self-perception of health, and increased frequency of intimate partner violence (p<0.075). Race/ethnicity and education did not differ by experience of RC. Women were significantly more likely to have had an undesired pregnancy or pregnancy ambivalence if they had experienced RC (p=0.004).

CONCLUSION:
In this unselected population, RC was present in a distinct minority of women without discrimination along racial, ethnic, education and economic lines. These data suggest that RC experience is associated with pregnancy ambivalence/unintendedness and poorer engagement in perinatal care.
The Impact of Rural or Urban Location on Clinical Availability of the Copper IUD: A Mystery Caller Study [14F]
Authors: Lilja Kristen , Infante Sofia , Micks Elizabeth 
Published: April 2018

INTRODUCTION:
The copper IUD is the only highly effective non-hormonal method of contraception. It is also the most effective form of emergency contraception (EC), when placed within 5 days of unprotected intercourse, and is the only method of EC that provides ongoing contraception. For these reasons, local availability of the copper IUD to women is essential.

METHODS:
A mystery caller model was employed with a single caller making inquiries to urban and rural clinics in Washington state over a two-month period regarding availability of copper IUDs using a standardized script. Clinic types included OB/GYN, primary care, family planning and multispecialty. Clinics were identified using the HRSA 340B database, with allocation as urban vs rural based on the Office of Management and Budget county designations. The primary outcome was the reported availability of the copper IUD. Secondary outcomes included ability to schedule an appointment for copper IUD placement within 5 days.

RESULTS:
A total of 97 urban and 97 rural clinics were included in the analysis. A greater proportion of urban clinics reported availability of copper IUDs than rural clinics (78 vs 50%; p <0.001). Only 19 urban clinics and 10 rural clinics were able to schedule an appointment for copper IUD placement within the 5 day window needed for EC use (19 vs 10%, p = 0.07).

CONCLUSION:
Rural clinics are less likely to have copper IUDs available, even when clinic type is taken into account. Efforts are needed to increase availability of this method, particularly in rural areas.
Women’s Intentions for Pregnancy and Breastfeeding Impact Breastfeeding Outcomes, Implications & Opportunities [16F]
Authors: Stalcup Alane M. 
Published: April 2018

INTRODUCTION:
Breastfeeding is the optimal form of infant feeding with short and long term advantages for baby and mother. The aim of this study was to assess whether pregnancy wantedness as defined by the WHO and intention to breastfeed are associated with breastfeeding outcomes.

METHODS:
A cross-sectional study of mother-infant dyads in North Carolina was randomly drawn from birth certificates. Mothers were contacted for a one-time telephone interview. 'Wantedness' of the pregnancy, as defined by the WHO, and pre-birth breastfeeding intention were analyzed in relation to breastfeeding duration taking into account confounding social, demographic, and support factors.

RESULTS:
Wantedness of the pregnancy was predictive of breastfeeding duration. Women with mistimed or unwanted pregnancies had higher odds of breastfeeding cessation than women with timely, wanted pregnancies.
Intention to breastfeed was strongly associated with breastfeeding initiation and duration, but doesn’t appear to be absolutely necessary for initiation or to guarantee initiation. A notable group of women who had not intended to breastfeed did initiate (15.9%), and a smaller group who had planned to breastfeed never initiated (5.5%).

CONCLUSION:
Timely, wanted pregnancies are more likely to lead to breastfeeding initiation and to longer duration. This highlights the importance of a woman’s ability to access effective and attractive contraception not only for the mother’s health outcomes, but also for those of her child and for society as a whole.
Intention to breastfeed was strongly associated with breastfeeding initiation and duration. Efforts to influence a woman’s pre-conception and/or prenatal breastfeeding intention may be a high-yield opportunity for improving breastfeeding outcomes.
Acceptability of Postpartum No-Cost LARC Among Women Using Emergency Medicaid for Labor and Delivery [19F]
Authors: Dempsey Angela , Billings Debbie , Mattison Amy , Burgis Judith , Tyson Adam 
Published: April 2018

INTRODUCTION:
In 2012, South Carolina (SC) instituted a Medicaid policy allowing full reimbursement for inpatient post-partum long acting reversible contraceptives (LARC) and related services; however, the policy does not apply when delivery costs are covered by Emergency Medicaid. This study evaluated the acceptability of inpatient postpartum no-cost LARC for women with Emergency Medicaid coverage.

METHODS:
This cross-sectional study enrolled participants following delivery in three teaching hospitals in SC between November 2016 and May 2017. Eligible women were at least 18 years old and qualified for Emergency Medicaid coverage. Data were collected through patient interviews and chart abstraction. Each site provided LARC at no cost regardless of study enrollment.

RESULTS:
Among the 220 women enrolled, 89 women (40%) left with either the implant (n=57) or an IUD (n=32). Among those women, 79% were “very satisfied” with the insertion. When comparing pre-delivery documented contraception plans with method recorded at discharge, we found an increase in those choosing implant (pre= 18%, postpartum=26%) and a decrease in no method (pre= 26%, postpartum=15%) and IUD (pre=17%, postpartum= 15%,). Contraceptive counseling was recorded in most inpatient records (81%) and prenatal records (76%). Few participants reported receiving the information they needed about the IUD (36%) or implant (38%). Though 89% of participants planned to breastfeed, only 70% and 6% received information about breastfeeding while using implants and IUDs, respectively.

CONCLUSION:
LARC methods were commonly selected postpartum among this population. Despite counseling documented by providers, patients receive insufficient information about specific LARC methods and their use while also breastfeeding.