Contraception最新文献_第7页

STUDENT EXPERIENCES WITH EMERGENCY CONTRACEPTION AND PREFERENCES FOR ON-CAMPUS VENDING MACHINES 学生使用紧急避孕药具的经验和对校内自动售货机的偏好

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110648

S Knifton, M Quasebarth, V Manthena, L Hasselbacher

Objectives

Vending machines that sell emergency contraception (EC) at discounted prices are becoming increasingly common on US college campuses. These machines facilitate convenient and timely access for college students by mitigating common barriers to obtaining EC. Limited research has investigated students’ attitudes toward this resource.

Methods

Currently enrolled students at a private university in Illinois were recruited via flyers and listservs to complete an electronic survey on EC accessibility between November 2023 and February 2024. Anonymous survey responses were recorded via RedCap and exported to Microsoft Excel and SPSS for analysis.

Results

372 students completed the survey. The majority of participants identified as cisgender women (73.1%), straight (45.8%), White (52.6%), and as undergraduate (60.1%). Results found that over one-third (38.2%) of participants had previously purchased EC. Nearly 20% of these participants found the experience difficult, mainly due to the high cost of EC. Over half (56.4%) of participants had concern about being noticed or having to interact with staff when obtaining EC at a store or at student health clinic. Most (90.4%) participants reported that they would use an on-campus EC vending machine if they needed EC. Less than half (43.6%) indicated that they would be willing to spend more than $20 for EC.

Conclusions

EC vending machines are a practical solution to increase EC accessibility on college campuses and support students’ reproductive and educational goals, especially in the face of increasing abortion restrictions. To best address student concerns, ensuring that EC is low-cost and machines are placed in an accessible, but confidential, location is crucial.

目的以折扣价出售紧急避孕药（EC）的自动售货机在美国大学校园里越来越常见。这些自动售货机减轻了大学生在获取紧急避孕药具时遇到的常见障碍，从而为他们提供了方便和及时的服务。方法通过传单和列表服务器招募伊利诺伊州一所私立大学的在校学生，让他们在 2023 年 11 月至 2024 年 2 月期间完成一项有关 EC 可及性的电子调查。匿名调查回复通过 RedCap 进行记录，并导出到 Microsoft Excel 和 SPSS 中进行分析。大多数参与者认为自己是顺性别女性（73.1%）、异性恋者（45.8%）、白人（52.6%）和本科生（60.1%）。结果发现，超过三分之一（38.2%）的参与者以前购买过心血管疾病药物。其中近 20%的参与者认为购买过程比较困难，主要原因是价格昂贵。超过一半（56.4%）的参与者担心在商店或学生健康诊所购买避孕药时会被注意到或与工作人员打交道。大部分參加者(90.4%)表示，如需要使用安全套，他們會使用校內的安全套售賣機。不到半数（43.6%）的参与者表示，他们愿意花费超过 20 美元购买安全套。结论自动售货机是一个切实可行的解决方案，可以增加大学校园内的安全用药，并支持学生的生殖和教育目标，尤其是在堕胎限制不断增加的情况下。为了最大限度地解决学生的顾虑，确保安全套价格低廉，并将自动售货机放置在方便使用但保密的地点至关重要。

{"title":"STUDENT EXPERIENCES WITH EMERGENCY CONTRACEPTION AND PREFERENCES FOR ON-CAMPUS VENDING MACHINES","authors":"S Knifton, M Quasebarth, V Manthena, L Hasselbacher","doi":"10.1016/j.contraception.2024.110648","DOIUrl":"10.1016/j.contraception.2024.110648","url":null,"abstract":"<div><h3>Objectives</h3><div>Vending machines that sell emergency contraception (EC) at discounted prices are becoming increasingly common on US college campuses. These machines facilitate convenient and timely access for college students by mitigating common barriers to obtaining EC. Limited research has investigated students’ attitudes toward this resource.</div></div><div><h3>Methods</h3><div>Currently enrolled students at a private university in Illinois were recruited via flyers and listservs to complete an electronic survey on EC accessibility between November 2023 and February 2024. Anonymous survey responses were recorded via RedCap and exported to Microsoft Excel and SPSS for analysis.</div></div><div><h3>Results</h3><div>372 students completed the survey. The majority of participants identified as cisgender women (73.1%), straight (45.8%), White (52.6%), and as undergraduate (60.1%). Results found that over one-third (38.2%) of participants had previously purchased EC. Nearly 20% of these participants found the experience difficult, mainly due to the high cost of EC. Over half (56.4%) of participants had concern about being noticed or having to interact with staff when obtaining EC at a store or at student health clinic. Most (90.4%) participants reported that they would use an on-campus EC vending machine if they needed EC. Less than half (43.6%) indicated that they would be willing to spend more than $20 for EC.</div></div><div><h3>Conclusions</h3><div>EC vending machines are a practical solution to increase EC accessibility on college campuses and support students’ reproductive and educational goals, especially in the face of increasing abortion restrictions. To best address student concerns, ensuring that EC is low-cost and machines are placed in an accessible, but confidential, location is crucial.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110648"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

ADVANCING INNOVATIVE MEASUREMENT OF PREGNANCY PREFERENCES WITH A SHORT-FORM DESIRE TO AVOID PREGNANCY SCALE 用简表避免怀孕意愿量表推进对怀孕偏好的创新测量

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110577

I Muñoz, BW Bullington, MR Wilson, CH Rocca

Objectives

The Desire to Avoid Pregnancy (DAP) Scale represents an important step forward for pregnancy “intention” measurement. The 14-item psychometric instrument captures pregnancy preferences prospectively across domains (cognitive, affective, consequences) and allows for nuance, uncertainty, and ambivalence. However, a DAP short-form scale is needed to reduce respondent burden and facilitate integration of this rigorous, person-centered measure into future research and surveillance.

Methods

We used state-representative data from >30,000 self-identified women, aged 18-44 years, from nine diverse US states (Surveys of Women, 2017–2023) to develop a four-item version of the DAP scale (DAP-4). After splitting the dataset in half, stratified by state, we used classical test theory and item response theory methods to iteratively identify a reduced item set that maintained construct validity (eg, included items across conceptual domains and were worded negatively and positively), internal structure validity (eg, monotonicity), and external validity (eg, no differential item functioning), while maintaining reasonable internal consistency reliability. Scale properties were retested on the second half of the dataset.

Results

The DAP-4 included two items in the cognitive domain and one each in the affective and practical consequences domains, and items worded in both directions. The internal consistency was high for a short-form (alpha=0.83), covered the full range of respondent pregnancy preferences, and met criteria for internal structure validity. We found no evidence of differential item functioning by age, race and ethnicity, relationship status or parity, and high correlation with the longer DAP scale (0.96).

Conclusions

A short-form DAP that maintains psychometric rigor is now available to measure pregnancy preferences.

避免怀孕意愿量表（DAP）是怀孕 "意愿 "测量的重要一步。该量表包含 14 个心理测量项目，可跨领域（认知、情感、后果）前瞻性地捕捉怀孕偏好，并可考虑细微差别、不确定性和矛盾心理。然而，我们需要一个 DAP 短式量表来减轻受访者的负担，并促进将这一严格的、以人为本的测量方法纳入未来的研究和监测中。方法我们使用了来自美国九个不同州的 >30,000 名自我认同的 18-44 岁女性的州代表性数据（妇女调查，2017-2023 年），开发了一个四项目版本的 DAP 量表（DAP-4）。在按州将数据集一分为二后，我们使用经典测验理论和项目反应理论方法反复确定了一个缩小的项目集，该项目集保持了建构效度（例如，包含跨概念领域的项目，并采用了否定和肯定的措辞）、内部结构效度（例如，单调性）和外部效度（例如，无差异项目功能），同时保持了合理的内部一致性可靠性。结果 DAP-4 包括认知领域的两个项目、情感和实际后果领域的各一个项目以及双向措辞的项目。短式问卷的内部一致性很高（α=0.83），涵盖了所有受访者的怀孕偏好，并符合内部结构有效性的标准。我们没有发现不同年龄、种族和民族、关系状况或胎次的项目功能有差异，而且与较长的 DAP 量表有很高的相关性（0.96）。

{"title":"ADVANCING INNOVATIVE MEASUREMENT OF PREGNANCY PREFERENCES WITH A SHORT-FORM DESIRE TO AVOID PREGNANCY SCALE","authors":"I Muñoz, BW Bullington, MR Wilson, CH Rocca","doi":"10.1016/j.contraception.2024.110577","DOIUrl":"10.1016/j.contraception.2024.110577","url":null,"abstract":"<div><h3>Objectives</h3><div>The Desire to Avoid Pregnancy (DAP) Scale represents an important step forward for pregnancy “intention” measurement. The 14-item psychometric instrument captures pregnancy preferences prospectively across domains (cognitive, affective, consequences) and allows for nuance, uncertainty, and ambivalence. However, a DAP short-form scale is needed to reduce respondent burden and facilitate integration of this rigorous, person-centered measure into future research and surveillance.</div></div><div><h3>Methods</h3><div>We used state-representative data from >30,000 self-identified women, aged 18-44 years, from nine diverse US states (Surveys of Women, 2017–2023) to develop a four-item version of the DAP scale (DAP-4). After splitting the dataset in half, stratified by state, we used classical test theory and item response theory methods to iteratively identify a reduced item set that maintained construct validity (eg, included items across conceptual domains and were worded negatively and positively), internal structure validity (eg, monotonicity), and external validity (eg, no differential item functioning), while maintaining reasonable internal consistency reliability. Scale properties were retested on the second half of the dataset.</div></div><div><h3>Results</h3><div>The DAP-4 included two items in the cognitive domain and one each in the affective and practical consequences domains, and items worded in both directions. The internal consistency was high for a short-form (alpha=0.83), covered the full range of respondent pregnancy preferences, and met criteria for internal structure validity. We found no evidence of differential item functioning by age, race and ethnicity, relationship status or parity, and high correlation with the longer DAP scale (0.96).</div></div><div><h3>Conclusions</h3><div>A short-form DAP that maintains psychometric rigor is now available to measure pregnancy preferences.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110577"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

TRANSGENDER, NONBINARY, AND GENDER-EXPANSIVE EXPERIENCES WITH TELEHEALTH MEDICATION ABORTION AND IMPLICATIONS FOR HEALTH EQUITY IN THE US 美国变性人、非二元性别者和性别扩张者在远程医疗药物流产方面的经验及其对健康公平的影响

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110572

A Becker, SM Shuster, LR Koenig, J Ko, UD Upadhyay

Objectives

Transgender, nonbinary, and gender-expansive (TGE) patients need abortion care. However, little is known about TGE patients’ experiences with telehealth abortion care, a growing mode of abortion service post-Dobbs.

Methods

We conducted 13 in-depth interviews with TGE patients of three US virtual abortion clinics — Choix, Hey Jane, and Abortion on Demand — who obtained telehealth abortion care between April 2021 and January 2024. Interviews were transcribed and analyzed abductively using Dedoose.

Results

The direct-to-patient telehealth model for abortion reduced barriers for trans and nonbinary patients. Many interviewees appreciated the ability to avoid entering an abortion clinic, a space typically associated with “women’s health.” Telehealth allowed patients to circumvent potential gender discrimination or uncomfortable gender-related interactions with providers and other patients, which they expected from in-person care. Patients appreciated the option to either report their preferred name and/or pronouns on intake forms or to not disclose their gender identity altogether — particularly for those who received care through asynchronous secure messaging without any face-to-face interaction. TGE Interviewees also appreciated the increased privacy, anonymity, reduced logistics, and speed of telehealth.

Conclusions

Telehealth abortion care is highly acceptable and beneficial for TGE patients, as they benefit from an at-home experience coupled with reduced gender discrimination. Findings can help direct gender-affirming abortion care in-person and via virtual clinics.

目标变性、非二元和性别扩张（TGE）患者需要人工流产护理。方法我们对 2021 年 4 月至 2024 年 1 月期间在 Choix、Hey Jane 和 Abortion on Demand 三家美国虚拟堕胎诊所接受远程健康堕胎护理的 TGE 患者进行了 13 次深入访谈。我们使用 Dedoose 对访谈进行了誊写和归纳分析。结果直接面向患者的远程医疗堕胎模式减少了变性和非二元患者的障碍。许多受访者对能够避免进入堕胎诊所这一通常与 "女性健康 "相关的场所表示赞赏。远程医疗让患者避免了潜在的性别歧视，也避免了与医疗服务提供者和其他患者进行与性别相关的不愉快互动，而这正是他们所期望的面对面医疗服务。患者可以选择在入院表格上报告自己喜欢的名字和/或代词，或者完全不披露自己的性别身份，他们对此表示赞赏，尤其是那些通过异步安全信息接受治疗而没有任何面对面交流的患者。TGE 受访者还对远程医疗增加的隐私、匿名性、减少的物流和速度表示赞赏。结论远程医疗流产护理对 TGE 患者来说是非常容易接受和有益的，因为他们受益于在家体验和减少的性别歧视。这些研究结果有助于引导患者亲自或通过虚拟诊所接受性别肯定的人工流产护理。

{"title":"TRANSGENDER, NONBINARY, AND GENDER-EXPANSIVE EXPERIENCES WITH TELEHEALTH MEDICATION ABORTION AND IMPLICATIONS FOR HEALTH EQUITY IN THE US","authors":"A Becker, SM Shuster, LR Koenig, J Ko, UD Upadhyay","doi":"10.1016/j.contraception.2024.110572","DOIUrl":"10.1016/j.contraception.2024.110572","url":null,"abstract":"<div><h3>Objectives</h3><div>Transgender, nonbinary, and gender-expansive (TGE) patients need abortion care. However, little is known about TGE patients’ experiences with telehealth abortion care, a growing mode of abortion service post-<em>Dobbs</em>.</div></div><div><h3>Methods</h3><div>We conducted 13 in-depth interviews with TGE patients of three US virtual abortion clinics — Choix, Hey Jane, and Abortion on Demand — who obtained telehealth abortion care between April 2021 and January 2024. Interviews were transcribed and analyzed abductively using Dedoose.</div></div><div><h3>Results</h3><div>The direct-to-patient telehealth model for abortion reduced barriers for trans and nonbinary patients. Many interviewees appreciated the ability to avoid entering an abortion clinic, a space typically associated with “women’s health.” Telehealth allowed patients to circumvent potential gender discrimination or uncomfortable gender-related interactions with providers and other patients, which they expected from in-person care. Patients appreciated the option to either report their preferred name and/or pronouns on intake forms or to not disclose their gender identity altogether — particularly for those who received care through asynchronous secure messaging without any face-to-face interaction. TGE Interviewees also appreciated the increased privacy, anonymity, reduced logistics, and speed of telehealth.</div></div><div><h3>Conclusions</h3><div>Telehealth abortion care is highly acceptable and beneficial for TGE patients, as they benefit from an at-home experience coupled with reduced gender discrimination. Findings can help direct gender-affirming abortion care in-person and via virtual clinics.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110572"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

PUBLIC SUPPORT FOR REPORTING AND PUNISHING PEOPLE WHO USE ALCOHOL OR DRUGS WHILE PREGNANT 公众支持举报和惩罚在怀孕期间酗酒或吸毒的人

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110564

S Auerbach, SCM Roberts, LJ Ralph, S Kaller, R Schroeder, MA Biggs

Objectives

Given increased criminalization of pregnant people and erosion of abortion rights, we need a better understanding of the extent of public support for reporting or punishing people for using alcohol or drugs while pregnant.

Methods

We administered a national probability-based online survey (December 2021-January 2022) to English- and Spanish-speaking people assigned female at birth (AFAB, ages 15-49) or male at birth (AMAB, ages 18-49) regarding their attitudes about punishing or reporting pregnant people who use alcohol or drugs and whether abortions performed within or outside the healthcare system should be legal. We used weighted analyses to estimate national support for reporting (reporting to police, to child protective services (CPS) and punishing (paying a fine, going to jail) pregnant people who use alcohol or drugs and their association with views on abortion legality.

Results

Among the 7,016 AFAB and 360 AMAB survey respondents, most supported reporting pregnant people for using alcohol or drugs to the police (57.6% AFAB, 54.8% AMAB) and CPS (69.1% AFAB, 71.3% AMAB); while fewer respondents supported punishing people with a fine (40.2% AFAB, 40.3% AMAB) or jail (31.3% AFAB, 35.1% AMAB). Support for reporting and punishing people for using alcohol or drugs while pregnant was associated with believing abortion, within or outside the healthcare system, should be illegal (OR 3.0, 95%CI 2.6-3.4 AFAB; OR 1.8, 95%CI 0.9-3.2 AMAB).

Conclusions

Public support for criminalizing alcohol and drug use during pregnancy is high and largely associated with views on abortion legality.

目标鉴于对孕妇的刑事定罪和对堕胎权利的侵蚀日益严重，我们需要更好地了解公众在多大程度上支持举报或惩罚在怀孕期间酗酒或吸毒的人。方法我们对出生时被分配为女性（AFAB，15-49 岁）或男性（AMAB，18-49 岁）的讲英语和西班牙语的人进行了基于概率的全国性在线调查（2021 年 12 月至 2022 年 1 月），调查内容涉及他们对惩罚或举报酗酒或吸毒的孕妇的态度，以及在医疗系统内或外进行的堕胎是否应该合法。我们使用加权分析来估计全国对举报（向警方、儿童保护服务机构 (CPS) 举报）和惩罚（支付罚款、入狱）酗酒或吸毒孕妇的支持率及其与堕胎合法性观点的关联。结果在接受调查的 7,016 名非洲裔美国人协会和 360 名阿拉伯裔美国人协会受访者中，大多数人支持向警方（57.6% 的非洲裔美国人协会受访者，54.8% 的阿拉伯裔美国人协会受访者）和儿童保护机构（69.1% 的非洲裔美国人协会受访者，71.3% 的阿拉伯裔美国人协会受访者）举报酗酒或吸毒的孕妇；而较少受访者支持对酗酒或吸毒的孕妇处以罚款（40.2% 的非洲裔美国人协会受访者，40.3% 的阿拉伯裔美国人协会受访者）或监禁（31.3% 的非洲裔美国人协会受访者，35.1% 的阿拉伯裔美国人协会受访者）。支持举报和惩罚在怀孕期间酗酒或吸毒的人与认为在医疗系统内外堕胎应属非法有关（OR 3.0，95%CI 2.6-3.4AFAB；OR 1.8，95%CI 0.9-3.2AMAB）。

{"title":"PUBLIC SUPPORT FOR REPORTING AND PUNISHING PEOPLE WHO USE ALCOHOL OR DRUGS WHILE PREGNANT","authors":"S Auerbach, SCM Roberts, LJ Ralph, S Kaller, R Schroeder, MA Biggs","doi":"10.1016/j.contraception.2024.110564","DOIUrl":"10.1016/j.contraception.2024.110564","url":null,"abstract":"<div><h3>Objectives</h3><div>Given increased criminalization of pregnant people and erosion of abortion rights, we need a better understanding of the extent of public support for reporting or punishing people for using alcohol or drugs while pregnant.</div></div><div><h3>Methods</h3><div>We administered a national probability-based online survey (December 2021-January 2022) to English- and Spanish-speaking people assigned female at birth (AFAB, ages 15-49) or male at birth (AMAB, ages 18-49) regarding their attitudes about punishing or reporting pregnant people who use alcohol or drugs and whether abortions performed within or outside the healthcare system should be legal. We used weighted analyses to estimate national support for reporting (reporting to police, to child protective services (CPS) and punishing (paying a fine, going to jail) pregnant people who use alcohol or drugs and their association with views on abortion legality.</div></div><div><h3>Results</h3><div>Among the 7,016 AFAB and 360 AMAB survey respondents, most supported reporting pregnant people for using alcohol or drugs to the police (57.6% AFAB, 54.8% AMAB) and CPS (69.1% AFAB, 71.3% AMAB); while fewer respondents supported punishing people with a fine (40.2% AFAB, 40.3% AMAB) or jail (31.3% AFAB, 35.1% AMAB). Support for reporting and punishing people for using alcohol or drugs while pregnant was associated with believing abortion, within or outside the healthcare system, should be illegal (OR 3.0, 95%CI 2.6-3.4 AFAB; OR 1.8, 95%CI 0.9-3.2 AMAB).</div></div><div><h3>Conclusions</h3><div>Public support for criminalizing alcohol and drug use during pregnancy is high and largely associated with views on abortion legality.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110564"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110559

O Wasser, L Ralph, S Kaller, MA Biggs

Objectives

We aimed to estimate the proportion of people seeking abortion whose out-of-pocket abortion-related costs constitute a catastrophic health expenditure (CHE) and whether these are associated with in-state or out-of-state travel for care.

Methods

In 2019, we surveyed people aged 15–45 seeking abortion in four clinics located in abortion-supportive states that serve many out-of-state patients. We calculated participants’ out-of-pocket abortion-related costs (procedure, transportation, accommodation, childcare, previous appointments, missed work, and other expenses) and assessed whether these costs were financially catastrophic by applying a 40% threshold to their estimated non-subsistence monthly household income, based on published methods (Zuniga et al, 2020). Using multivariable Poisson regressions, we examined associations between traveling in-state or out-of-state for care and experiencing abortion-related costs as CHE.

Results

784 people (of 1,092 approached) completed the survey; 675 responded to the abortion-related costs questions. We found that 42% of participants experienced out-of-pocket abortion-related costs as financially catastrophic. Patients who traveled out-of-state for care were significantly more likely to experience abortion-related costs as CHE (65%, adjusted Prevalence Ratio (aPR) 2.24, 95% confidence interval (CI) 1.67-3.00) than in-state patients (32%). Individuals who resided more than 100 miles from the clinic (aPR 2.05, 95% CI 1.54-2.74) or sought abortion beyond 13 weeks’ gestation (aPR 1.80, 95% CI 1.30-2.51) were also significantly more likely to experience abortion as CHE, compared to their counterparts.

Conclusions

Out-of-pocket costs for abortion care are financially catastrophic for many abortion patients, especially those traveling out-of-state. The adverse impact on people’s financial well-being is likely exacerbated post-Dobbs v Jackson Women’s Health Organization, where more people are traveling for abortion care.

目标我们旨在估算寻求人工流产的人群中自付人工流产相关费用构成灾难性医疗支出（CHE）的比例，以及这些费用是否与州内或州外的就医旅行有关。方法2019 年，我们在位于支持人工流产州的四家诊所对寻求人工流产的 15-45 岁人群进行了调查，这些诊所为许多州外患者提供服务。我们计算了参与者自付的人工流产相关费用（手术、交通、住宿、儿童保育、之前的预约、误工及其他费用），并根据已公布的方法（Zuniga et al，2020 年），对其估计的非自给性家庭月收入采用 40% 的阈值，以评估这些费用是否具有经济灾难性。利用多变量泊松回归，我们研究了州内或州外就医与经历与流产相关的费用之间的关联。结果有 784 人（共 1092 人）完成了调查；675 人回答了与流产相关的费用问题。我们发现，42% 的参与者认为自付的人工流产相关费用在经济上是灾难性的。与州内患者（32%）相比，前往州外接受治疗的患者更有可能将人工流产相关费用视为灾难性费用（65%，调整流行率 (aPR) 2.24，95% 置信区间 (CI)1.67-3.00）。与同类患者相比，居住地距离诊所超过 100 英里（aPR 2.05，95% 置信区间 1.54-2.74）或寻求妊娠超过 13 周的人工流产（aPR 1.80，95% 置信区间 1.30-2.51）的患者经历 CHE 人工流产的可能性也明显更高。多布斯诉杰克逊妇女健康组织一案发生后，越来越多的人前往州外接受堕胎治疗，这可能会加剧对人们经济福祉的不利影响。

{"title":"ABORTION-RELATED COSTS AS CATASTROPHIC HEALTH EXPENDITURES AND THEIR ASSOCIATIONS WITH IN-STATE OR OUT-OF-STATE TRAVEL TO ABORTION CARE","authors":"O Wasser, L Ralph, S Kaller, MA Biggs","doi":"10.1016/j.contraception.2024.110559","DOIUrl":"10.1016/j.contraception.2024.110559","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to estimate the proportion of people seeking abortion whose out-of-pocket abortion-related costs constitute a catastrophic health expenditure (CHE) and whether these are associated with in-state or out-of-state travel for care.</div></div><div><h3>Methods</h3><div>In 2019, we surveyed people aged 15–45 seeking abortion in four clinics located in abortion-supportive states that serve many out-of-state patients. We calculated participants’ out-of-pocket abortion-related costs (procedure, transportation, accommodation, childcare, previous appointments, missed work, and other expenses) and assessed whether these costs were financially catastrophic by applying a 40% threshold to their estimated non-subsistence monthly household income, based on published methods (Zuniga et al, 2020). Using multivariable Poisson regressions, we examined associations between traveling in-state or out-of-state for care and experiencing abortion-related costs as CHE.</div></div><div><h3>Results</h3><div>784 people (of 1,092 approached) completed the survey; 675 responded to the abortion-related costs questions. We found that 42% of participants experienced out-of-pocket abortion-related costs as financially catastrophic. Patients who traveled out-of-state for care were significantly more likely to experience abortion-related costs as CHE (65%, adjusted Prevalence Ratio (aPR) 2.24, 95% confidence interval (CI) 1.67-3.00) than in-state patients (32%). Individuals who resided more than 100 miles from the clinic (aPR 2.05, 95% CI 1.54-2.74) or sought abortion beyond 13 weeks’ gestation (aPR 1.80, 95% CI 1.30-2.51) were also significantly more likely to experience abortion as CHE, compared to their counterparts.</div></div><div><h3>Conclusions</h3><div>Out-of-pocket costs for abortion care are financially catastrophic for many abortion patients, especially those traveling out-of-state. The adverse impact on people’s financial well-being is likely exacerbated post-<em>Dobbs v Jackson Women’s Health Organization</em>, where more people are traveling for abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110559"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Copyright info/Contents 版权信息/内容

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/S0010-7824(24)00412-8

引用次数: 0

A QUALITATIVE STUDY EXPLORING PATIENT EXPERIENCES WITH TELEHEALTH AND IN-CLINIC MEDICATION ABORTION: STIGMA, PRIVACY, AND SUPPORT 一项定性研究，探讨患者在远程医疗和诊室药物流产方面的体验：耻辱感、隐私和支持

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110621

M Barnes, E Piqueiras, L Gutierrez-Palominos, R Patil

Objectives

We aimed to explore the experiences of people obtaining medication abortion through telemedicine medication abortion and clinic-based medication abortion at a single academic center.

Methods

We conducted an exploratory qualitative study utilizing semi-structured teleconference interviews with 23 (9 telemedicine medication abortion and 14 clinic-based medication abortion) patients with a gestational age up to 77 days who obtained a medication abortion between June 2018 and December 2022. Purposive sampling was adopted for the recruitment of participants at a single academic center in California. All interviews were recorded, transcribed, and coded by the authors to generate salient themes via thematic analysis.

Results

Participants discussed the effects of abortion stigma from society and social networks, leading to an increased desire for privacy, support, and urgency with time to appointment. Qualitative analysis indicates that telemedicine medication abortion participants preferred the increased privacy afforded via telemedicine. Clinic-based medication abortion participants highlighted the in-clinic environment as more invasive to their privacy, often requiring more people to know about their abortion which increased feelings of unease. Many participants described uncertainty about sharing abortion information with social networks because they (1) did not want to introduce others' opinions into their decision-making and (2) were unclear about how they might feel or react.

Conclusions

The results suggest that telemedicine abortion is an important tool to counteract pervasive societal stigma as well as improve accessibility. This study also suggests that abortion stigma (both actual and perceived) significantly impacts patient experiences despite being in a state with protective abortion laws, and improving accessibility and privacy can counteract the stigma associated with abortion care.

方法我们采用半结构化远程会议访谈的方式进行了一项探索性定性研究，访谈对象为 2018 年 6 月至 2022 年 12 月期间接受药物流产的 23 名（9 名远程医疗药物流产患者和 14 名门诊药物流产患者）孕龄不超过 77 天的患者。在加利福尼亚州的一个学术中心招募参与者时采用了有目的的抽样。所有访谈均由作者记录、转录和编码，通过主题分析产生突出主题。结果参与者讨论了社会和社交网络对人工流产污名化的影响，从而导致对隐私、支持和预约时间紧迫性的渴望增加。定性分析显示，远程医疗药物流产参与者更喜欢通过远程医疗增加隐私。门诊药物流产参与者强调，门诊环境更容易侵犯他们的隐私，往往需要更多的人知道他们的流产情况，这增加了他们的不安感。许多参与者表示不确定是否要与社交网络分享堕胎信息，因为他们（1）不想在做决定时引入他人的意见，（2）不清楚自己会有什么感觉或反应。这项研究还表明，尽管美国各州都有保护堕胎的法律，但堕胎耻辱感（包括实际耻辱感和感知耻辱感）会严重影响患者的体验，而提高可及性和隐私性可以抵消与堕胎护理相关的耻辱感。

{"title":"A QUALITATIVE STUDY EXPLORING PATIENT EXPERIENCES WITH TELEHEALTH AND IN-CLINIC MEDICATION ABORTION: STIGMA, PRIVACY, AND SUPPORT","authors":"M Barnes, E Piqueiras, L Gutierrez-Palominos, R Patil","doi":"10.1016/j.contraception.2024.110621","DOIUrl":"10.1016/j.contraception.2024.110621","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to explore the experiences of people obtaining medication abortion through telemedicine medication abortion and clinic-based medication abortion at a single academic center.</div></div><div><h3>Methods</h3><div>We conducted an exploratory qualitative study utilizing semi-structured teleconference interviews with 23 (9 telemedicine medication abortion and 14 clinic-based medication abortion) patients with a gestational age up to 77 days who obtained a medication abortion between June 2018 and December 2022. Purposive sampling was adopted for the recruitment of participants at a single academic center in California. All interviews were recorded, transcribed, and coded by the authors to generate salient themes via thematic analysis.</div></div><div><h3>Results</h3><div>Participants discussed the effects of abortion stigma from society and social networks, leading to an increased desire for privacy, support, and urgency with time to appointment. Qualitative analysis indicates that telemedicine medication abortion participants preferred the increased privacy afforded via telemedicine. Clinic-based medication abortion participants highlighted the in-clinic environment as more invasive to their privacy, often requiring more people to know about their abortion which increased feelings of unease. Many participants described uncertainty about sharing abortion information with social networks because they (1) did not want to introduce others' opinions into their decision-making and (2) were unclear about how they might feel or react.</div></div><div><h3>Conclusions</h3><div>The results suggest that telemedicine abortion is an important tool to counteract pervasive societal stigma as well as improve accessibility. This study also suggests that abortion stigma (both actual and perceived) significantly impacts patient experiences despite being in a state with protective abortion laws, and improving accessibility and privacy can counteract the stigma associated with abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110621"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IMMEDIATE POSTPARTUM LEVONORGESTREL (LNG) IUD INSERTION: ANALYSIS OF INSERTION TECHNIQUE AND EXPULSION RATES 产后立即插入左炔诺孕酮（LNG）节育器：插入技术和排出率分析

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110639

RA Desai, AR Brant, T Pal, M Yao

Objectives

Prior studies report expulsion rates for immediate postpartum (IPP) IUDs as high as 27%. It is unclear whether modifiable insertion techniques affect the expulsion rate. We examined whether the technique of IPP LNG IUD insertion after vaginal delivery (manual vs device applicator vs ring forceps) was associated with IUD expulsion or other complications by six months postpartum.

Methods

We conducted a retrospective cohort study of all patients who delivered vaginally and received an IPP LNG IUD (Mirena®) in a multihospital healthcare system from 2019-2022. We identified eligible patients using ICD-10 codes and MAR administration. We manually extracted outcomes and confounding variables: expulsion, IUD complications, use of ultrasound, and obstetrical characteristics. Statistical analysis was performed using chi square tests.

Results

We included 647 IPP LNG IUD insertions; 48% (311) were inserted manually, 14% (90) via ring forceps, and 38% (246) via device applicator. The overall expulsion rate was 14.4%. We found no difference in the rate of expulsion between manual, ring forceps, or device applicator insertion (14.8%, 10.0%, and 15.4% respectively; p=0.43), nor was there a difference in the rate of composite IUD complications (13.2%, 10.0%, and 16.7%, respectively; p=0.25). Providers were more likely to use ultrasound with ring forceps (24.4%) and device applicator (22.0%) compared to manual insertion (11.3%; p <0.001).

Conclusions

Real world data suggest an LNG IUD expulsion rate of 14% after vaginal delivery. Our study found no difference in rates of IUD expulsion or complication based on insertion technique. These findings should inform pre-delivery long-acting reversible contraception (LARC) counseling and intrapartum practice patterns.

目的先前的研究报告显示，产后立即放置（IPP）宫内节育器的排出率高达 27%。目前尚不清楚可改变的插入技术是否会影响宫内节育器的排出率。我们研究了阴道分娩后插入 IPP LNG 宫内节育器的技术（手动 vs 器械涂抹器 vs 环形钳）是否与产后 6 个月的宫内节育器排出或其他并发症有关。方法我们对 2019-2022 年间在一家多医院医疗系统中经阴道分娩并接受 IPP LNG 宫内节育器 (Mirena®) 的所有患者进行了一项回顾性队列研究。我们通过 ICD-10 编码和 MAR 管理确定了符合条件的患者。我们手动提取了结果和混杂变量：排出、宫内节育器并发症、超声波的使用和产科特征。结果我们纳入了 647 例 IPP LNG 宫内节育器置入；48%（311 例）为人工置入，14%（90 例）通过环钳置入，38%（246 例）通过器械涂抹器置入。总体排出率为 14.4%。我们发现人工、环钳或器械涂抹器插入的宫内节育器排出率没有差异（分别为 14.8%、10.0% 和 15.4%；P=0.43），复合宫内节育器并发症的发生率也没有差异（分别为 13.2%、10.0% 和 16.7%；P=0.25）。与人工插入宫内节育器（11.3%；p <0.001）相比，医疗人员更倾向于使用带环钳的超声（24.4%）和器械涂抹器（22.0%）。我们的研究发现，宫内节育器排出率或并发症发生率与插入技术没有差异。这些发现应为产前长效可逆避孕法 (LARC) 咨询和产中实践模式提供参考。

{"title":"IMMEDIATE POSTPARTUM LEVONORGESTREL (LNG) IUD INSERTION: ANALYSIS OF INSERTION TECHNIQUE AND EXPULSION RATES","authors":"RA Desai, AR Brant, T Pal, M Yao","doi":"10.1016/j.contraception.2024.110639","DOIUrl":"10.1016/j.contraception.2024.110639","url":null,"abstract":"<div><h3>Objectives</h3><div>Prior studies report expulsion rates for immediate postpartum (IPP) IUDs as high as 27%. It is unclear whether modifiable insertion techniques affect the expulsion rate. We examined whether the technique of IPP LNG IUD insertion after vaginal delivery (manual vs device applicator vs ring forceps) was associated with IUD expulsion or other complications by six months postpartum.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of all patients who delivered vaginally and received an IPP LNG IUD (Mirena®) in a multihospital healthcare system from 2019-2022. We identified eligible patients using ICD-10 codes and MAR administration. We manually extracted outcomes and confounding variables: expulsion, IUD complications, use of ultrasound, and obstetrical characteristics. Statistical analysis was performed using chi square tests.</div></div><div><h3>Results</h3><div>We included 647 IPP LNG IUD insertions; 48% (311) were inserted manually, 14% (90) via ring forceps, and 38% (246) via device applicator. The overall expulsion rate was 14.4%. We found no difference in the rate of expulsion between manual, ring forceps, or device applicator insertion (14.8%, 10.0%, and 15.4% respectively; p=0.43), nor was there a difference in the rate of composite IUD complications (13.2%, 10.0%, and 16.7%, respectively; p=0.25). Providers were more likely to use ultrasound with ring forceps (24.4%) and device applicator (22.0%) compared to manual insertion (11.3%; p <0.001).</div></div><div><h3>Conclusions</h3><div>Real world data suggest an LNG IUD expulsion rate of 14% after vaginal delivery. Our study found no difference in rates of IUD expulsion or complication based on insertion technique. These findings should inform pre-delivery long-acting reversible contraception (LARC) counseling and intrapartum practice patterns.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110639"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

CHANGES IN DISTANCE TRAVELED AMONG CHICAGO ABORTION FUND CALLERS FROM 2020-2023 2020-2023 年芝加哥堕胎基金来电者旅行距离的变化

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110609

LA McGuinn, M Quasebarth, M Daniel, L Hasselbacher, K Rivlin

Objectives

To examine changes in the distance traveled by Chicago Abortion Fund (CAF) callers from 2020-2023, overall and by demographic and geographic indicators.

Methods

We included 6,512 out-of-state CAF callers seeking abortion care in Illinois between 2020-2023 who provided a zip code of residence. We approximated distance traveled by calculating the distance from each caller’s population-weighted zip code centroid to the clinic location. We defined urban/rural status using zip code derived Rural-Urban Community Area categories. We derived area level social deprivation measures using US Census data. We assessed median differences in distances (miles) traveled for callers over time and by geographic indicators.

Results

Overall, among out-of-state CAF callers, 68% (n=4,404) traveled ≥ 100 miles to access abortion care. The median one-way travel distance decreased from 90.3 miles (interquartile range [IQR]: 123) in 2020 to 50.6 miles (IQR: 126) in 2021. However, it then increased to 173 miles (IQR: 323) in 2022 and further to 191 miles (IQR: 384) in 2023. Individuals residing in rural zip codes had a median travel distance of 277 miles (IQR: 258), compared to 164 miles (IQR: 315) for those residing in urban zip codes. Individuals in more deprived rural areas traveled further (median: 373 miles, IQR:294) compared to those in less deprived rural areas (median 204 miles, IQR: 200).

Conclusions

CAF callers experience complex challenges accessing abortion, including intersections between geography and socioeconomic status. Abortion funds play a critical role in maintaining abortion access for those living in restrictive states, and should account for the structural barriers their grantees face.

目标研究 2020-2023 年期间芝加哥堕胎基金（CAF）来电者旅行距离的总体变化以及人口和地理指标的变化。方法我们纳入了 2020-2023 年期间在伊利诺伊州寻求堕胎护理的 6512 位提供居住地邮政编码的外州 CAF 来电者。我们通过计算每位来电者的人口加权邮政编码中心点到诊所地点的距离来近似计算旅行距离。我们使用邮政编码得出的农村-城市社区区域类别来定义城市/农村状态。我们利用美国人口普查数据得出了地区级社会贫困度量。结果总体而言，在州外的 CAF 求诊者中，68%（n=4,404）的求诊距离≥ 100 英里。单程旅行距离的中位数从 2020 年的 90.3 英里（四分位数间距 [IQR]：123）下降到 2021 年的 50.6 英里（四分位数间距 [IQR]：126）。然而，2022 年又增至 173 英里（四分位数间距 [IQR]：323），2023 年进一步增至 191 英里（四分位数间距 [IQR]：384）。居住在农村邮政编码的居民的中位旅行距离为 277 英里（IQR：258），而居住在城市邮政编码的居民的中位旅行距离为 164 英里（IQR：315）。与贫困程度较低的农村地区（中位数为 204 英里，IQR：200）相比，贫困程度较高的农村地区的个人旅行距离更远（中位数：373 英里，IQR：294）。堕胎基金在维持生活在限制性州的人们获得堕胎机会方面发挥着至关重要的作用，并应考虑到其受赠者所面临的结构性障碍。

{"title":"CHANGES IN DISTANCE TRAVELED AMONG CHICAGO ABORTION FUND CALLERS FROM 2020-2023","authors":"LA McGuinn, M Quasebarth, M Daniel, L Hasselbacher, K Rivlin","doi":"10.1016/j.contraception.2024.110609","DOIUrl":"10.1016/j.contraception.2024.110609","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine changes in the distance traveled by Chicago Abortion Fund (CAF) callers from 2020-2023, overall and by demographic and geographic indicators.</div></div><div><h3>Methods</h3><div>We included 6,512 out-of-state CAF callers seeking abortion care in Illinois between 2020-2023 who provided a zip code of residence. We approximated distance traveled by calculating the distance from each caller’s population-weighted zip code centroid to the clinic location. We defined urban/rural status using zip code derived Rural-Urban Community Area categories. We derived area level social deprivation measures using US Census data. We assessed median differences in distances (miles) traveled for callers over time and by geographic indicators.</div></div><div><h3>Results</h3><div>Overall, among out-of-state CAF callers, 68% (n=4,404) traveled ≥ 100 miles to access abortion care. The median one-way travel distance decreased from 90.3 miles (interquartile range [IQR]: 123) in 2020 to 50.6 miles (IQR: 126) in 2021. However, it then increased to 173 miles (IQR: 323) in 2022 and further to 191 miles (IQR: 384) in 2023. Individuals residing in rural zip codes had a median travel distance of 277 miles (IQR: 258), compared to 164 miles (IQR: 315) for those residing in urban zip codes. Individuals in more deprived rural areas traveled further (median: 373 miles, IQR:294) compared to those in less deprived rural areas (median 204 miles, IQR: 200).</div></div><div><h3>Conclusions</h3><div>CAF callers experience complex challenges accessing abortion, including intersections between geography and socioeconomic status. Abortion funds play a critical role in maintaining abortion access for those living in restrictive states, and should account for the structural barriers their grantees face.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110609"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

OXYTOCIN RECEPTION EXPRESSION IN PREGNANCY: “IS IT TIME TO ADD THE PIT?” 妊娠期催产素接收表达："是时候加坑了吗？

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception

Pub Date : 2024-10-07 DOI: 10.1016/j.contraception.2024.110595

JA Reid, M Baldwin, A Edelman, J Jensen, S Yao, R Godiah, L Han

Objectives

We aimed to measure oxytocin receptor (OXTR) expression changes in the myometrium throughout pregnancy to inform clinical management of post-abortion hemorrhage.

Methods

We obtained myometrial tissue through transcervical core needle biopsies under ultrasound guidance in anesthetized participants immediately following procedural abortion. We also obtained tissue from non-pregnant and term control participants. We compared relative OXTR expression throughout pregnancy using quantitative PCR (qPCR) to evaluate gene expression and immunohistochemistry to assess OXTR protein in samples.

Results

We collected myometrial samples from 29 participants including n=22 following abortion at 6-26 weeks, n=3 undergoing cesarean delivery at term prior to labor, and n=4 undergoing laparoscopic permanent contraception (non-pregnant). Using qPCR, we observed an increase in relative OXTR expression with increasing gestational age. Compared to non-pregnant levels, the relative expression ranges increased from 2.5-fold (SD 3.9) in the first trimester to 96-fold (SD 10.3) at term. To further investigate the changes in expression in the second trimester, we compared mRNA expression in early-, mid-, and late-second trimester subgroups. Compared to the first trimester (<14 week), relative expression increased by 5.8-fold at 14-17 weeks, 16.2-fold at 18-20 weeks, 22.4-fold at 20-26 weeks, and 38.4-fold at term (>37 weeks). Immunohistochemical staining confirmed gestational week dependent increases in OXTR protein levels in the cytosol of myometrial cells.

Conclusions

This study defines changes in OXTR expression throughout pregnancy and provides evidence for an increase in the second trimester. This supports the use of oxytocin in second trimester hemorrhage management, with a notable increase in expression by 18 weeks.

目的我们旨在测量整个妊娠期子宫肌层中催产素受体（OXTR）表达的变化，为人工流产后大出血的临床治疗提供参考。方法我们在超声引导下，通过经宫颈核心针活检获取子宫肌层组织，受检者在手术流产后立即进行麻醉。我们还从未孕和足月的对照组参与者身上获取了组织。我们使用定量 PCR（qPCR）评估基因表达，并使用免疫组织化学方法评估样本中的 OXTR 蛋白，从而比较了整个妊娠期间 OXTR 的相对表达。通过 qPCR，我们观察到随着妊娠年龄的增加，OXTR 的相对表达量也在增加。与未孕水平相比，相对表达范围从头三个月的 2.5 倍（标准差 3.9）增加到足月时的 96 倍（标准差 10.3）。为了进一步研究妊娠后三个月的表达变化，我们比较了妊娠后三个月早期、中期和晚期亚组的 mRNA 表达。与妊娠头三个月（14 周）相比，相对表达量在 14-17 周增加了 5.8 倍，18-20 周增加了 16.2 倍，20-26 周增加了 22.4 倍，足月时（37 周）增加了 38.4 倍。免疫组化染色证实，子宫肌细胞胞浆中 OXTR 蛋白水平的增加与孕周有关。这支持了催产素在妊娠后三个月出血处理中的应用，其表达在 18 周时显著增加。

{"title":"OXYTOCIN RECEPTION EXPRESSION IN PREGNANCY: “IS IT TIME TO ADD THE PIT?”","authors":"JA Reid, M Baldwin, A Edelman, J Jensen, S Yao, R Godiah, L Han","doi":"10.1016/j.contraception.2024.110595","DOIUrl":"10.1016/j.contraception.2024.110595","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to measure oxytocin receptor (OXTR) expression changes in the myometrium throughout pregnancy to inform clinical management of post-abortion hemorrhage.</div></div><div><h3>Methods</h3><div>We obtained myometrial tissue through transcervical core needle biopsies under ultrasound guidance in anesthetized participants immediately following procedural abortion. We also obtained tissue from non-pregnant and term control participants. We compared relative OXTR expression throughout pregnancy using quantitative PCR (qPCR) to evaluate gene expression and immunohistochemistry to assess OXTR protein in samples.</div></div><div><h3>Results</h3><div>We collected myometrial samples from 29 participants including n=22 following abortion at 6-26 weeks, n=3 undergoing cesarean delivery at term prior to labor, and n=4 undergoing laparoscopic permanent contraception (non-pregnant). Using qPCR, we observed an increase in relative OXTR expression with increasing gestational age. Compared to non-pregnant levels, the relative expression ranges increased from 2.5-fold (SD 3.9) in the first trimester to 96-fold (SD 10.3) at term. To further investigate the changes in expression in the second trimester, we compared mRNA expression in early-, mid-, and late-second trimester subgroups. Compared to the first trimester (<14 week), relative expression increased by 5.8-fold at 14-17 weeks, 16.2-fold at 18-20 weeks, 22.4-fold at 20-26 weeks, and 38.4-fold at term (>37 weeks). Immunohistochemical staining confirmed gestational week dependent increases in OXTR protein levels in the cytosol of myometrial cells.</div></div><div><h3>Conclusions</h3><div>This study defines changes in OXTR expression throughout pregnancy and provides evidence for an increase in the second trimester. This supports the use of oxytocin in second trimester hemorrhage management, with a notable increase in expression by 18 weeks.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"139 ","pages":"Article 110595"},"PeriodicalIF":2.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0