Journal of women's health最新文献

Introduction: U.S. maternal mortality rates are high. Inequities in birth outcomes are pervasive. Patient perception of bias during pregnancy-related care, especially among minoritized communities, is a risk factor for adverse perinatal health outcomes. Addressing this may be vital to lowering maternal mortality and improving care. The aim of this review was to explore the association between patient perception of provider bias and U.S. perinatal health care quality in birthing people. Methods: Following PRISMA-ScR guidelines, we conducted a scoping review of original published studies (2003-2023) addressing perceived bias/discrimination and perinatal care quality metrics. Both qualitative and quantitative studies were evaluated to formulate a broad conceptualization of the research examining perceived bias and perinatal health care quality. Results: Four addressed themes arose from this review that related to the association of perceived bias with: (i) demographic factors such as race/ethnicity and insurance type; (ii) patients' pregnancy-related health care engagement; (iii) a breakdown in communication and trust between patients and providers; and (iv) patients' sense of choice/control in their perinatal health care engagement. Conclusions: Researchers are using first-person accounts of perceived bias to better understand the etiology of inequitable maternal health statistics in the United States. Preliminary outcomes from this body of work indicate a relationship between the perception of bias, provider relationships, health care engagement, and maternal agency. The role of bias perception on maternal mortality may be an important barrier to improved health outcomes, particularly in minoritized populations.

Objective: To examine the risk of pregnancy complications and adverse delivery outcomes among births conceived using medically assisted reproduction (MAR) in same-sex, different-sex, and single-parent households. Methods: We conducted a cross-sectional population-based analysis of all MAR births in Louisiana from 2016 to 2023. Based on the sex of both parents listed on the child's birth certificate, we classified births as occurring in different-sex (reference category), same-sex, and single-parent households. We used modified Poisson regression with robust standard errors to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CIs) for all study outcomes including gestational diabetes mellitus (GDM), gestational hypertension (gHTN), induced labor, cesarean delivery, breech delivery, preterm birth, and low birth weight. Results: Among 2,934 MAR-conceived births, 177 (6.0%) were in same-sex relationships, 93 (3.2%) were in single-parent households, and 2,664 (90.8%) were in different-sex relationships. After adjusting for sociodemographic, preexisting health, and pregnancy risk factors, birthing people in same-sex relationships experienced higher risks of labor induction (aRR: 1.23; 95% CI: 1.06, 1.43) and lower risks of cesarean delivery (aRR: 0.89; 95% CI: 0.81, 0.98) compared to those in different-sex relationships. Single-parent households exhibited higher risks of gHTN (aRR: 1.56; 95% CI: 1.10, 2.21). Conclusions: Birthing people in same-sex relationships were at higher risk for labor induction and lower risk of cesarean delivery, while single parents were at greater risk for gHTN. These findings underscore the importance of considering family structure in research and clinical care to address disparities in reproductive health.

Background: Data regarding pregnancy and perinatal outcomes of oocyte donation (OD) recipients older than age 45 are limited. Materials and Methods: A total of 459,528 singleton pregnancies with 946 OD pregnancies and 458,582 spontaneous pregnancies were grouped according to maternal age ≥45 years and <45 years. Results: The mean maternal age of the OD recipients was 47.6 for patients >45 and 40.7 for patients ≤45 (p < 0.001). Among the spontaneous conceptions, the mean maternal age was 47.8 years for patients >45 and 31.1 for patients ≤45 (p < 0.001). Multivariable logistic regression for preterm birth (PTB) <37 weeks and for small gestational age (SGA) among the OD recipients demonstrated that age >45 is a protective factor for PTB <37 weeks (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.4-0.9, p = 0.03) and for SGA (OR: 0.3, 95% CI: 0.1-0.7, p = 0.006, respectively). Among the spontaneous group, age >45 is a risk factor for PTB <37 weeks (OR: 3.2, 95% CI: 2.7-3.9, p < 0.001), PTB <34 weeks (OR: 4.7, 95% CI: 3.4-6.4, p < 0.001), SGA (OR: 1.6, 95% CI: 1.2-2.1, p < 0.001), and pregnancy-induced hypertension (OR: 3.1, 95% CI: 2.1-4.7, p < 0.001). Other obstetric complications were comparable between the age-groups of the oocyte recipients but were higher among patients >45 years who conceived spontaneously. Conclusions: As opposed to spontaneous pregnancies, OD pregnancies of recipients >45 are not associated with higher rates of obstetric or perinatal morbidity compared with younger recipients.

On April 26, 2024, the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) issued a Final Rule titled "HIPAA Privacy Rule to Support Reproductive Health Care Privacy."¹ As per the attendant Federal Register, the Final Rule was to become effective on June 25, 2024.¹ In so doing, HHS was complying with President Biden's Executive Order 14076 the sole focus of which was "Securing Access to Reproductive and Other Healthcare Services."² The newly (announced Final Rule bolsters the Health Insurance Portability and Accountability Act of 1996 [HIPAA; Public Law No: 104-191) which "provides penalties" for "wrongful disclosure of individually identifiable health information."¹ Among its leading objectives, the Final Rule seeks to protect women who cross state lines in search of an abortion.¹ Data reported by the Guttmacher Institute suggest that nearly one in five abortion patients sought out-of-state care during the first 6 months of 2023, a two-fold increase when compared with the same period in 2020.³ The Final Rule also protects those who provide or facilitate lawful reproductive health care who might otherwise be targeted by state prosecutors with criminal probes or lawsuits in mind.¹ The administration and enforcement of the newly issued Final Rule will be the designated responsibility of the OCR.¹ In a clear reference to Dobbs v. Jackson Women's Health Organization, HHS Secretary Xavier Becerra made note of the reality that "with reproductive health under attack by some lawmakers, these protections are more important than ever."⁴ It is the objective of this Commentary to review the multiple facets of the reproductive privacy imperative and the projected oversight thereof.

Background: Autoimmune diseases disproportionately impact women, and pregnancy-related events could play an underlying role. We summarized literature on the association between pregnancy complications and future risk of autoimmune disease. Materials and Methods: We systematically searched Medline, EMBASE, CINAHL Plus, and Web of Science from database inception to January 2024 for observational studies that reported on history of pregnancy complications (exposure), risk of newly diagnosed autoimmune disease (outcome), and included a comparison group of unaffected women. Two reviewers independently assessed study eligibility, extracted data, and rated risk of bias. We estimated pooled risk ratios (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) for pregnancy complications with ≥3 identified studies using DerSimonian and Laird random effects models and otherwise summarized findings following synthesis without meta-analysis (SWiM). Results: We screened 7,763 citations and included 25 studies (12 cohort, 13 case-control). Most studies were from Denmark (n = 10) or the United Kingdom (n = 5), with sample sizes ranging from 138 to >1.5 million women (median = 1,304 women). Risk of bias was moderate, serious, and critical in 10, 13, and 2 studies, respectively, with quality adversely impacted by potential unmeasured confounding. Meta-analyses indicated an elevated risk of autoimmune disease following preeclampsia (adjusted RR: 1.61, 95% CI: 0.98-2.65, I² = 90.0%) and small fetal/infant size (adjusted OR: 2.02, 95% CI: 1.16-3.52, I² = 28.4%), and possibly spontaneous pregnancy loss (adjusted RR: 1.58, 95% CI: 0.66-3.79, I² = 99.4%) and stillbirth (adjusted RR: 2.18, 95% CI: 0.65-7.34, I² = 99.2%), although estimates were often imprecise. SWiM findings generally supported a positive association between pregnancy complications and autoimmune disease; there were insufficient studies for gestational diabetes, placental disorders, and preterm birth. Conclusions: History of certain pregnancy complications may be a novel risk factor for autoimmune disease in women. Additional high-quality research with geographically diverse data sources would be valuable.

Objective: Physical activity (PA) and pain are bidirectionally related during pregnancy. There are limited data on how prenatal changes in PA relate to labor and postpartum pain. The current study examined associations between PA change from the second to third trimester (increasing vs. decreasing) with (1) labor pain, (2) postpartum hospitalization pain, and (3) the likelihood of increasing versus decreasing PA at 6-months postpartum (relative to the third trimester). Methods: A sample of pregnant people with overweight/obesity were enrolled in a longitudinal study between 12- and 20-weeks' gestation (n = 257). A subsample, with at least three pain ratings documented (n = 233), were included in the current analysis. PA change was characterized with the Paffenbarger. Pain was assessed regularly during labor and postpartum hospitalization from 0 (no pain) to 10 (most pain). Labor and postpartum pain were summarized using minimum/maximum pain ratings, percent improvement in pain following analgesia, and overall pain burden. t-Tests compared pain between the PA groups, and chi-square analyses examined the likelihood of increasing versus decreasing PA at 6-months postpartum. Results: The increasing PA group (n = 52; 22%) reported lower minimum pain scores (d = 0.46) during postpartum hospitalization. Most individuals with decreasing PA between trimesters two and three reported increasing PA at 6-months postpartum. Conclusion: Relative to individuals with decreasing PA, individuals with increasing PA experienced less pain during postpartum hospitalization highlighting potential benefits of prenatal PA for postpartum recovery.

Background: The transition from obstetric to primary care is often suboptimal, particularly for individuals with barriers to accessing care. We aimed to understand experiences of primary care clinicians regarding provision of care and their perceptions of barriers to the transition of care in this critical period. Methods: We conducted focus groups with primary care clinicians recruited from diverse, urban health care settings, including an academic medical center, private practice, and federally qualified health centers. Groups were conducted in person or virtually (December 2019 to February 2021) using a semi-structured approach. Data were analyzed using the constant comparative method to identify themes regarding barriers to providing primary care to postpartum individuals. Results: The study included 28 primary care clinicians (26 physicians and two advanced practice providers) who participated in eight focus groups. Clinicians identified multiple barriers to the successful transition from obstetric to primary care in the postpartum period. Clinician-based barriers included the lack of a clear hand-off from the obstetric care team and limited capacity to adequately address social determinants of health. Clinician perceptions of patient-based barriers included adverse social determinants of health such as lack of childcare and financial and transportation limitations, challenges addressing ongoing health needs (such as persistence of postpartum medical conditions), and limited health care engagement. Conclusions: Our results illustrate multiple complex and interrelated challenges to providing optimal primary care during and after the postpartum period that are related to a fragmented health care system, suboptimal support for complex social needs, and insufficient communication between obstetric and primary care clinicians.