Journal of women's health最新文献

Background: Ovarian aging, often leads to increased use of a donor oocyte, which is associated with greater risk for age-related diseases. Objective: To evaluate the association between women conceiving through oocyte donation (OD) and future cancer-related morbidity, as compared with women conceiving through IVF (in vitro fertilization) with autologous oocytes (AO), spontaneous conceptions (SC), and nulliparas. Methods: This retrospective, cohort study was based on the electronic health records of a very large health maintenance organization. The cohort included mothers who delivered before age 45, during 2000-2019. The index date for surveillance was the delivery date of the relevant pregnancy. Each woman from the OD group was matched to a woman the same age at delivery and with the same number of children. Cancer diagnosis was the main outcome. Results: Matching: 664 OD cases to 664 AO, 700 OD cases to 700 SC, and 700 OD cases to 700 nulliparas. Mean follow-up times were 8.9 ± 3.8 OD, 10 ± 4.1 AO, and 6.4 ± 4.1 years SC. Cancer-related morbidity rates were comparable between OD and the other groups, but compared with nulliparas, a trend was noted (1.6% and 3.1%, respectively, p = 0.07). Survival analysis curves were not significantly different, although a trend was shown in the curve comparing to nulliparity (p = 0.07). In a Cox regression model corrected for BMI, smoking and hormone replacement therapy exposure, cancer in the OD group did not differ compared to the other groups. Conclusion: Women conceiving through OD do not have increased risk for cancer-related morbidity in the decade following delivery.

Purpose: To determine if socioeconomic, demographic, and clinical characteristics are associated with postpartum readmission. Methods: A retrospective cohort study evaluating all pregnant patients that delivered at seven hospitals within a large academic health system in New York between January 1, 2018 and March 1, 2020. Demographic information, medical comorbidities, and characteristics of antepartum, intrapartum, and postpartum care were compared between patients who were readmitted within 6 weeks postpartum and those who were not. Postpartum patients who presented to the emergency department but remained less than 23 hours were excluded. Patient ZIP codes were linked to data from the United States Census Bureau's American Community Survey and used as a proxy for neighborhood socioeconomic status. Mixed effects logistic regression was used to evaluate factors associated with an increased risk of postpartum readmission while adjusting for potential confounders. Results: A total of 57,507 delivery hospitalizations were evaluated, and 1,481 (2.5%) patients were readmitted. Black race (aOR: 1.56, 95% CI: 1.30-1.86, p < 0.001) and public health insurance (aOR: 1.19, 95% CI: 1.05-1.35, p = 0.007) were associated with an increased likelihood of postpartum readmission. Chronic hypertension (aOR: 2.83, 95% CI: 2.33-3.44, p < 0.001), body mass index >25 kg/m² (aOR: 1.22, 95% CI: 1.05-1.42, p = 0.01), gestational weight gain >40 lb (aOR: 1.19, 95% CI: 1.01-1.40, p = 0.04), and administration of blood products (aOR: 2.18, 95% CI: 1.68-2.82, p < 0.001) were associated with an increased odd of readmission. Neighborhood characteristics were not associated with postpartum readmission. Conclusion: Efforts to reduce postpartum readmissions should focus on high-risk populations. Specific sociodemographic and clinical characteristics are associated with this complication.

Objective: Reproductive coercion has been associated with adverse reproductive health experiences. This study examined the relationship between nonuse of contraception due to partner objection, one aspect of reproductive coercion, and selected pregnancy-related outcomes. Methods: We used 2016-2020 data from the Pregnancy Risk Assessment Monitoring System in 22 jurisdictions to assess the prevalence of nonuse of contraception due to a partner objection by select characteristics among individuals with a recent live birth who reported an unintended pregnancy. We calculated adjusted prevalence ratios (aPRs) to understand associations with health care utilization, postpartum behaviors and experiences, postpartum contraceptive use, and infant birth outcomes. Results: Among people with a recent live birth in the study jurisdictions (n = 29,071), approximately 5% reported nonuse of contraception due to a partner objection and unintended pregnancy. This experience was associated with lower prevalence of attending a health care visit before pregnancy (aPR 0.8, 95% confidence interval [CI] 0.7-0.9), first trimester prenatal care, and attending a postpartum checkup (aPR 0.7, 95% CI 0.6-0.9 for both). Higher prevalence was observed for postpartum depressive symptoms (aPR 1.3, 95% CI 1.1-1.6) and partner objecting to using birth control postpartum (aPR 2.8, 95% CI 2.1-3.9). Conclusions: Nonuse of contraception due to a partner objection at conception was associated with poor mental health and lower health care utilization around the time of pregnancy. Prevention efforts may include strategies that ensure provider screening for intimate partner violence, and evidence-based approaches that teach about healthy relationships, enhance self-efficacy, and address underlying drivers of violence.

Cardiovascular disease (CVD) is the leading cause of death among Black women. When compared with their non-Hispanic White counterparts, Black women are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review examined the updated literature on the efficacy of primary prevention self-management interventions for Black women with CVD risk factors. Searches were run on PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases based on the following inclusion criteria: papers published from September 22, 2018; English language; U.S. studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices for primary prevention; comorbid conditions without a cardiovascular event; at least one patient-level outcome; and Black women at least 18 years of age. Twelve papers met the inclusion criteria. Health practices targeted included physical activity, nutrition, weight loss, health knowledge, and BP control. Nine of the 12 papers reported statistically significant improvements on at least one CVD risk factor including weight loss, physical activity, BP control, waist circumference, and depression. Culturally tailored self-management interventions appear to be feasible with weak to moderately high evidence of efficacy for reducing CVD risk factors in Black women. Further research should focus on the influence that social determinants of health, including mental health, may have on self-management and CVD risk in this population.

Objective: To examine publication trends pertaining to fertility-sparing management in patients of reproductive age with gynecological malignancies. Methods: Ovid MEDLINE was used to aggregate all publications on gynecological cancers and fertility between 1946 and 2022. Original research, reviews, case series/reports, and editorials were included. Publication information was extracted from Ovid MEDLINE. Individual authors' subspecialty credentials were individually reviewed and confirmed. Descriptive statistics were generated. Results: The initial query generated 2,057 publications. Of these, 1,057 (51.4%) publications met search criteria, with the first study being published in 1991 and with 16.6% published in the last 2 years. Only 34 (5.5%) studies were published with collaboration between reproductive endocrinology and infertility (REI) and gynecological oncology physicians in the United States. Gynecological oncologists comprised most senior authors (50.9%), followed by REI specialists (18.6%). Topics of the publications centered on fertility-sparing surgical management (43.1%), medical management of gynecological malignancies (11.3%), and oocyte/ovarian tissue preservation (6.0%). Most publications focused on ovarian malignancies (349, 33.3%), followed by cervical cancer (299, 28.5%), and uterine/endometrial cancer (258, 24.6%). While the number of publications regarding fertility-sparing management has increased over the last 30 years, the majority are retrospective studies and case reports/series. In the last 10 years, only five studies were randomized controlled trials. Conclusions: There is an urgent need for more prospective research in oncofertility. While fertility care in the setting of gynecological cancer is a collaborative effort between the specialties of gynecological oncology and REI, this partnership is not reflected in the authorship of current literature.

Objective: Failure to "make weight" carries significant consequences for military personnel including additional training burdens, stigma, possible demotion, or even separation from service. The aim of this study was to examine potential gender differences in, and investigate relationships between, military making weight behavior and obesity, eating pathology, and mental health later in life. Method: Iraq and Afghanistan war era Veterans (N = 1,126, 51.8% women) completed the Making Weight Inventory (MWI), a measure of making weight behaviors engaged in during military service, and validated measures of eating behavior and mental health. Analyses compared participants who engaged in at least one making weight behavior (MWI+) versus those who did not (MWI-). Results: Overall, 41% (n = 462) of the sample was categorized as MWI+. The most frequently endorsed making weight behavior was excessive exercise (35.7%). Among those who were MWI+, there was a significantly greater proportion of women (58.2% versus 47.3%, p < 0.001). The MWI+ group had higher rates of obesity (52.4% versus 26.2%) and had significantly higher levels of dietary restraint, emotional eating, food addiction, depression, anxiety, and posttraumatic stress disorder than the MWI- group (p's < 0.001). Conclusions: Military making weight behavior was associated with female gender, higher weight, eating pathology, and mental health later in life. Collectively, these findings suggest these factors may place female service members at a disadvantage for career advancement and salary. Efforts to better understand and address extreme making weight efforts in military populations, particularly in female service members and Veterans, are warranted.

Introduction: Postpartum acute care utilization (PACU), including visits to an emergency department, obstetric triage, or urgent care ("outpatient"), and hospital readmissions, may indicate medical complications and signal unmet health needs. Methods: We estimated the incidence of PACU and examined patterns by sociodemographic factors, pregnancy and birth characteristics, time since discharge from the birth hospitalization, and medical indications. We constructed a retrospective cohort of people aged ≥18 years who delivered ≥1 liveborn infant >20 weeks of gestation from July 1, 2021, to December 31, 2022, using electronic health record data from a quaternary maternity hospital in the Southeastern United States PACU data throughout the health care system were collected through March 31, 2023. We excluded people with a hospital stay >6 days (n = 29). Results: In this cohort of 6,041 birthing people, 11.3% had ≥1 outpatient encounters (range 0-6) and 3.2% had ≥1 hospital readmissions (range 0-4) within 12 weeks of discharge from the birth hospitalization. Median time to first outpatient PACU was 10 days post-discharge and 6 days for first hospital readmission. Among encounters for the top five medical indications, time to first postpartum acute care encounter varied by medical indication (log-rank test of equality over strata Chi-square = 69.93, degrees of freedom = 4, p < 0.0001). Complications specified during the puerperium (n = 234) and hypertension and hypertensive-related conditions complicating the puerperium (n = 87) were the two most frequent indications. Conclusion: These findings can inform efforts to direct health resources to improve postpartum health care and health outcomes.

Background: Migraine prevalence has been estimated to be as high as 25% during reproductive years. Despite this, and the known significantly lower odds of acute stroke being correctly diagnosed among women versus men, little is known about the migraine-stroke connection in this vulnerable population. Our study seeks to provide a consolidated examination of cerebrovascular and obstetric complications of migraines in pregnant women and to evaluate the role of concurrent comorbidities. Methods: We utilized the 2016-2020 Healthcare Cost and Utilization Project's National Inpatient Sample with the International Classification of Diseases, 10th Revision diagnostic codes to compare pregnant patients with migraines with those without migraines. Multivariable logistic regression was used to examine the incidence of subtypes of stroke while controlling for confounding variables. Results: Overall, 19,825,525 pregnant patients were evaluated; 219,175 (1.1%) had a concomitant diagnosis of migraine. Pregnant patients with migraines were more likely to suffer ischemic (0.1% versus 0.0%) or hemorrhagic stroke (0.3% versus 0.1%). On multivariate analysis, acute ischemic stroke was most strongly associated with migraine with aura (odds ratio [OR], 23.26; 95% confidence interval [CI], 18.46-29.31), followed by migraine without aura (OR, 8.15; 95% CI, 4.79-13.88). Conclusions: Pregnant women with migraine are at a significantly increased risk for both ischemic and hemorrhagic stroke. Pregnant women with migraines should be cautioned that they may be at an increased risk of stroke, particularly if they are experiencing an aura, and encouraged to contact their medical providers to rule out neurological complications.