Journal of women's health最新文献

Purpose: To evaluate how migraine impacts the risk for postpartum depression (PPD) in women of reproductive age as well as the effect of comorbidities on this risk. Methods: This is a retrospective observational study in a tertiary neurology center involving 6248 women with migraine and 4154 women without migraine between the ages of 18 and 45 seen from January 1, 2017, to January 30, 2024. The primary outcome was the odds ratio (OR) for PPD in migraine relative to women without migraine. Secondary outcomes included the OR for PPD in women with chronic migraine who also had comorbidities. Results: After adjusting for demographic factors and comorbid conditions, only chronic migraine, with and without aura, was associated with higher OR for PPD; chronic migraine without aura had the highest risk for PPD (OR: 2.13; 95% CI: 1.29 to 3.53, p = 0.003). In patients with chronic migraine, preeclampsia was associated with the largest OR for PPD, followed by depression, gestational diabetes, and premenstrual dysphoric disorder. Anxiety, advanced maternal age, endometriosis, and post-traumatic stress disorder were not associated with a statistically significant increase in OR for PPD. Conclusions: Chronic migraine, with and without aura, is associated with a higher OR for PPD relative to non-migraine controls. Patients with chronic migraine, preeclampsia, depression, gestational diabetes, and premenstrual dysphoric disorder were also associated with increased risk of PPD. These data support screening patients with both chronic migraine and these comorbidities for PPD with validated screening tools to connect them with optimal resources best.

Objective: To assess whether state-level legislation mandating insurance coverage for medical fertility preservation (MFP) was associated with a change in the neighborhood disadvantage of individuals accessing fertility preservation care. Methods: This is a retrospective cohort study of individuals with ovaries seen for MFP consultation from 2017 to 2020 at a large academic medical center. Neighborhood disadvantage, as measured by median area deprivation index (ADI) in those who had MFP consultation and initiated ovarian stimulation for MFP was assessed; insurance type and other demographics were also assessed. Patients who underwent ovarian stimulation in 2017-2018 (pre-legislation) were compared to those who underwent stimulation between 2019 and 2021 (post-legislation). Results: Overall, 427 individuals with ovaries were seen for MFP consultation from 2017 to 2020; 203 of which were seen prior to legislation mandating insurance coverage (2017-2018), and 224 were seen following expansion of legislation (2019-2020). Overall, 278 individuals initiated ovarian stimulation cycles for MFP, 122 pre-legislation and 156 post-legislation. More patients with Medicaid insurance coverage were seen for MFP consultation and initiated stimulation post-legislation than pre-legislation (28 versus 12 for consultation, p = 0.020; 17 versus 3 for stimulation, p = 0.007). The predicted median ADI of patients initiating stimulation was 8 points higher post-legislation, representing increased neighborhood disadvantage, though this difference did not reach statistical significance (p = 0.053). After adjusting for other sociodemographic factors, the predicted median ADI of patients initiating stimulation was 3.5 points higher post-legislation (p = 0.25). Conclusions: While the implementation of an insurance mandate for MFP increased the median ADI of those initiating stimulation, this difference was not statistically significant. Legislation alone may not be enough to expand access to care to those living in the most disadvantaged areas.

Background: Despite universal coverage of all highly effective contraceptive (HEC) methods in the Military Health System (MHS), active duty service women (ADSW) have higher rates of unintended pregnancy and lower rates of HEC use than the general U.S. population. Between 2016 and 2019, racial minority and lower socioeconomic status (SES) ADSW demonstrated lower odds of HEC use. This study further investigated factors associated with HEC use among ADSW to assess their reproductive health needs. Methods: We conducted a cross-sectional study using fiscal year 2020-2023 data from the MHS Data Repository for all ADSW aged 18-45 years. Statistical analyses included descriptive statistics and logistic regression models, adjusted and unadjusted, determining the odds of HEC use overall, by method, and by social characteristics, including race and military rank as a proxy for SES. Results: Of the 339,011 ADSW identified, 164,756 (48.6%) used at least one HEC method during the study period. Black (odds ratio [OR] = 0.89; 95% confidence interval [CI] = 0.88-0.91) and Asian/Pacific Islander (OR = 0.88; 95% CI = 0.78-0.82) ADSW demonstrated lower odds of overall HEC use than White ADSW. Junior Enlisted ADSW demonstrated lower odds of overall HEC use than nearly all other ranks. Conclusions: The proportion of ADSW using HEC methods has decreased since 2019, while HEC use in the general population has increased. Racial and socioeconomic disparities remain, highlighting the need for future research to investigate reasons for these disparities in order to design effective mitigation strategies to ensure access to contraceptive care for all ADSW.

Background: Urinary tract infections (UTIs) occur in 10-18% of United States pregnancies and may lead to maternal and neonatal complications. We examined differences in the incidence and treatment of UTI during pregnancy by race and ethnicity. Methods: We conducted a cohort study within an integrated health care system, including members aged 15-49 years with live births, stillbirths, spontaneous abortions, or terminations between January 2011 and August 2023. Self-reported race and ethnicity were documented in the electronic health record (EHR). UTIs were defined from diagnosis, medication, and laboratory data. We used modified poisson regression to estimate the cumulative incidence and adjusted risk ratios ([aRR]; with non-Hispanic [NH] White individuals as a reference) of the first UTI per pregnancy, adjusted for maternal age. Results: Among 63,029 pregnancies across eight racial and ethnic categories, 5,083 (8.1%) individuals experienced UTI during pregnancy. Cohort mean maternal age was 30.4 years and 75.9% of birth outcomes were live or stillbirths. UTI risk ranged from 7.2% among NH White individuals to 14.3% among NH Native Hawaiian/Pacific Islander [NHPI] individuals. Compared to NH White individuals, UTI risk was elevated among NH NHPI (aRR 1.80, 95% confidence interval [CI] 1.50-2.15), NH Black (aRR 1.32, 95% CI 1.19-1.46), NH Asian (aRR 1.13, 95% CI 1.04-1.24), and Hispanic (aRR 1.45, 95% CI 1.32-1.59) individuals. We observed no differences in UTI treatment by race or ethnicity. Conclusion: UTI burden during pregnancy is greater among racially minoritized groups, suggesting a need for more focus on upstream risk factors, screening, and alleviating the influence of structural racism on infection risk.

Background: Hepatitis C virus (HCV) infection affects between 1% and 2.5% of pregnant people in the United States and has maternal and fetal sequelae. Direct-acting antivirals are a highly effective curative strategy for HCV, yet data on their use in pregnancy are limited. Thus, family planning counseling of pregnancy-capable people seeking treatment for HCV is imperative. We aimed to examine whether and how pregnancy-capable people with HCV received family planning counseling from their clinicians during their treatment of HCV. Methods: This retrospective cohort study included all female patients between 18 and 50 years of age with HCV who sought care at a large, multihospital medical system between 2016 and 2020. Outcomes included whether patients who sought care for HCV received family planning or preconception counseling and the type of counseling they received. Analysis was conducted using descriptive statistics. Results: In this analysis of 194 people meeting inclusion criteria, 146 sought treatment for HCV, of whom 16 were currently pregnant. Of those seeking treatment, 24% discussed the uncertainty of treatment safety during pregnancy with their clinician, 23% received contraceptive counseling, 7% received preconception counseling, and 10% discussed family planning goals. Of the participants who were pregnant, 74% discussed the risks of treatment during pregnancy, and 67% had a postpartum treatment plan. Conclusions: In this cohort of pregnancy-capable people with HCV, patients infrequently received counseling about reproductive planning before or during their HCV treatment. Although most patients who were pregnant received counseling on treatment recommendations, few were referred to maternal-fetal medicine subspecialists.

Background: Multimorbidity affects approximately 1 in 3 adults and is associated with adverse health outcomes. However, there is a paucity of information describing patterns of multimorbidity among the birthing population. The objective of this study was to describe the clustering of pre-pregnancy chronic conditions in the birthing population by age, race and ethnicity, insurance status, and parity using latent class analysis (LCA). Study design: We conducted a retrospective cohort study of deliveries using medical record data between 2015 and 2019. Multimorbidity was defined as having at least two chronic conditions before the start of the index pregnancy, using adapted versions of obstetric comorbidity indices. The final LCA model was selected based on clinical interpretability and statistical fit. We also compared the distribution of sociodemographic factors across classes. Results: Of 6,455 deliveries, 1,870 (29%) deliveries were to patients with multimorbidity. LCA resulted in a 3-class model: Class 1 (45% of individuals with multimorbidity) was characterized by mood/anxiety and substance use disorders; class 2 (39%) was defined by body mass index ≥30 kg/m² and chronic hypertension; and class 3 (16%) was characterized by reproductive conditions and infertility. Individuals who were <25 years or non-Hispanic White were more frequently in class 1; individuals who were ≥35 years or non-Hispanic Black were disproportionately in class 2. Nulliparas and individuals with private insurance were more frequently in class 3. Conclusion: Multimorbidity is prevalent in pregnancy and distinct chronic condition clusters vary across sociodemographic sub-groups, demonstrating the need for integrative approaches to periconceptional care for birthing individuals with multimorbidity.

Background: The opioid overdose crisis remains a public health concern, and rates of suicide with opioid involvement have increased. Objective: To describe the prevalence of and factors associated with self-reported past 30-day suicide attempt or attempt "only when high or in withdrawal from alcohol or drugs" among reproductive-age women with past 30-day nonmedical prescription opioid use. Methods: Estimates are reported among women 18-55 years from 338 locations in 35 states using 2018-2020 National Addictions Vigilance Intervention and Prevention Program data. Bivariate analysis and multinomial logistic regression identified prevalence of and factors associated with past 30-day suicide attempt and attempt "only when high or in withdrawal from alcohol or drugs." Results: Among 10,095 women, 2.7% reported a past 30-day suicide attempt, and 1.5% reported an attempt "only when high or in withdrawal from alcohol or drugs." The largest magnitude of association for suicide attempt was extreme alcohol problem (adjusted odds ratio [aOR] = 2.84, 95% confidence interval [CI]: 1.80-4.47), and the largest magnitude of association for attempt "only when high or in withdrawal from alcohol or drugs" was no stable living arrangement (aOR = 2.66, 95% CI: 1.78-3.98). Conclusion: Comprehensive, upstream suicide prevention initiatives and substance use treatment can address factors associated with suicide attempt among reproductive-age women.