Journal of women's health最新文献

Background: Women who experience violence from an intimate partner are at risk of experiencing lower levels of reproductive autonomy. Among Arab American women, cases of intimate partner violence may also involve other family members, including in-laws or natal family, a phenomenon also known as family violence. This study examined the role of family violence on reproductive autonomy among Arab American women. Methods: Data were collected from a convenience sample (N = 99) of self-identified Arab American women between 18 and 65 years in Dearborn, Michigan, through a cross-sectional survey of self-reported experiences with family violence and reproductive autonomy. Analyses included univariate statistics on sociodemographic characteristics and prevalence of family violence, a psychometric analysis of a multidimensional scale of reproductive autonomy, and adjusted linear regressions to assess how sociodemographic characteristics and family violence were associated with reproductive autonomy. Results: Nearly 60% of the sample had ever experienced family violence. Among women who had ever had sex (N = 74), higher educational attainment was positively associated with communication and freedom from coercion, and receipt of public assistance was negatively associated with communication. Several types of family violence were negatively associated with the communication and freedom from coercion subscales from the reproductive autonomy measure. Conclusion: This study demonstrated that sociodemographic factors and family violence are both associated with reproductive autonomy among Arab American women. More research is needed to address family violence and reproductive autonomy in this community and examine how these experiences shape the reproductive health of Arab American women.

Objective: Vulvodynia is a condition characterized by chronic pain and discomfort in the vulvar region often accompanied with physical and psychological comorbidities. Interstitial cystitis (IC)/bladder pain syndrome (BPS), a chronic condition characterized by bladder pain and urinary urgency, has repeatedly been shown to comorbidly be present in a large proportion of women with vulvodynia. However, recent studies have shown that women with vulvodynia experienced additional bladder-related symptoms beyond that of just IC/BPS. Materials and Methods: Using Swedish National Registry data, we assessed the association between urological symptoms in the presence and absence of IC/BPS in women with vulvodynia/vaginismus relative to women with no vulvar pain history. Results: After adjustment for birth year, parity, education, and residential location, women with vulvar pain had a 2.2-fold greater risk of cystitis or urethritis as expected (95% confidence interval [CI] 1.9-2.6). However, when women with cystitis codes were excluded, those with urethra disorders or other urinary symptoms codes were 1.9 times more likely to be vulvar pain cases (95% CI 1.7-2.1). Conclusions: These findings support the belief that vulvodynia is not limited to being comorbid with IC/BPS but may also likely be associated with a wide range of urological disorders.

Aims: We aimed to identify changes in United States practice patterns in gestational diabetes mellitus (GDM) diagnosis and treatment following publication of the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study that supported transition toward a 2-hour oral glucose tolerance test. Methods: A total of 1,030 U.S. obstetric providers were surveyed in 2021 about GDM screening, diagnosis, and treatment, as well as perceptions surrounding preparation for the 1-hour, 50-g glucose loading test (GLT). Data were compared with data from a similar 2003 survey. The study was reviewed by the Institutional Review Board at Stanford University and was determined to be exempt. Results: Of 1,030 providers surveyed, 304 (30%) responded. Most respondents continued using the two-step screening method (95.0% versus 95.2% in 2003, p = 0.18). Fewer providers used insulin as a first-line medication (64.1% in 2021 versus 82.3% in 2003, p < 0.001). However, providers practicing for 0-10 years often used insulin as first-line compared with providers practicing for over 10 years (79% versus 55%, p < 0.001). Of 2021 respondents, 39.3% believed that fasting before the 1-hour GLT lowers the glucose result, 34.3% believed it increases the result, and 26.4% believed it would have no effect. Conclusions: Despite data from the HAPO trial, the majority of providers surveyed still use the two-step method for GDM screening. There is wide variability in perceptions and counseling regarding preparation for the 1-hour GLT.

Objective: Utilization of fertility preservation treatments has increased since the American Society for Reproductive Medicine lifted the "experimental" label for oocyte cryopreservation in 2012. This study characterizes changes in insurance coverage, clinical outcomes, and live birth probabilities over a span of a decade (2012-2022) in patients who underwent planned oocyte cryopreservation. Methods: Retrospective analysis of planned oocyte cryopreservation cycles using vitrification from 2012 to 2022. Medically indicated cycles were excluded. Age, anti-mullerian hormone (AMH), number of mature oocytes vitrified, and insurance coverage were evaluated by year of procedure. Comparative statistics were performed using Kruskal-Wallis and chi-square analysis. Linear regression models and Cochran-Armitage trend test were performed to determine the relationships between each variable and time. Result(s): A total of 4,544 planned oocyte cryopreservation cycles were included. Mean age at egg retrieval decreased significantly over time (37.9 ± 2.9 years versus 34.9 ± 3.3, p < 0.0001). Mature oocytes frozen per cycle rose significantly over time (10.7 ± 7.4 in 2012 versus 13.3 ± 8.6 in 2022, p ≤ 0.0001). Cycles with insurance coverage significantly increased, 0% covered in 2012 versus 46.9% covered in 2022 (p ≤ 0.0001). Conclusions: Since 2012, patient age at time of egg freezing has decreased, coinciding with a mean increase in AMH and number of mature oocytes frozen per cycle. Younger participation in extending fertility is likely driven by a boost in social awareness regarding reproductive aging, cryopreservation technologies, and improved access to treatment. Modern oocyte cryopreservation includes more access to insurance coverage, shown by nearly half of current cycles benefiting from plan support. Shifts in patient demographics and insurance coverage, paired with updates to stimulation protocols that optimize oocyte yield, are expected to improve the overall prognosis and future fertility of patients who utilize thawed oocytes.

Objective: This study aims to identify whether there are inequities in care for pregnant individuals with mental health or substance use disorders (MH/SUDs) seeking treatment in emergency departments (EDs) for pregnancy-related concerns. Considering their risk for poor maternal and infant outcomes, we sought to examine their experiences in EDs to target future interventions and institute referrals to integrated care systems. Methods: This retrospective, exploratory analysis identified ED visits for pregnancy-related concerns using the National Hospital Ambulatory Medical Care Survey database from 2016 to 2020 (n = 1,233) to compare experiences of care by pregnant people with (n = 149) and without MH/SUD (n = 1,084). Results: 11.9% (95% confidence interval [CI]: 9.8 - 15.1%) of ED visits for pregnancy-related concerns were cross-coded for MH/SUD. Compared to visits by pregnant individuals without MH/SUD, visits by pregnant people with MH/SUD were 70% less likely to be asked to return to the ED for follow-up treatment (p = 0.027), had 3.8 times greater odds of leaving the ED prior to completing care (p = 0.005), and received 40% more medication upon discharge (p = 0.049) after controlling for demographic variables. Of those visits by pregnant people with MH/SUD, only 6.8% were given a toxicology screen and only 1.2% were seen by an MH provider. Conclusion: This nationally representative analysis of ED visits for pregnancy-related concerns identified multiple opportunities to address care inequities that affect health outcomes. Special training and processes are needed within EDs to engage pregnant people with MH/SUD to provide effective, evidence-based care interventions and referrals.

Background: The Female Athlete Triad is the connection between energy deficiency with or without an eating disorder, menstrual disturbances, and bone loss that is found in female athletes. Affected women can have significant short- and long-term health consequences, such as decreased athletic performance, infertility, and osteoporosis. These sequelae can be minimized with early intervention, which requires both an understanding of the Female Athlete Triad and screening practices. Athletic trainers (ATs) are an important part of the athlete's care team with frequent interactions with patients. This cross-sectional study investigates the understanding and screening of the Female Athlete Triad in ATs. Materials and Methods: A cross-sectional survey was developed to assess certified athletic trainers' demographics, knowledge, and screening practices regarding the female athlete triad. Survey content was based on the 2007 ACSM position stand, the 2014 Female Athlete Triad Coalition consensus statement, and prior studies evaluating awareness among coaches. Knowledge was assessed using a 7-point Likert scale, and screening practices were assessed using a 5-point Likert scale. The survey was distributed via email to certified members of the National Athletic Trainers' Association (NATA). Participation was voluntary. IRB exemption was granted by both NATA and Daemen University. Results: One hundred and sixteen ATs with varying gender, practice setting, and years of experience completed this study's survey assessing knowledge of the Female Athlete Triad and subsequent screening practices. ATs showed limited knowledge of the Female Athlete Triad and were rarely screened for it. Female trainers, those who worked with majority female athletes, and Division 1 trainers had better knowledge of the Female Athlete Triad compared with their respective counterparts. Years of experience did not significantly impact knowledge scores. Practice setting and years of experience did significantly impact screening scores. High school trainers and those with <10 years of experience also had the best screening scores. Conclusions: Female ATs, those who worked with female athletes, and trainers who took care of higher-level athletes demonstrated superior understanding of the Female Athlete Triad. Improved awareness, training, and more frequent, focused screening should be implemented for ATs to bridge remaining gaps.

Background: This article aims to characterize midpregnancy food timing profiles and examine their association with gestational weight gain (GWG). Materials and Methods: This secondary data analysis of a randomized controlled trial of two gestational diabetes screening approaches included 641 individuals with primary exposures and outcomes data. Food timing indicators (i.e., first and last eating episode time, caloric midpoint time, and the total eating window) were assessed using two 24-hour dietary recalls conducted in midpregnancy. Latent profile analysis was used to identify distinct food timing profiles based on these indicators. Regression analyses explored the associations between individual food intake timing indicators, food timing profiles, and GWG. Results: We identified four food timing profiles: extended window eating (n = 133; earliest first eating episode and the longest eating window), restricted window eating (n = 120; latest first eating episode and shortest eating window), early eating (n = 188; earliest caloric midpoint), and typical eating (n = 200; food intake aligning with the sample median). Participants with a restricted window eating profile (vs. typical eating profile) had an increased risk of insufficient GWG (unadjusted relative risk [RR] = 1.85, 95% confidence interval [CI] 1.12, 3.05). Each hour increase in the timing of the last eating episode was associated with 0.39 kg (0.03, 0.75) higher GWG. Both associations were attenuated in adjusted models and no longer statistically significant in adjusted models. Conclusions: We identified four distinct midpregnancy food timing profiles, but these profiles were not independently associated with GWG. These findings suggest that midpregnancy food timing may not play a major role in GWG.