Journal of women's health最新文献

Background: People diagnosed with pelvic organ prolapse (POP) face preference-sensitive treatment decisions. We conducted a systematic review, meta-analysis, and narrative synthesis to determine the effect of decision-making interventions for prolapse on patient-reported outcomes. To gain a more complete understanding of all potentially accessed resources, we also conducted an environmental scan to determine the quantity and quality of online interventions for prolapse decision-making. Methods: We searched Ovid MEDLINE, Cochrane Trials, and Scopus from inception to August 2022, trial registries, and reference lists of included articles. For the systematic review, we included studies that compared a decision-making intervention to usual care among patients with prolapse. We calculated mean difference (MD), 95% confidence intervals (CIs), and statistical heterogeneity (I²). For the environmental scan, we also searched Google, app stores, and clinical society websites. We assessed intervention quality using DISCERN, the International Patient Decision Aid Standards checklist, and readability metrics. Results: We identified eight publications in the systematic review, including 512 patients across three countries. The average patient age was 60. In the meta-analysis and narrative synthesis, there were no differences in decisional conflict (MD 0.09, 95% CI: -2.91, 3.09; I² = 0%), decision regret (MD 0.00, 95% CI: -0.22, 0.22; I² = 0%), satisfaction (MD -0.10, 95% CI: -0.23, 0.03; I² = 0%), knowledge, or shared decision-making. Study quality was low to moderate. We included 32 interventions in the environmental scan analysis. Most (22/32) were not interactive. Overall quality was low with a mean DISCERN of 48.2/80, and the mean reading grade level was 10.0. Conclusions: Existing decision-making interventions for prolapse did not improve patient-reported outcomes, and interventions were not tested in younger populations. The quality of online interventions is generally low with poor readability. Future research should address these gaps through the user-centered design of digital interventions with younger patients.

Background: Research on the association between age at menarche and menopause, reproductive lifespan, and the risk of obesity in China is unclear and requires further clarification. Materials and Methods: Data were obtained from the China Hypertension Survey, a cross-sectional study using a stratified multistage random sampling method, conducted from October 2012 to December 2016, with a total of 187,162 women included in the analysis. Logistic regression models and restricted cubic spines were used to estimate the relationship between obesity and age at menarche, age at menopause, and reproductive lifespan. Results: The mean (standard deviation) age at menarche and menopause, and reproductive lifespan were 15.5 (1.8), 48.7 (3.5), and 33.2 (3.9) years, respectively. Age at menarche was negatively related to the risk of obesity (odds ratio [OR]: 0.968; 95% confidence interval [CI]: 0.961-0.975). There was a positive association between age at menopause and the risk of obesity in postmenopausal women (OR: 1.019; 95% CI: 1.014-1.023). Reproductive lifespan was positively related to obesity (OR: 1.020; 95% CI: 1.017-1.025). The restricted cubic spines showed the association between age at menarche, age at menopause, reproductive lifespan, and obesity was nonlinear when fully adjusted. Conclusions: Based on the large nationally representative sample, Chinese women with earlier age at menarche, later age at menopause, and longer reproductive lifespan have a higher risk of obesity.

Introduction: In the first year postpartum, hypertension is a leading cause of morbidity and mortality, particularly for those with hypertensive disorders of pregnancy (HDPs). Given that timely recognition of hypertension is key to reducing short- and long-term cardiovascular risk, we assessed knowledge of when to seek medical attention for blood pressure (BP) elevations and rates of BP measurement in the first year postpartum. Methods: This was a secondary analysis of a cohort of 405 primiparas who enrolled in a randomized trial during pregnancy. We calculated the proportion who stated they would contact a clinician for a systolic BP above 140 and a diastolic BP above 90 at 3 months postpartum, and the frequency and location of BP checks reported from 2 to 12 months postpartum by HDP status. Results: HDPs were reported by 16% of participants. Mean age was 32 ± 5 years; 40% identified as non-White, and 25% had public insurance. At 3 months postpartum, 44.6% with HDPs and 23.5% without identified a systolic BP of 140 as the threshold above which to contact a clinician (p < 0.01); 52.4% with HDPs and 28.5% without identified a diastolic BP threshold of 90 (p < 0.01). From 3 to 12 months postpartum, people with HDPs were more likely to report a BP check (83.1% versus 59.4%, p < 0.01) and home BP monitoring (41.6% versus9.7%, p < 0.01). Home monitoring was not associated with awareness of when to seek help for hypertension among those with HDPs. Conclusions: Efforts are needed to improve awareness of when to seek medical attention for postpartum hypertension.

Objective: This study examines postpartum health care utilization among women with severe maternal morbidity (SMM) subtypes (e.g., blood transfusion, renal), focusing on both early (within 7 days) and late (8-42 days) postpartum periods. By including outpatient visits alongside inpatient and emergency department (ED) visits, the study offers a comprehensive view of postpartum health care needs among women with SMM. Methods: This retrospective cohort study used data from Optum's de-identified Clinformatics® Data Mart Database from 2008 to 2019. The primary outcomes were early and late postpartum inpatient readmissions, early and late ED visits, and outpatient care within 42 days after delivery. Multilevel logistic regression models were used to estimate the association between SMM subtypes and postpartum readmission, ED, and outpatient care. Results: Except for hemorrhage, most SMM subtypes increased the postpartum odds of health care utilization. Women with other medical SMM (e.g., puerperal cerebrovascular disorders or sickle cell disease with crisis) had 2.9 times the odds (odds ratio [OR]: 2.87, 95% confidence interval [CI]: 1.30-6.34) of experiencing early readmissions compared with those without other medical SMM. Women with sepsis had 4.5-fold elevated odds (OR: 4.53, 95% CI: 2.48-8.28) of late readmission, a 1.9-fold increased odds (OR: 1.85, 95% CI: 1.12-3.04) of early ED visits, and over a 2-fold increased odds (OR: 2.27, 95% CI: 1.67-3.08) of postpartum outpatient visits compared with those without sepsis. Conclusion: This study reveals that certain SMM subtypes significantly increase postpartum health care utilization, emphasizing the need for further research and interventions to improve outcomes for affected women.

Background: Mental health conditions and epilepsy frequently coexist and have independently been associated with severe maternal morbidity (SMM). Since little is known about the risks of these conditions when they occur together in pregnancy, we evaluated the associations of mental health conditions, epilepsy, and SMM. Methods: We conducted a population-based study of births in California between 2007 and 2018. Antenatal epilepsy and mental health conditions (defined as depression, anxiety, posttraumatic stress disorder, and other) were identified using billing codes. We categorized individuals into the following mutually exclusive exposure groups: no epilepsy or mental health conditions (referent), mental health conditions alone, epilepsy alone, or both epilepsy and mental health conditions. Our primary outcome was SMM, defined by the 20-indicator Centers for Disease Control and Prevention Index. We conducted multivariable logistic regression models adjusted for sociodemographic and clinical confounding factors. Results: In a cohort of 5,275,994 births, SMM occurred more frequently in individuals with mental health conditions alone, epilepsy alone, and both mental health conditions and epilepsy (1.8%, 3.0%, 4.2%, respectively) compared with the referent group (0.8%). The odds of SMM were significantly increased for each exposure group: adjusted odds ratio (aOR) 2.13, 95% confidence interval (CI) 2.05-2.22 for mental health conditions; aOR 3.79, 95% CI 3.45-4.18 for epilepsy; and aOR 4.91, 95% CI 4.01-6.00 for both. Conclusion: Epilepsy and mental health conditions were independently associated with SMM, and individuals carrying both diagnoses had the highest odds of SMM. Our results highlight the need for awareness of SMM risks in this population.

Background: Previous studies suggest an association between late pregnancy exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) and increased postpartum hemorrhage (PPH) risk. This is the first pregnancy registry study to compare PPH outcomes among women with psychiatric illness exposed or unexposed to SSRIs/SNRIs proximate to delivery. Methods: This study used data from the National Pregnancy Registry for Psychiatric Medications to evaluate the relationship between SSRI/SNRI exposure in late pregnancy and PPH risk. The sample included n = 953 participants with retrospectively collected medical record data on postpartum blood loss, n = 453 unexposed to SSRIs/SNRIs during pregnancy, and n = 500 exposed at least during the week of delivery. PPH was defined as an estimated blood loss ≥500 mL following vaginal delivery or ≥1,000 mL following cesarean section (C-section), with onset of excessive bleeding occurring within the first 24 hours postpartum. Univariate and multivariate logistic regression analyses were performed to determine odds ratios. Results: Overall PPH incidence was 13.1%. SSRI/SNRI exposure was associated with a PPH unadjusted odds ratio of 1.42 compared to no exposure (95% confidence interval [CI: 0.97, 2.08]) and an adjusted odds ratio of 1.33 (95% CI [0.90, 1.97]). When stratified by delivery type, the odds ratio following vaginal delivery among women exposed to SSRIs/SNRIs was 1.04 (95% CI [0.63, 1.70]) versus 2.31 (95% CI [1.25, 4.26]) for C-section delivery; the adjusted C-section odds ratio was 2.21 (95% CI [1.18, 4.13]). Conclusions: Although these findings align with accumulating evidence suggesting SSRI/SNRI exposure may confer a modestly increased risk of PPH, particularly after C-section, the study was underpowered to make definitive conclusions. These preliminary data highlight the need for further research with larger sample sizes. Nevertheless, the findings underscore the importance of greater clinical monitoring for PPH following C-section, especially in women who may have other known PPH risk factors and are exposed to SSRIs/SNRIs in late pregnancy.

Background: The postpartum period is a window to engage birthing people in their long-term health and facilitate connections to comprehensive care. However, postpartum systems often fail to transition high-risk patients from obstetric to primary care. Exploring patient experiences can be helpful for optimizing systems of postpartum care. Methods: This is a qualitative study of high-risk pregnant and postpartum individuals. We conducted in-depth interviews with 20 high-risk pregnant or postpartum people. Interviews explored personal experiences of postpartum care planning, coordination of care between providers, and patients' perception of ideal care transitions. We performed thematic analysis using the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change as a framework. COM-B allowed for a formal structure to assess participants' ability to access postpartum care and primary care reengagement after delivery. Results: Participants universally identified difficulty accessing primary care in the postpartum period, with the most frequently reported barriers being lack of knowledge and supportive environments. Insufficient preparation, inadequate prenatal counseling, and lack of standardized care transitions were the most significant barriers to primary care reengagement. Participants who most successfully engaged in primary care had postpartum care plans, coordination between obstetric and primary care, and access to material resources. Conclusions: High-risk postpartum individuals do not receive effective counseling on the importance of primary care engagement after delivery. System-level challenges and lack of care coordination also hinder access to primary care. Future interventions should include prenatal education on the benefits of primary care follow-up, structured postpartum planning, and system-level improvements in obstetric and primary care provider communication.