Women's health reports (New Rochelle, N.Y.)最新文献

Purpose: Intimate partner violence (IPV) and related stressors increased during the COVID-19 pandemic, uniquely impacting perinatal women during a vulnerable time. This study examined the association between IPV, psychosocial correlates, and COVID-19 stressors.

Methods: Our sample included 122 pregnant and postpartum women (average age = 30.1 years; standard deviation = 6.2 years) enrolled in a multisite clinical trial evaluating an IPV-focused intervention for perinatal women who had sought mental health treatment within the last year. Baseline data association between partner abuse (physical, emotional/sexual, severe combined, harassment) and sociodemographic variables was investigated. We analyzed sociodemographic characteristics and measures of Positive Affect and Well Being, Emotional Support, Empowerment, and Self-Efficacy. Furthermore, we conducted an exploratory analysis to examine the role of the intersection between education and employment status on IPV.

Results: Participants reporting more COVID-19-related stress (above median) perceived higher emotional abuse than those in the lower half of the stress spectrum (p = 0.04). Partner emotional abuse was inversely associated with Emotional Support (r = -0.26, p = 0.004) and otherwise not correlated with other psychosocial measures. Perinatal women reporting the most abuse were those reporting part-time employment and an educational level of less than a high school diploma. Ethnicity, pregnancy status, and education were all associated with the severe abuse.

Conclusion: Overall, we demonstrate associations between greater emotional abuse and greater levels of both COVID-19-related stress and lack of emotional support. Also, multiple, overlapping, sociodemographic characteristics impacted perinatal IPV risk. Results offer promising direction for future research.

Objective: Preconception care reduces adverse maternal and neonatal outcomes. Despite the World Health Organization's recommendations, it has not been uniformly implemented. The specific objectives of the study were to measure the change in calorie and protein intake, body mass index (BMI), and hemoglobin among women receiving preconception care, including behavioral change communication (BCC).

Materials and methods: We conducted an implementation study with the government's support. Accredited social health activists conducted a house-to-house survey in four blocks (2 for intervention and 2 for comparisons). Each arm had one tribal and one rural block. They enrolled women desiring pregnancy within a year and collected desired information, including a 24-hours dietary recall. A repeat diet survey was carried out after 6 months. The authors provided preconception care in the intervention blocks. Health care workers followed the women monthly. The study was conducted from 2018 to 2020.

Results: The study enrolled 7875 women from four blocks. In the intervention group, the proportion of women with very low-calorie intake reduced from 1.1% to 0.1%, and very low-protein intake reduced from 0.9% to 0.2%. In the comparison group, very-low-calorie intake was reduced from 1.7% to 1.5%, whereas very low protein intake was reduced from 1.6% to 0.8%. The proportion of underweight (BMI < 18.5) decreased from 40.70% at enrolment to 15.35% at the last follow-up. The mean hemoglobin improved from 10.56 gm% (SD = 1.25) to 11.10 gm% (SD = 1.07).

Conclusions: The provision of preconception care, including BCC activities, through the public health system optimized the BMI and increased hemoglobin.

Objective: This study aimed to evaluate the effectiveness of the information-motivation-behavioral skills (IMB) model-based nursing intervention in improving maternal and neonatal outcomes in patients with gestational diabetes mellitus (GDM).

Methods: A total of 240 pregnant women with GDM were enrolled and randomly assigned to either the IMB group or the traditional health education group between June 2023 and May 2024. The IMB group received a 6-week intervention incorporating information support, motivational enhancement, and behavioral skill development. The control group received standard health education. Outcomes assessed included fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), insulin treatment rates, adverse delivery outcomes, and postpartum glucose metabolism abnormalities.

Results: The IMB group showed a significant reduction in FPG from 8.05 mmol/L (145.05 mg/dL) to 4.95 mmol/L (89.19 mg/dL) (p < 0.001) and HbA1c from 6.60% to 4.98% (p < 0.001) postintervention, compared with the control group's reduction to 6.00 mmol/L (108.11 mg/dL) (p < 0.001) and 5.78% (p < 0.001), respectively. The rate of insulin treatment was 2.5% in the IMB group versus 13.3% in the control group (p = 0.003). The IMB group had a lower cesarean section rate (15.0% vs. 40.0%, p < 0.001) and neonatal respiratory distress syndrome incidence (1.67% vs. 10.0%, p = 0.007). Postpartum, the IMB group exhibited a lower total incidence of abnormal glucose metabolism (12.5%) compared to the control group (25.0%, p < 0.001).

Conclusion: The IMB model-based nursing intervention was more effective in managing blood glucose levels, reducing the need for insulin therapy, and improving both maternal and neonatal outcomes compared to traditional health education. This intervention may offer a promising approach to enhance the care of women with GDM.

Background: The SAMANTA questionnaire and the Heavy Menstrual Bleeding-Visual Analog Scale (HMB-VAS) tool have been validated for diagnosing heavy menstrual bleeding (HMB). We assessed their value for screening iron deficiency (ID).

Material and methods: Post hoc analysis of the prospective, randomized, phase 4 Cooper and Levonorgestrel Intrauterine Device (IUD) Barcelona Research Iniciative (COLIBRI) study, which assessed the bleeding profile of two intrauterine devices. We used information collected during the last follow-up visit (month 36): sociodemographics, hemoglobin/ferritin levels, SAMANTA questionnaire, HMB-VAS tool, and EuroQoL five-dimension five-level scores. The primary outcome was the accuracy of these diagnostic tools in identifying ID. We also assessed their relationship with EQ-5D-5L.

Results: We analyzed information from 57 women, 18 (31.6%) and 14 (24.6%) with HMB according to the SAMANTA questionnaire and the HMB-VAS tool, respectively. Ferritin levels showed better inverse correlation than hemoglobin with these HMB diagnostic tools' scores: r = -0.539 and r = -0.557, respectively, both p < 0.001. In women with HMB according to these tools, the ferritin threshold showing the best sensitivity and specificity to identify ID was <10 ng/mL with the SAMANTA questionnaire (71.4% [Confidence Interval (CI) 95% 35.2-93.5] and 78% [CI 95% 65.2-87.7], respectively) and <15 ng/mL for the HMB-VAS tool (58.3% [CI 95% 31.2-87.7] and 82.2% [CI 95% 69.2-91.2], respectively). Only the EQ-VAS scores correlated inversely with the scores of both HMB diagnostic tools (r = -0.308, p = 0.02, and r = -0.294, p = 0.026, respectively).

Conclusions: This exploratory analysis shows the SAMANTA questionnaire's good potential for ID screening. The scores of both HMB diagnostic tools correlated with the EQ-VAS, demonstrating their value in capturing the HMB impact on quality of life.

Introduction: Cardiovascular disease remains the leading cause of death among women. Across the lifespan, exposure to both traditional and lifestyle-related cardiovascular risk factors (CVRFs) is high. Behavioral trends such as increased sedentary behavior, psychosocial stress, and tobacco use have diminished the protective cardiovascular effects classically attributed to estrogen, with women underestimating their personal CVRF.

Objective: To assess the prevalence and recognition of CVRF among women over 18 years attending general practice in the north of France.

Materials and methods: An exploratory, cross-sectional study was conducted between October 2023 and June 2024 in 10 general practices. Women aged ≥18 or older completed a self-administered online questionnaire, which assessed 17 established CVRF and their recognition of these as risks.

Results: Among the 308 participants, the prevalence of CVRF was perceived psychosocial stress 69%, sedentary lifestyle 56%, overweight (body mass index >25) 36%, abdominal obesity (waist circumference >88 cm) 26%, hypertension 13%, diabetes 5%, and hyperlipidemia (low-density lipoprotein >1.6 g/L) 11%. Most (91%) reported at least two modifiable CVRF; 74% had at least three. Prevalence estimates for hypertension, diabetes, and hyperlipidemia increased sharply with age. The majority recognized smoking (86%), overweight (61%), and hypertension (83%) as risks, but only 29% recognized menopause and 57% identified estrogen-containing contraception as such.

Conclusions: A substantial proportion of women, including the younger age groups, exhibit multiple coexisting modifiable CVRF, underscoring the need for early, targeted prevention. General recognition is high for some CVRF, but knowledge about those specific to women remains insufficient. Broad lifestyle determinants must be considered for universal CVRF prevention and management in primary care.

Background: Placenta accreta spectrum (PAS) is a life-threatening obstetric condition characterized by abnormal placental adherence to the uterine wall, leading to severe maternal morbidity and mortality. Rising cesarean delivery rates have contributed to its increasing prevalence, yet recent national data on PAS trends and disparities remain limited. This study provides updated estimates of PAS prevalence, racial and geographic disparities, and associated maternal-fetal outcomes using a large, nationally representative dataset from 2016 to 2022.

Method: We conducted a retrospective cross-sectional analysis using the Nationwide Inpatient Sample (NIS), capturing 27,339,861 pregnancy-related hospitalizations. PAS cases (n = 36,310) were identified using International Classification of Disease, Tenth Revision, codes. Temporal trends were assessed using joinpoint regression. Survey logistic regression models estimated associations between PAS and maternal-fetal outcomes, adjusting for demographic, clinical, and hospital factors.

Results: PAS prevalence increased significantly between 2016 and 2022 (annual percent change: 2.9%, p < 0.05), with notable increases among Black and White individuals. PAS was strongly associated with prior cesarean delivery, placenta previa, advanced maternal age, and comorbidities including hypertension, diabetes, and obesity. PAS significantly increased the risk of severe maternal morbidity, including hysterectomy (adjusted odds ratio [aOR] range: 52.2-151.3), blood transfusion (aOR range: 4.3-7.1), and preterm birth (aOR range: 2.4-3.2).

Conclusions: These findings highlight the growing burden of PAS and the urgent need for prevention strategies, such as reducing unnecessary cesarean deliveries, promoting vaginal birth after cesarean when appropriate, enhancing prenatal screening, and ensuring multidisciplinary care. Addressing racial and geographic disparities in PAS diagnosis and outcomes is essential to improve maternal and neonatal health.

Background: Half of maternal deaths occur after 42 days postpartum, a time when women are already out of obstetrical care. The American College of Obstetricians and Gynecologists recommends postpartum transition to primary care within 12 weeks of delivery. The majority of women do not transition to primary care, even those with chronic conditions like hypertension and diabetes. Those who do may experience the "postpartum cliff," a drop-off in communication between obstetrician-gynecologist (OB/GYN) and primary care provider (PCP).

Objective: The purpose of this study is to assess attendance rates at primary care appointments among high-risk postpartum patients who were referred through an enhanced postpartum referral system and to evaluate follow-up care in the early postpartum period.

Methods: A dedicated "Healthy Moms Clinic" (HMC) and referral protocol were established using patient navigators between maternal fetal medicine (MFM) and primary care in January 2023. A retrospective chart review was conducted in November 2024 of women who were referred from MFM to primary care. The primary outcome variable was attendance rate at the HMC. Secondary outcomes included preventive screenings, contraception use, and management of chronic conditions such as hypertension and diabetes.

Results: Of 106 referrals between January 2023 and July 2024, 93.4% attended their 6-week postpartum OB/GYN visit. Half (53.8%) attended the initial PCP visit, and 30.2% of the missed appointments were rescheduled. If the visit was rescheduled, half of those patients attended their rescheduled appointment with an overall show rate of 70.8%. There was no difference in show rates by race/ethnicity (patients identified primarily as Black or Hispanic) nor by insurance type.

Conclusion: Coordination between obstetrics and primary care through dedicated transition clinics allows interdisciplinary collaboration, providing a solution for missed care postpartum. More time is needed to assess long-term outcomes such as hypertension control, diabetes control, and weight loss.

Background: Endometrial intraepithelial neoplasia (EIN) is a known precursor to endometrial endometrioid carcinoma, with a 40% risk of concurrent endometrial cancer at the time of hysterectomy. Many benign gynecologists (GYN) refer to gynecologic oncologists (GYO) for this risk of malignancy. This retrospective cohort study describes the pathological outcomes of patients with EIN who underwent hysterectomy at a single military treatment facility (MTF) and a civilian partner hospital.

Methods: A retrospective chart review was performed for patients with a diagnosis of EIN at a single MTF and civilian hospital from 1/1/2021 to 10/30/2023. Preoperative risk factors for malignancy of cases performed by GYN and GYO were compared.

Results: A total of 58 patients with EIN were included (8 from the MTF, 50 from the civilian partner hospital). Of these, 48 (82.8%) patients were referred to GYO for hysterectomy. Thirty-three (56.9%) patients were upstaged to endometrial cancer, with 28 (84.5%) Stage IA, 3 (9.1%) Stage IB, and 2 (3.4%) Stage III. Of the 48 patients in the GYO cohort, 36 patients underwent nodal sampling with only one lymph node positive for metastasis. No patients required secondary staging procedures. No significant preoperative risk factors were identified for advanced cancer.

Conclusions: Our data supports prior literature suggesting that the likelihood of nodal involvement and advanced metastatic disease in patients with EIN is low. Current guidelines allow flexibility in the management of EIN by either GYN or GYO. Additional research into and application of preoperative risk algorithms may help identify patient risk for advanced malignancy and accurately guide low-risk patients towards management by GYN and high-risk patients by GYO.

Background: Combined oral contraceptives (COCs) can relieve dysmenorrhea, but utilization is low in Chinese women. This systematic literature review was conducted to summarize the design of clinical studies and the effectiveness and safety of COCs for dysmenorrhea in Chinese women.

Methods: The PubMed, EMBASE, CNKI, Wanfang, VIP, Chinese clinical trial register, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs), non-RCTs, and cohort studies investigating COCs for dysmenorrhea in the Chinese population. A narrative synthesis and descriptive statistics were used to summarize the clinical study designs, intensity of dysmenorrhea symptoms, and safety of COCs for dysmenorrhea in Chinese women.

Results: Twenty-eight clinical studies (24 RCTs, 2 non-RCTs, 2 cohort studies) with 3409 patients were included in this review. Primary (PD) and secondary dysmenorrhea (SD) were investigated in 9 and 18 studies, respectively, and 1 study did not specify the type. Most studies gave cyclic versus continuous COCs (92.9% [n = 26/28] vs. 14.3% [n = 4/28 studies]). Traditional Chinese medicines were common comparators (PD: 66.7% [n = 6/9 studies]; SD: 61.1% [n = 11/18 studies]). Most studies reported intensity of dysmenorrhea symptoms (n = 22/28), usually with the visual analogue scale pain score (59.1% [n = 13/22 studies]). COCs significantly reduced symptoms of dysmenorrhea in PD and SD. Abnormal menstrual bleeding was the most common adverse event (2.4%-51.4%).

Conclusions: COCs are effective for PD and SD in China with an acceptable safety profile. Additional head-to-head comparative trials are needed to clarify the role of COCs versus other treatments in Chinese patients.

Objective: This prospective study aimed to investigate the short-term effects of single-port laparoscopic hysterectomy for benign conditions on postoperative pelvic floor symptoms, pelvic floor structure, and pelvic floor muscle function.

Study design: The study was conducted at Zhongda Hospital, Southeast University, from May 2022 to September 2023. Patients who underwent elective single-port laparoscopic hysterectomy for benign conditions were recruited. Paired t-tests and non-parametric rank-sum tests were used to compare changes in pelvic floor function, female sexual function index (FSFI), 4D pelvic floor ultrasonography, and surface electromyography (sEMG) indicators between pre- and postoperative periods.

Results: A total of 71 participants were included, with 69 patients successfully followed up. There was a significant improvement in pelvic floor function postoperatively (p < 0.001). FSFI scores significantly decreased postoperatively. Bladder neck descent increased significantly postoperatively (p = 0.024) in 6 months. However, there were no significant differences in the other ultrasound indicators between preoperative and 6-month postoperative assessments. The time after the peak of the tonic contraction phase significantly decreased postoperatively (p = 0.047), and the average mean of post-baseline value decreased postoperatively with statistical significance (p < 0.001). There were no significant differences in other pelvic floor sEMG indicators between preoperative and postoperative assessments.

Conclusions: Within 6 months post-hysterectomy, Pelvic Floor Disorders Impact Questionnaire-20 (PFDI-20) scores significantly improved, and FSFI scores significantly decreased postoperatively. Single-port laparoscopic hysterectomy did not significantly affect pelvic floor structure or muscle function in the short-term postoperative period. However, overall sexual function decreased within the same timeframe.