Contraception最新文献

Objective: To update a previous systematic review on sickle cell disease (SCD) and adverse health outcomes associated with hormonal contraception (HC) use.

Study design: We searched multiple databases for articles from inception through December 12, 2022. We included articles that assessed risk of adverse health outcomes (e.g., thrombosis, painful episodes, osteoporosis) among women with SCD using any HC method. We assessed risk of bias for each study and certainty of evidence for all outcomes.

Results: Nine articles met inclusion criteria; four were new. Eight studies had high risk of bias and one had moderate risk. Three studies examined thrombosis among HC users with SCD; one found that 2.9% of 67 women using combined oral contraception (COC) and none of 84 women using other HC methods experienced venous thromboembolism (VTE), another found no VTE among 20 HC users, and another found elevated risk of ischemic stroke among oral contraception users (presumed mostly COC) versus non-users (adjusted hazards ratio 3.6, 95% confidence interval 0.8-16.5). Six studies with disparate study methods generally found that HC users did not report increases in painful episodes, and in some studies but not all, use of progestin-only methods appeared to decrease painful episodes. One study found no differences in bone mineral density between HC users and non-users with SCD, and another found no diagnoses of osteopenia among 20 HC users with SCD.

Conclusions: Evidence remains limited for adverse health outcomes, especially thrombosis, with HC use among women with SCD. The certainty of evidence was low for all outcomes.

Implications: Sickle cell disease (SCD) increases risk for stroke, venous thromboembolism, and pregnancy complications. Access to safe contraception is essential for women with SCD who are at risk for and do not desire pregnancy or who wish to optimize pre-pregnancy health. This updated review can help providers counsel patients with SCD about safe use of contraception.

Objective: Women on anticoagulant therapy are at risk for bleeding and may be at risk for recurrent thrombosis, which may be further increased with use of certain contraceptive methods. Our objective was to update a previous systematic review on safety of contraception among women on anticoagulant therapy.

Study design: We searched multiple databases from inception through December 12, 2022 for articles on concurrent use of contraception and anticoagulant therapy. Outcomes were thromboembolism, bleeding, and drug-drug interactions. Among women on anticoagulant therapy, we compared outcomes for women using and not using contraception. We assessed risk of bias for each study, and certainty of evidence for all outcomes.

Results: Fourteen articles met inclusion criteria (12 were new); one had low risk of bias, three had moderate risk of bias, and 10 had high risk of bias. Anticoagulants examined included warfarin, heparin, aspirin, rivaroxaban, enoxaparin, phenindione, acenocoumarol, combined therapy, and unspecified. Four studies (two comparative and two non-comparative studies) in women using anticoagulant therapy found no evidence that use of combined or progestin-only hormonal contraceptive increased the risk of recurrent venous thromboembolism (VTE). Ten studies (four comparative and six non-comparative studies) examined uterine bleeding with use of anticoagulant therapy and generally found that bleeding was increased during use of copper intrauterine devices (IUDs) and decreased during use of levonorgestrel (LNG) IUDs. Two studies examined pharmacokinetic outcomes and found no decreases in anticoagulant levels with combined oral contraceptive exposure.

Conclusions: Limited evidence suggests risk for recurrent VTE may not be increased with hormonal contraceptive use among women using anticoagulants. Bleeding among women on anticoagulant therapy might worsen with copper IUD use but might improve with LNG-IUD use. The certainty of evidence for most outcomes is very low.

Implications: Women on anticoagulant therapy are at risk for recurrent thrombosis and bleeding, which might be further exacerbated with use of certain contraceptive methods. Additional evidence is needed on safety of concurrent use of anticoagulant medications and contraceptives.

Objectives: While the implications of AI for health care are frequently discussed, AI's relationship to abortion has received limited attention. This paper surveys research on AI and abortion to date, adapts AI ethics principles for abortion contexts, and proposes a research agenda for abortion and AI.

Study design: We conducted an exploratory literature review, identifying peer-reviewed and grey literature relevant to AI, abortion and/or reproductive health and rights by iteratively searching academic databases. We identified pioneering articles on the implications of AI for reproductive health and two branches of empirical work: AI tools tailored for abortion, and assessments of ChatGPT's responses to questions about abortion. We compared abortion AI tools included in the category 'FemTech' with ChatGPT vis-à-vis their ethical implications for abortion access. Building on this analysis, we propose an Abortion AI research agenda.

Results: The rapid development of AI holds both promise and challenges in sensitive and stigmatized areas like abortion. While existing AI tools allow humans with clinical expertise to review user-facing content for accuracy, concerns have been raised about abortion misinformation propagated by ChatGPT. Likewise, while ChatGPT's data use raises concerns about privacy and consent, precautions taken by specialized abortion AI tools highlight opportunities for harnessing AI while mitigating privacy risks in an era when abortion seekers' digital data has been used in criminal cases against them.

Conclusions: Existing AI applications designed for abortion support privilege contextual appropriateness over technological novelty, avoiding more sophisticated forms of AI when they do not serve patient needs or undermine bodily autonomy. Such choices help mitigate risks of AI misinformation and privacy breach.

Implications: With commitments to privacy, accuracy, and meaningful consent, AI can be harnessed to advance abortion access and reproductive autonomy and should be explored with the same rigor as it is in other fields. Community-engaged methodologies are well-positioned to explore appropriateness of AI to community needs.

Objectives: Period tracker downloads worldwide continue to increase year over year even though users are exposed to intimate data surveillance, unconsented third-party data sharing, and unauthorized commercial use of their reproductive information. This paper argues that data protection measures such as Europe's General Data Protection Regulation, considered the gold standard for personal privacy protection, could be bolstered if an intimate privacy design code was applied.

Study design: As no code, such as the United Kingdom Information Commissioner's Children's Code, exists for reducing data protection risks associated with online processing of sensitive reproductive information, we developed 15 measures operationalizing the concept of intimate privacy. Risk assessments based on intimate privacy criteria were compared to General Data Protection Regulation requirements in our 2023 United Kingdom-based pilot study auditing three popular period trackers, Flo, Clue, and Eve.

Results: When our intimate privacy criteria were applied, we identified tracker data protection weaknesses and privacy elements falling outside of existing General Data Protection Regulation requirements. Particularly worrisome was the lack of dynamic consent for data sharing, no built-in surveillance detection measures, and few user-determined data retention and deletion processes. Processing and storage of United Kingdom Flo and Eve users' data in the United States raises significant intimate privacy protection concerns, especially as legal implications of such data transfers were not well explained to users. Privacy policies were complex, requiring college education.

Conclusions: Incorporating intimate privacy-by-design would provide Femtech device users enhanced protection for their sensitive, private intimate data.

The US Centers for Disease Control and Prevention publishes evidence-based contraception guidelines to assist healthcare providers when counseling patients about safe and effective contraceptive use. The US Medical Eligibility Criteria for Contraceptive Use (US MEC) and the US Selected Practice Recommendations for Contraceptive Use (US SPR) have been updated on a regular basis, with the most recent full update published in 2024. This paper provides an overview of research gaps identified throughout the update process and discusses in further depth evidence gaps on several topics, including risk of thrombosis with hormonal contraception, medications for intrauterine device placement, and bleeding irregularities during implant use. Expanded study on these research gaps is needed to bolster guidelines and to improve safe and effective delivery of contraception.

Objective: To update a previous systematic review on contraceptive safety and effectiveness among women with solid organ transplants.

Study design: We searched multiple databases from inception through December 7, 2022, for studies of any design that examined contraceptive safety and effectiveness for any contraceptive method among women with solid organ transplants. We extracted data from included articles; for studies that were not case series/reports, we assessed risk of bias and determined certainty of evidence.

Results: Twenty-six articles satisfied inclusion criteria, 11 cohort studies and 15 case series/reports. Among the 11 cohort studies, most had moderate or high risk of bias. For levonorgestrel intrauterine devices (LNG-IUDs), four non-comparative cohort studies of women with transplants (total n = 55) observed no pregnancies and no pelvic infections. One comparative cohort study (n = 16) suggested similar LNG-IUD effectiveness between women with and without transplants, based on uterine histologic and inflammatory markers. Another comparative cohort study found no unwanted pregnancies among 178 IUD users (type unspecified) with kidney transplants. For non-IUD hormonal contraception, one comparative cohort study (n = 48) found no differences in transplant-related safety outcomes or pregnancy rates for etonogestrel implant use compared with no hormonal contraception; another (n = 126 with kidney transplant) observed fewer unwanted pregnancies among oral contraceptive users (11.8%) compared with non-users (59.8%). Four non-comparative cohort studies of combined hormonal contraception users (total n = 76) observed no clinically meaningful safety outcomes and no pregnancies.

Conclusions: Very low certainty evidence does not suggest adverse safety or effectiveness outcomes among LNG-IUD and non-IUD hormonal contraception users with solid organ transplant.

Implications: While limited, this evidence can be used by health care providers and women with solid organ transplants in counseling and shared decision-making about contraception. Further studies are needed to address concerns about contraceptive use among women with transplants, such as the risk of thrombosis and other cardiovascular risks with hormonal contraceptive use.

Objectives: To systematically review evidence on the safety and effectiveness of contraceptive use among women with chronic kidney disease (CKD).

Study design: We searched for articles in multiple databases from database inception through December 12, 2022, that assessed safety and effectiveness of contraceptive use among women with CKD; all study designs were included. We extracted data from included articles; for studies that were not case series or case reports, we assessed risk of bias and determined certainty of evidence for each outcome.

Results: Eight articles, including 5 case reports, met inclusion criteria. All articles assessed safety outcomes associated with contraceptive use among women with CKD; none examined contraceptive effectiveness. Risk of bias for three studies (not including case reports) ranged from moderate to high and varied by outcome. One prospective cohort study observed no increased risk of hypertension or end stage renal disease among oral contraceptive (type unknown) users compared with non-users, while a non-randomized trial observed no changes in blood pressure over 21 days among 5 peritoneal dialysis patients using combined oral contraceptives. Another non-randomized trial examined hyperkalemia risk among drospirenone progestin-only pill users; hyperkalemia did not develop in participants with normal, mild, or moderate renal impairment. Four case reports described adverse events among intrauterine device (IUD) users, and one case report described decreased bleeding with levonorgestrel IUD use.

Conclusion: Despite several theoretical concerns (e.g., worsening kidney disease, worsening hypertension, and thrombosis) about the safety of contraception among women with CKD, data are limited, and the certainty of existing evidence is very low.

Implications: Health care providers can use the information in this review when counseling women with CKD about contraceptive decision-making. More research is needed to better understand the safety and effectiveness of the full range of available contraceptive methods among women with CKD.

Background: Chatbots are increasingly utilized in the health care landscape, including in sexual and reproductive health (SRH). These tools have shown significant potential in enhancing accessibility to health education and services, particularly with the addition of artificial intelligence (AI). This commentary explores the utilization of chatbots for delivering SRH care, assessing their potential to impact health equity and access within rural and underserved settings and evaluating their effectiveness and safety.

Methods: Synthesizing existing literature on SRH chatbots, this commentary examines their development and functionality, assessing their impact on health equity, particularly across diverse demographic and sociocultural contexts. The effectiveness and safety of these tools are also reviewed based on their design, content validation processes, and adherence to privacy regulations.

Results: SRH chatbots have the potential to enhance health literacy and equity, increasing user knowledge and autonomy. Through equitable development and implementation, they can democratize access to essential health information across diverse populations, providing tailored advice based on individual factors. This personalized guidance empowers users to make informed decisions about their health. However, their effectiveness can be influenced by factors such as technological literacy, ethics, and privacy concerns.

Conclusions: Chatbots in SRH present a promising tool for improving health care delivery and empower patients by providing immediate, personalized information. They increase access to evidence-based information while allowing health care workers to allocate more resources to complex cases. As AI becomes increasingly available, those using it for SRH should focus on enhancing technological capabilities, ensuring rigorous content validation, and overcoming technological and socio-economic barriers to maximize the public health benefits, including misinformation correction, of chatbots in SRH. The development of these tools must prioritize equity and user trust by ensuring equitable access, data privacy, and tailoring interactions to meet diverse needs across populations.

Implications: AI-enabled chatbots can expand equitable access to sexual and reproductive health by improving health literacy, autonomy, and timely decision-making. Their success, however, depends on rigorous validation, privacy protections, and equity-focused design to ensure they reduce, rather than exacerbate, health disparities in underserved populations.

Objectives: This study evaluated a Reproductive Health Kit program, offered through a FemTech Platform, GetPersonal. Kits included emergency contraception, menstrual and safer sex supplies, and informational materials to adults across Mississippi. Researchers assessed participants' self-reported satisfaction, comfort, perceived benefit, and experiences from receiving a kit.

Study design: Researchers employed a concurrent parallel mixed methods design, collecting 106 online surveys and 23 in-depth phone interviews with participants from April 2023 to April 2024. Surveys included the Service User Technology Acceptability Questionnaire and validated measures of health care access and food insecurity. Using an exploratory approach, researchers analyzed quantitative data. Researchers applied a phenomenological approach to analyze interviews and identify themes using Dedoose software.

Results: Participants reported high satisfaction and perceived benefit. Respondents without a primary care provider and those who identified as bisexual reported significantly greater engagement with sexual and reproductive health care that they attributed to receiving the kit. Participants reported minimal concerns with privacy and confidentiality when using GetPersonal. Qualitative themes included (1) Real Access to Care and Resources, including subthemes of barriers and facilitators and adolescent-specific needs; (2) Outreach and Referral Sources; (3) Comfortability of Materials and Services; (4) Confidentiality and Privacy. Interviewees shared that the kits were seen as discreet, timely, and inclusive and valuable for youth and those in rural areas.

Conclusions: This study underscores the complementary role of GetPersonal in increasing vulnerable populations' access to services. Platforms providing low-barrier, person-centered services have the potential to significantly contribute to health care equity in oppressive and underserved environments.

Implications: Health organizations can leverage FemTech platforms to improve outcomes, such as access to health resources and information for BIPOC, LGBTQIA, adolescents, and people with low health care access. This study highlights how the GetPersonal platform in Mississippi advanced tangible access to services, discretion, and privacy for vulnerable populations.