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Wingo E, Dehlendorf C. Lack of pregnancy intention or interest in pregnancy prevention now? How best to screen for desire for contraceptive care. Contraception 2024; 135:110303. [PMID: 37806473 DOI: 10.1016/j.contraception.2023.110303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES To assess the relationship between pregnancy intention and current desire for pregnancy prevention. STUDY DESIGN Using data from two state population-based surveys, we compared One Key Question and current pregnancy prevention desire. RESULTS The majority with ambivalence toward pregnancy (54%) and some respondents who wanted to become pregnant in a year (30%) desired pregnancy prevention now. CONCLUSIONS One Key Question did not capture the current pregnancy prevention desires of a sizeable minority of respondents. IMPLICATIONS A pregnancy prevention-focused screening approach may be better suited to identify those in need of contraceptive services compared to pregnancy intention screening.
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Affiliation(s)
- Erin Wingo
- Person-Centered Reproductive Health Program, Department of Family and Community Medicine, UCSF, San Francisco, CA, United States.
| | - Christine Dehlendorf
- Person-Centered Reproductive Health Program, Department of Family and Community Medicine, UCSF, San Francisco, CA, United States.
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Congdon JL, Vittinghoff E, Dehlendorf C. Comparison of a person-centered pregnancy prevention question and One Key Question to assess postpartum contraceptive needs. Contraception 2024; 135:110465. [PMID: 38636583 DOI: 10.1016/j.contraception.2024.110465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To explore the relevance of pregnancy intention as a screen for contraceptive needs among postpartum individuals. STUDY DESIGN We surveyed 234 postpartum individuals to assess the alignment between pregnancy intentions in the next year and current desire to prevent pregnancy. RESULTS Most individuals (87%) desired pregnancy prevention now, including 73% of individuals who desired or were ambivalent about pregnancy in the next year. CONCLUSION A majority of individuals considering pregnancy in the next year desired pregnancy prevention now. Directly assessing current desire to prevent pregnancy may be more specific for contraceptive needs in postpartum individuals. IMPLICATIONS Our ability to ensure that all individuals who want to prevent pregnancy have access to contraception depends on the use of effective screening questions. These findings prompt consideration of broader clinical implementation of screening for desire to prevent pregnancy in lieu of questions about pregnancy intention in the next year.
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Affiliation(s)
- Jayme L Congdon
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States.
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States.
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Cintron D, Chang JC, Sadun RE. Transition to Adult Rheumatology Care: A Disease-Specific Guide. J Clin Rheumatol 2024; 30:159-167. [PMID: 38527973 DOI: 10.1097/rhu.0000000000002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
ABSTRACT Young adults with childhood-onset rheumatic diseases are more frequently establishing and continuing care with adult rheumatologists. The transfer of care can be challenging for both the young adult patients and their adult rheumatologists, in large part due to differences between pediatric-onset rheumatic diseases and their adult-onset counterparts, or due to the rarity of some pediatric-onset rheumatic conditions. Other challenges are due to cultural differences between pediatric and adult medical care and to the young adult needing to increasingly perform self-management skills that were previously managed by parents or other caregivers. In this review, we will provide a summary of strategies for working effectively with young adults as they transition to adult care. We will then discuss a subset of childhood-onset rheumatic diseases-including juvenile idiopathic arthritis, localized scleroderma, autoinflammatory diseases, pediatric-onset systemic lupus erythematosus, juvenile-onset dermatomyositis, and autoimmune encephalitis-for which clinical manifestations, management, and prognosis frequently differ between pediatric onset and adult onset. Our aim is to highlight differences that make caring for this population of transitioning young adults unique, providing tools and knowledge to empower the adult rheumatologist to care for these young adults in ways that are evidence-based, effective, efficient, and rewarding.
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Affiliation(s)
| | - Joyce C Chang
- Boston Children's Hospital and Harvard Medical School, Boston, MA
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Din HN, Strong D, Singh-Carlson S, Corliss HL, Hartman SJ, Madanat H, Su HI. The effect of changing pregnancy intentions on preconception health behaviors: a prospective cohort study. J Cancer Surviv 2023; 17:1660-1668. [PMID: 36289184 PMCID: PMC10539193 DOI: 10.1007/s11764-022-01281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Pregnancy intentions are associated with preconception health behaviors but are understudied among female adolescent and young adult (AYA) cancer survivors. Preconception health is critical for survivors because they face unique risks to fertility and pregnancy from late effects of cancer treatments. This study prospectively assessed the effect of pregnancy intention on physical activity (PA) and smoking behaviors among female AYA survivors. METHODS A cohort of 1049 female AYA survivors were recruited between 2013 and 2017. Participants were 18-39 years and had completed primary cancer treatment. Longitudinal mixed effects analysis was conducted on participants who completed at least 2 of 4 questionnaires over 1.5 years. Two measures were used to capture multiple dimensions of pregnancy intention. The pregnancy intention score (PIS) captured wanting and planning dimensions and represented a scaled response of low to high intention. The trying dimension captured urgent intention and ranged from not trying, ambivalent (neither attempting nor avoiding pregnancy), and trying now. Intention change was assessed between each consecutive time points. Final analysis was conducted with multiple imputations. RESULTS Survivors with increased intention measured by trying was associated with increased PA over time (adjusted B [95%CI]: 0.3 [0.01, 0.5]) compared to survivors with no changes or decreased trying intention. PIS was not significantly associated with preconception behaviors. No measure of intention was associated with smoking behavior. CONCLUSIONS Increasingly urgent pregnancy intention (trying dimension) was associated with higher preconception PA. IMPLICATIONS FOR CANCER SURVIVORS Screening for immediate intentions can identify AYA survivors in need of early preconception health promotion.
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Affiliation(s)
- Hena Naz Din
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA.
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., La Jolla, CA, 92037, USA
| | - Savitri Singh-Carlson
- School of Nursing, San Diego State University, 5500 Campanile Mall, San Diego, CA, 92182, USA
| | - Heather L Corliss
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Center for Research On Sexuality and Sexual Health, Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., La Jolla, CA, 92037, USA
| | - Hala Madanat
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Division of Research & Innovation, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182, USA
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
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Spielvogel R, Stephens RB, Clark R, Guillen M, Hankins A, Parise C. Providing family planning counseling services for women with chronic medical conditions in an inpatient setting: A randomized feasibility trial. Contraception 2023; 128:110133. [PMID: 37549724 DOI: 10.1016/j.contraception.2023.110133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES This study aimed to evaluate the feasibility and effectiveness of providing bedside family planning services to women with chronic medical conditions in the inpatient setting. STUDY DESIGN We initiated a parallel randomized controlled trial of patients listed as female aged 18 to 44 years who were admitted to the hospital from February 2018 to May 2021 with at least one chronic medical condition associated with lower rates of contraception usage and no documentation of contraception. Patients who confirmed they were not using contraception were enrolled and randomized to one of the three arms. They received bedside family planning counseling and an offer of contraception prior to discharge (oral contraceptive pills, etonogestrel implant, or medroxyprogesterone injection), received a flyer recommending they talk with their outpatient physician about contraception, or received standard care. The primary outcomes were contraception use at 3 months and 12 months after discharge. RESULTS Altogether 76 subjects were enrolled and randomized with 22 in the counseling arm and 27 each in the other arms. In the counseling arm, five (23%; 95% CI: 8.0%-45%) elected to receive contraception prior to discharge. Inferential statistics at follow-up were not able to be calculated due to high attrition. CONCLUSIONS Providing counseling and offering immediate contraception initiation in the inpatient setting may be a feasible approach to improving contraception access for this population. Additional investigation into the acceptability, efficacy, and generalizability of this approach is warranted. IMPLICATIONS Utilizing the inpatient setting may be a feasible approach for delivering contraception counseling to women with chronic medical conditions. This approach merits further study for effectiveness and acceptability. This study highlights the need for contraceptive counseling and initiation to become a standard part of hospital care for pregnancy-capable individuals.
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Affiliation(s)
- Ryan Spielvogel
- Department of Family Medicine, Sutter Medical Center Sacramento, Sacramento, CA, United States.
| | - Rebecca B Stephens
- Department of Family Medicine, Sutter Medical Center Sacramento, Sacramento, CA, United States
| | - Robert Clark
- Department of Family Medicine, Sutter Medical Center Sacramento, Sacramento, CA, United States
| | - Michele Guillen
- Sutter Institute for Medical Research, Sacramento, CA, United States
| | - Andrea Hankins
- Sutter Center for Health Systems Research, Sacramento, CA, United States
| | - Carol Parise
- Sutter Center for Health Systems Research, Sacramento, CA, United States
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Sims CA, Eudy AM, Doss J, Rogers JL, Sadun RE, Criscione-Schreiber L, Sun K, Clowse ME. The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus. Lupus 2023; 32:1666-1674. [PMID: 37966369 DOI: 10.1177/09612033231216602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Women with systemic lupus erythematosus (SLE) who get pregnant while SLE is active or while on teratogens have higher risk of poor pregnancy outcomes. The American College of Rheumatology (ACR) Reproductive Health Guidelines recommend women conceive when SLE is well controlled and treated with pregnancy-compatible medications. The Healthy Outcomes in Pregnancy with SLE Through Education of Providers (HOP-STEP) Intervention was created to ascertain pregnancy interest and contraceptive use followed by a personalized pregnancy prevention and/or planning discussion (https://www.LupusPregnancy.org). All study participants were adult females enrolled in a prospective registry who met ACR or SLICC criteria. Women were defined as "not medically ready for pregnancy" if they were currently prescribed a teratogen, had proteinuria ≥500 mg, or had elevated SLE activity according to the physician's global assessment. Two time periods were assessed: 2/2018-12/2019 and 10/2020-4/2021 to evaluate pre- and post-pandemic periods, with some post-pandemic visits taking place via telehealth. The interest in pregnancy was similar between the first time period (17%) and the second time period, whether in-person (18%) or virtual (18%). Pregnancy interest was assessed significantly more frequently during in-person visits (90%) compared to virtual encounters (67%) (p = .02). Contraceptive use was not significantly different during either time period with use of a teratogen or increased SLE activity. Of the 52 women in both time periods who were not medically ready for pregnancy and were not on effective contraception, three women (5.8%) conceived. None of the women who were using moderate or highly effective contraception became pregnant. Pregnancy outcomes were similar between unintended or high-risk and well-timed pregnancies. The HOP-STEP Intervention effectively identified pregnancy interest, giving rheumatologists the opportunity to address patient reproductive goals, optimize disease activity, and adjust medication regimens prior to conception.
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Affiliation(s)
- Catherine A Sims
- Department of Rheumatology, Duke University, Durham, NC, United States
| | - Amanda M Eudy
- Department of Rheumatology, Duke University, Durham, NC, United States
| | - Jayanth Doss
- Department of Rheumatology, Duke University, Durham, NC, United States
| | - Jennifer L Rogers
- Department of Rheumatology, Duke University, Durham, NC, United States
| | - Rebecca E Sadun
- Department of Rheumatology, Duke University, Durham, NC, United States
| | | | - Kai Sun
- Department of Rheumatology, Duke University, Durham, NC, United States
| | - Megan Eb Clowse
- Department of Rheumatology, Duke University, Durham, NC, United States
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Jain R, Kazmerski TM, Taylor-Cousar JL. The modern landscape of fertility, pregnancy, and parenthood in people with cystic fibrosis. Curr Opin Pulm Med 2023; 29:595-602. [PMID: 37789771 PMCID: PMC10629848 DOI: 10.1097/mcp.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
PURPOSE OF REVIEW With improved long-term survival and the expanding availability of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies that treat the underlying genetic defect in cystic fibrosis, more people are interested in parenthood. Cystic fibrosis care centers and people with cystic fibrosis need more information to guide decisions related to parenting. RECENT FINDINGS Here we present currently available data on fertility, pregnancy, and parenthood in the modern era of cystic fibrosis care. Fertility may be improving in female individuals with cystic fibrosis with the use of CFTR modulator therapies, and there is an associated increase in annual pregnancies. Infertility in male individuals with cystic fibrosis remains approximately 97-98% and is unchanged with CFTR modulators in those already born with cystic fibrosis. As more female individuals with cystic fibrosis experience pregnancy, questions remain about the impact of pregnancy on their health and that of their child. Fortunately, there are multiple routes to becoming a parent; however, more work is needed to understand the impact of pregnancy and parenthood in the context of CF as some previous data suggests potential challenges to the health of parents with cystic fibrosis. SUMMARY We encourage cystic fibrosis care teams to have knowledge and resources available to support the reproductive goals of all individuals with cystic fibrosis.
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Affiliation(s)
- Raksha Jain
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Traci M Kazmerski
- University of Pittsburgh School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L Taylor-Cousar
- National Jewish Health, Departments of Internal Medicine and Pediatrics Denver, CO, USA
- University of Colorado Anschutz Medical Campus, Departments of Internal Medicine and Pediatrics, Aurora, CO, USA
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Hall JA, Barrett G, Stephenson JM, Edelman NL, Rocca C. Desire to Avoid Pregnancy scale: clinical considerations and comparison with other questions about pregnancy preferences. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:167-175. [PMID: 36717217 PMCID: PMC10359540 DOI: 10.1136/bmjsrh-2022-201750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Clinicians and women of reproductive age would benefit from a reliable way to identify who is likely to become pregnant in the next year, in order to direct health advice. The 14-item Desire to Avoid Pregnancy (DAP) scale is predictive of pregnancy; this paper compares it with other ways of assessing pregnancy preferences to shortlist options for clinical implementation. METHODS A cohort of 994 UK women of reproductive age completed the DAP and other questions about pregnancy preferences, including the Attitude towards Potential Pregnancy Scale (APPS), at baseline and reported on pregnancies quarterly for a year. For each question, DAP item and combinations of DAP items, we examined the predictive ability, sensitivity, specificity, area under the receiver operating curve (AUROC), and positive and negative predictive values. RESULTS The AUROCs and predictive ability of the APPS and DAP single items were weaker than the full DAP, though all except one had acceptable AUROCs (>0.7). The most predictive individual DAP item was 'It would be a good thing for me if I became pregnant in the next 3 months', where women who strongly agreed had a 66.7% chance of pregnancy within 12 months and the AUROC was acceptable (0.77). CONCLUSION We recommend exploring the acceptability to women and healthcare professionals of asking a single DAP item ('It would be a good thing for me if I became pregnant in the next 3 months'), possibly in combination with additional DAP items. This will help to guide service provision to support reproductive preferences.
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Affiliation(s)
- Jennifer Anne Hall
- Research Department of Reproductive Health, UCL Institute for Women's Health, London, UK
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL Institute for Women's Health, London, UK
| | - Judith M Stephenson
- Research Department of Reproductive Health, UCL Institute for Women's Health, London, UK
| | - Natalie Lois Edelman
- School of Sport & Health Sciences, University of Brighton, Brighton, UK
- Primary Care & Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Corinne Rocca
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco (UCSF) School of Medicine, Oakland, San Francisco, California, USA
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Wang S, Minguez-Alarcon L, Capotosto MP, Mitsunami M, Gaskins AJ, Charlton BM, Hart JE, Rich-Edwards JW, Chavarro JE. Pregnancy Intention, Changes in Pregnancy Intention, and Pregnancy Incidence Among Female Nurses in North America. JAMA Netw Open 2023; 6:e2311301. [PMID: 37133861 PMCID: PMC10157424 DOI: 10.1001/jamanetworkopen.2023.11301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/20/2023] [Indexed: 05/04/2023] Open
Abstract
Importance Pregnancy intention assessment is a key element of preconception and contraceptive care. The association between a single screening question and the incidence of pregnancy is unknown. Objective To prospectively evaluate the dynamics of pregnancy intention and pregnancy incidence. Design, Setting, and Participants This prospective cohort study (the Nurses' Health Study 3) was conducted from June 1, 2010, to April 1, 2022, in 18 376 premenopausal, nonpregnant female nurses aged 19 to 44 years. Main Outcomes and Measures Pregnancy intention and pregnancy status were assessed at baseline and approximately every 3 to 6 months thereafter. Cox proportional hazards regression models were used to estimate the association between pregnancy intention and pregnancy incidence. Results A total of 18 376 premenopausal, nonpregnant women (mean [SD] age, 32.4 [6.5] years) participated in the study. At baseline, 1008 women (5.5%) were trying to conceive, 2452 (13.3%) were contemplating pregnancy within 1 year, and the remaining 14 916 (81.2%) were neither trying to conceive nor thought they would be pregnant within 1 year. A total of 1314 pregnancies were documented within 12 months of pregnancy intention assessment. The cumulative incidence of pregnancy was 38.8% in women actively trying to conceive (median [IQR] time to pregnancy, 3.3 [1.5-6.7] months), 27.6% in women contemplating pregnancy (median [IQR] time to pregnancy, 6.7 [4.2-9.3] months), and 1.7% in women neither trying to conceive nor contemplating pregnancy (median [IQR] time to pregnancy, 7.8 [5.2-10.5] months) among those who became pregnant. Women who were actively trying to conceive were 23.1 times (95% CI, 19.5-27.4 times) and women who were contemplating pregnancy were 13.0 times (95% CI, 11.1-15.2 times) more likely to conceive within 12 months than women who were neither attempting nor contemplating pregnancy. Among women contemplating pregnancy at baseline who did not get pregnant during follow up, 18.8% were actively trying and 27.6% were not trying by 12 months. Conversely, only 4.9% of women neither trying to conceive nor contemplating pregnancy within 1 year at baseline changed pregnancy intention during follow up. Conclusions and Relevance In this cohort study of reproductive-aged nurses in North America, pregnancy intention was highly fluid among women who were contemplating pregnancy but relatively stable among women trying to conceive and women who were neither trying to conceive nor contemplating pregnancy. Pregnancy intention was strongly associated with pregnancy incidence, but the median time to pregnancy points to a relatively short time window to initiate preconception care.
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Affiliation(s)
- Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lidia Minguez-Alarcon
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Makiko Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Brittany M. Charlton
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Janet W. Rich-Edwards
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Ren M, Shireman H, VanGompel EW, Bello JK, Carlock F, McHugh A, Stulberg D. Preconception, Interconception, and reproductive health screening tools: A systematic review. Health Serv Res 2023; 58:458-488. [PMID: 36573542 PMCID: PMC10012234 DOI: 10.1111/1475-6773.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify and describe the standardized interconception and preconception screening tools for reproductive health needs that are applicable in general outpatient clinical practice. DATA SOURCES AND STUDY SETTING This systematic review identifies research on pregnancy intention screening and counseling tools, and standardized approaches to preconception and interconception care. We focus on tools designed for clinical settings, but also include research tools with potential for clinical implementation. These tools may include a component of contraceptive counseling, but those focusing solely on contraceptive counseling were excluded. Data were collected from studies done in the United States between January 2000 and March 2022. STUDY DESIGN We performed a systematic literature search to generate a list of unique tools, assessed the quality of evidence supporting each tool, and described the peer-reviewed clinical applications of each. We used the Mixed Methods Appraisal Tool to appraise the quality of individual studies. DATA COLLECTION/EXTRACTION METHODS We searched PubMed, Web of Science, and CINAHL databases for standardized preconception and interconception health screening tools published in English from January 2000 through March 2022. We used keywords "preconception care," "interconception care," "family planning," "contraception," "reproductive health services," and "counseling." Utilizing the Preferred Reporting Items for Systematic Reviews guidelines, we screened titles and abstracts to identify studies for full text review. PRINCIPAL FINDINGS The search resulted in 15,399 studies. After removing 4172 duplicates, we screened 11,227 titles/abstracts and advanced 207 for full-text review. From these, we identified 53 eligible studies representing 22 tools/standardized approaches, of which 10 had evidence from randomized clinical trials. These ranged widely in design, setting, and population of study. CONCLUSIONS Clinicians have a choice of tools when implementing standard reproductive screening services. A growing body of research can inform the selection of an appropriate tool, and more study is needed to establish effects on long-term patient outcomes.
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Affiliation(s)
- Megan Ren
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Hannah Shireman
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
| | - Emily White VanGompel
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA.,Northshore University Healthsystem, Evanston, Illinois, USA
| | - Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University, St Louis, Missouri, USA
| | | | - Ashley McHugh
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
| | - Debra Stulberg
- Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
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Mc Laughlin L, Jones C, Neukirchinger B, Noyes J, Stone J, Williams H, Williams D, Rapado R, Phillips R, Griffin S. Feminizing care pathways: Mixed‐methods study of reproductive options, decision making, pregnancy, post‐natal care and parenting amongst women with kidney disease. J Adv Nurs 2023. [PMID: 37002600 DOI: 10.1111/jan.15659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
AIMS To identify the needs, experiences and preferences of women with kidney disease in relation to their reproductive health to inform development of shared decision-making interventions. DESIGN UK-wide mixed-methods convergent design (Sep 20-Aug 21). METHODS Online questionnaire (n = 431) with validated components. Purposively sampled semi-structured interviews (n = 30). Patient and public input throughout. FINDINGS Kidney disease was associated with defeminization, negatively affecting current (sexual) relationships and perceptions of future life goals. There was little evidence that shared decision making was taking place. Unplanned pregnancies were common, sometimes influenced by poor care and support and complicated systems. Reasons for (not) wanting children varied. Complicated pregnancies and miscarriages were common. Women often felt that it was more important to be a "good mother" than to address their health needs, which were often unmet and unrecognized. Impacts of pregnancy on disease and options for alternates to pregnancy were not well understood. CONCLUSION The needs and reproductive priorities of women are frequently overshadowed by their kidney disease. High-quality shared decision-making interventions need to be embedded as routine in a feminized care pathway that includes reproductive health. Research is needed in parallel to examine the effectiveness of interventions and address inequalities. IMPACT We do not fully understand the expectations, needs, experiences and preferences of women with kidney disease for planning and starting a family or deciding not to have children. Women lack the knowledge, resources and opportunities to have high-quality conversations with their healthcare professionals. Decisions are highly personal and related to a number of health, social and cultural factors; individualized approaches to care are essential. Healthcare services need to be redesigned to ensure that women are able to make informed choices about pregnancy and alternative routes to becoming a parent. PATIENT OR PUBLIC CONTRIBUTION The original proposal for this research came from listening to the experiences of women in clinic who reported unmet needs and detailed experiences of their pregnancies (positive and negative). A patient group was involved in developing the funding application and helped to refine the objectives by sharing their experiences. Two women who are mothers living with kidney disease were co-opted as core members of the research team. We hosted an interim findings event and invited patients and wider support services (adoption, fertility, surrogacy, education and maternal chronic kidney disease clinics) from across the UK to attend. We followed the UK national standards for patient and public involvement throughout.
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12
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Wang S, Rexrode KM, Florio AA, Rich-Edwards JW, Chavarro JE. Maternal Mortality in the United States: Trends and Opportunities for Prevention. Annu Rev Med 2023; 74:199-216. [PMID: 36706746 DOI: 10.1146/annurev-med-042921-123851] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Maternal mortality is unusually high in the United States compared to other wealthy nations and is characterized by major disparities in race/ethnicity, geography, and socioeconomic factors. Similar to other developed nations, the United States has seen a shift in the underlying causes of pregnancy-related death, with a relative increase in mortality resulting from diseases of the cardiovascular system and preexisting medical conditions. Improved continuity of care aimed at identifying reproductive-age women with preexisting conditions that may heighten the risk of maternal death, preconception management of risk factors for major adverse pregnancy outcomes, and primary care visits within the first year after delivery may offer opportunities to address gaps in medical care contributing to the unacceptable rates of maternal mortality in the United States.
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Affiliation(s)
- Siwen Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea A Florio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA;
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA; .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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13
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Meiss LN, Jain R, Kazmerski TM. Family Planning and Reproductive Health in Cystic Fibrosis. Clin Chest Med 2022; 43:811-820. [PMID: 36344082 DOI: 10.1016/j.ccm.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Family planning in cystic fibrosis (CF) is an increasingly important aspect of care, as improvements in care and outcomes lead to a rise in the number of pregnancies and parenthood in people with CF. This article highlights: (1) Health considerations for people with CF related to pregnancy, contraception, and parenthood. (2) Facets of reproductive planning, fertility, and preconception counseling. (3) Relationship-centered reproductive health discussions.
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Affiliation(s)
- Lauren N Meiss
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Raksha Jain
- Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8558, USA
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, USA.
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14
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Rocca CH, Smith MG, Hale NL, Khoury AJ. Ranges of pregnancy preferences and contraceptive use: Results from a population-based survey in the southeast United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:90-98. [PMID: 36071572 DOI: 10.1363/psrh.12205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Understanding how pregnancy preferences shape contraceptive use is essential for guiding contraceptive interventions and policies that center individuals' preferences and desires. Lack of rigorous measurement of pregnancy preferences, particularly on the population level, has been a methodologic challenge. METHODS We investigated associations between prospective pregnancy preferences, measured with a valid instrument, the Desire to Avoid Pregnancy (DAP) scale, and contraceptive use in a representative sample of 2601 pregnancy-capable self-identified women, aged 18-44 years, in Alabama and South Carolina (2017-2018). We used multivariable regression with weighting to investigate how probability of modern contraceptive use, and use of different contraceptive method types, changed with increasing preference to avoid pregnancy. RESULTS Desire to Avoid Pregnancy scale scores (range:0-4, 4 = greater preference to avoid pregnancy, median = 2.29, IQR: 1.57-3.14; α:0.95) were strongly associated with contraceptive use among sexually active respondents (aPR = 1.15 [1.10, 1.20]; predicted 45% using contraception among DAP = 0, 62% among DAP = 2, 86% among DAP = 4). Method types used did not differ by DAP score. The most common reasons for nonuse were concern over side effects and not wanting to use a method (32% each) among respondents with mid-range and high DAP scores. Among those with mid-range DAP scores, 20% reported nonuse due to not minding if pregnancy were to occur (vs. 0% among those with high DAP scores). CONCLUSIONS Pregnancy preferences strongly influence likelihood of contraceptive use. Providion of appropriate contraceptive care to those not explicitly desiring pregnancy must differentiate between ranges of feelings about pregnancy, perceived drawbacks to contraceptive use, and legitimate psychological and interpersonal benefits of nonuse to promote autonomy in contraceptive decision-making.
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Affiliation(s)
- Corinne H Rocca
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, School of Medicine, Oakland, California, USA
| | - Michael G Smith
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Nathan L Hale
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal J Khoury
- College of Public Health, Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee, USA
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15
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Jacob CM, Hanson M. The preconception period as a platform for preventing diabetes and non‐communicable diseases. PRACTICAL DIABETES 2022. [DOI: 10.1002/pdi.2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chandni Maria Jacob
- Institute of Developmental Sciences, School of Human Development and Health, Faculty of Medicine, University of Southampton Southampton UK
| | - Mark Hanson
- Institute of Developmental Sciences, School of Human Development and Health, Faculty of Medicine, University of Southampton Southampton UK
- Southampton NIHR Biomedical Research Centre University Hospital Southampton UK
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16
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Thorman A, Engle A, Brintz B, Simmons RG, Sanders JN, Gawron LM, Turok DK, Kaiser JE. Quantitative and qualitative impact of One Key Question on primary care providers' contraceptive counseling at routine preventive health visits. Contraception 2022; 109:73-79. [PMID: 35038448 PMCID: PMC9258909 DOI: 10.1016/j.contraception.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES One Key Question (OKQ) is a clinical screening tool to assess pregnancy desire in the next year. We aimed to 1) describe the effect of OKQ implementation on contraceptive counseling rates at preventive health visits and 2) evaluate primary care providers' perception of OKQ implementation on their contraceptive counseling practices. STUDY DESIGN We performed a quantitative retrospective chart review of preventive health visits at eight federally qualified health centers in Utah between 2014 and 2017. Implementation of OKQ included a brief training and inclusion of OKQ in the electronic medical record. Providers received OKQ training in August 2015 and re-training in March 2017. We assessed OKQ and contraceptive counseling documentation rates using interrupted-time-series analysis. We then conducted semi-structured interviews with providers and queried them about the impact of OKQ. We identified dominant themes using modified grounded theory to create an explanatory framework. RESULTS Abstracting 6634 charts yielded 9840 visits with 56 unique providers (51% physician assistant, 34% physician, 14% nurse practitioner). Interrupted-time-series analysis showed a documentation increase of OKQ in late 2015 (2.6%) and again in spring 2017 (9%), however rates remained low. Contraceptive counseling rates (39.7%) did not change after OKQ implementation. Charts with evidence of a current contraceptive method were less likely to have a OKQ response documented. Interviewees reported OKQ's algorithm did not alter their contraceptive counseling. CONCLUSIONS OKQ did not change documented rates of contraceptive counseling and uptake was low in quantitative and qualitative analyses. Our study suggests limited usefulness of OKQ in the primary care setting. IMPLICATIONS Implementation of the One Key Question tool through training and optional EHR field did not increase documented rates of contraceptive counseling in a large federally qualified health center or affect provider contraceptive counseling. Our study suggests limited usefulness of OKQ as a robust screening tool in this primary care setting.
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Affiliation(s)
- Alyssa Thorman
- University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Alyssa Engle
- University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Benjamin Brintz
- University of Utah, Study Design and Biostatistics Center, Salt Lake City, UT, United States
| | - Rebecca G Simmons
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Jessica N Sanders
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Lori M Gawron
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - David K Turok
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States
| | - Jennifer E Kaiser
- University of Utah, Division of Family Planning, Salt Lake City, UT, United States.
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17
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Ferketa M, Schueler K, Song B, Carlock F, Stulberg DB, White VanGompel E. Facilitators of and Barriers to Successful Implementation of the One Key Question ® Pregnancy Intention Screening Tool. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:326-334. [PMID: 35415707 PMCID: PMC8994428 DOI: 10.1089/whr.2021.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/05/2022]
Abstract
Background: One Key Question® (OKQ) is a tool that embeds a patient-centered screening into routine visits with the goal of making pregnancy intention screening universal, but widespread implementation has not yet been adopted. We aimed to explore the barriers and facilitators of OKQ implementation to better understand how to best implement the tool across different settings. Methods: We invited staff and clinicians from one obstetrics and gynecology clinic and one family medicine clinic, which previously implemented OKQ, to complete surveys and qualitative interviews about their experiences with the tool. The interview guide and thematic analysis of the interview transcripts were informed by the Consolidated Framework for Implementation Research (CFIR). Main Findings: Major facilitators of OKQ implementation are the simplicity of the tool, engagement of clinic leadership, and compatibility between the perceived goals of the tool and those of practice staff and clinicians. Although participants indicated that OKQ had a minimal impact on clinic workflow during its implementation, preimplementation time concerns were a major barrier to implementation in both clinics. Barriers seen in the family medicine practice included OKQ distracting from the visit agenda, and concerns about the OKQ gold standard protocol of screening each patient at every visit. Participants even suggested asking OKQ only during annual check-up appointments. Conclusions: The perceived alignment between the tool's goals and those of clinic stakeholders was an important facilitator of OKQ implementation success. However, characteristics of the clinic setting, such as competing medical priorities and time constraints, influenced initial attitudes toward the feasibility of the intervention. Clinical Trial Registration Number: NCT03947788
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Affiliation(s)
- Meron Ferketa
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Kellie Schueler
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Bonnie Song
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research Institute, Evanston, Illinois, USA
| | - Debra B Stulberg
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.,Department of Family Medicine, University of Chicago, Chicago, Illinois, USA
| | - Emily White VanGompel
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.,NorthShore University HealthSystem (NSUHS) Research Institute, Evanston, Illinois, USA
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18
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Galvin AM, Garg A, Griner SB, Diener AK, Thompson EL. ‘The chances are zero’: a qualitative study on perceived susceptibility to pregnancy among women experiencing homelessness. Sex Health 2022; 19:164-171. [DOI: 10.1071/sh21241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022]
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19
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Robbins CL, Zapata LB, D'Angelo D, Brewer LI, Pazol K. Pregnancy Intention: Associations with Maternal Behaviors and Experiences During and After Pregnancy. J Womens Health (Larchmt) 2021; 30:1440-1447. [PMID: 34190626 PMCID: PMC10102922 DOI: 10.1089/jwh.2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The associations between levels of pregnancy intention and adverse behaviors or experiences during pregnancy and postpartum have not been well described. Materials and Methods: We used 2018 Pregnancy Risk Assessment Monitoring System data from 31 jurisdictions in the United States (n = 32,777) to estimate prevalence of inadequate prenatal care (PNC), inappropriate gestational weight gain, depression during pregnancy, intimate partner violence (IPV) during pregnancy, third trimester smoking, no breastfeeding, no postpartum visit, postpartum depressive symptoms, and postpartum smoking by categories of pregnancy intention: unwanted, ambivalent (i.e., unsure), mistimed (i.e., wanted later), or wanted (i.e., wanted then/sooner). Regression models estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) of associations between pregnancy intention and maternal behaviors or experiences. Results: Approximately 16% of women reported pregnancy ambivalence. Women with pregnancy ambivalence (versus wanted pregnancies) had higher prevalence of all adverse maternal behaviors and experiences. Separate models found women with unwanted pregnancy (vs. ambivalent) had higher prevalence for depression during pregnancy (aPR: 1.40, 95% CI: 1.21-1.63), IPV (aPR: 1.75, 95% CI: 1.11-2.77), no breastfeeding (aPR: 1.22, 95% CI: 1.04-1.44), no postpartum visit (aPR: 1.28, 95% CI: 1.06-1.55), and postpartum depressive symptoms (aPR: 1.19, 95% CI: 1.00-1.42); Women with mistimed pregnancy (vs. ambivalent) had lower prevalence for inadequate PNC (aPR: 0.89, 95% CI: 0.81-0.98), third trimester smoking (aPR: 0.68, 95% CI: 0.57-0.80), no breastfeeding (aPR: 0.85, 95% CI: 0.74-0.98), and postpartum smoking (aPR: 0.83, 95% CI: 0.73-0.95). Discussion: The results emphasize the importance of recommended screening and care during the preconception, prenatal, and postpartum periods.
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Affiliation(s)
- Cheryl L Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,U.S. Public Health Service Commissioned Corps, Atlanta, Georgia, USA
| | - Denise D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lara I Brewer
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Pazol
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Gawron LM, Simonsen S, Millar MM, Lewis-Caporal J, Patel S, Simmons RG. Pregnancy Risk Screening and Counseling for Women Veterans: Piloting the One Key Question in the Veterans Healthcare Administration. South Med J 2021; 114:150-155. [PMID: 33655308 DOI: 10.14423/smj.0000000000001218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Women veterans have a high prevalence of comorbidities that increase the risk of adverse pregnancy outcomes. Screening for pregnancy desires in primary care provider (PCP) visits offers an opportunity to optimize preconception health. This pilot quality improvement initiative sought to assess Veterans Healthcare Administration provider preferences on One Key Question (OKQ) implementation, identification of veterans' reproductive needs, and the effect of training on documentation in a women's primary care clinic in Salt Lake City, Utah. METHODS We hosted OKQ training sessions for providers and staff, audio recorded group discussions on implementation barriers, and explored themes. Women veterans presenting for a PCP visit in July 2018 self-completed a paper OKQ screening tool. We calculated summary statistics on responses. We conducted a pre-post analysis, with respect to training sessions, to measure for changes in family planning documentation during PCP visits. RESULTS Nineteen providers and staff completed the training. They acknowledged the importance, but believed that the screening tool should be completed by veterans and not be provider prompted. Forty-two women veterans completed the screening tool: 21% desired pregnancy in the next year and 26% desired contraceptive information. Chart reviews found a nonsignificant increase in current contraceptive method documentation between periods (20% vs 37%; P = 0.08), a decline in documentation of reproductive goals (22% vs 3%; P = 0.02), and no significant change in counseling. CONCLUSIONS Veterans identify reproductive needs via the OKQ screening tool, but provider documentation did not reflect changes in care following training. Further study is necessary to develop an optimal, patient-centered tool and implementation plan to support women veterans in their reproductive goals.
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Affiliation(s)
- Lori M Gawron
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Sara Simonsen
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Morgan M Millar
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Jessica Lewis-Caporal
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Shardool Patel
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
| | - Rebecca G Simmons
- From the Department of Obstetrics and Gynecology, the College of Nursing, and the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, the Salt Lake City Veterans Healthcare Administration, Salt Lake City, Utah
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21
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Abstract
OBJECTIVE In seeking new approaches to improve lupus pregnancy outcomes, we study the association between pregnancy planning, behaviors recommended by American College of Rheumatology's Reproductive Health Guideline 2020, and pregnancy and infant outcomes. METHODS Lupus pregnancies in a prospective registry (1/1/2018 to 4/1/2020) were classified as planned or not-planned using the patient-reported London Measure of Unplanned Pregnancy. These groups were compared for demographics, pre-pregnancy disease activity, pregnancy planning behaviors, and delivery outcomes. RESULTS Among 43 women with 43 singleton pregnancies the average age was 29.4 years and 42% were Black. Overall, 60% were planned pregnancies and 40% were not-planned (16 ambivalent, 1 unplanned). Women with not-planned pregnancies had lower age, income, and education, and more required Medicaid. Women with not-planned pregnancies were more likely to conceive when lupus activity was higher (p = 0.001), less likely to receive pre-pregnancy counseling with a rheumatologist (p = 0.02), and less likely to continue pregnancy-compatible medications (p = 0.03). Severe PROMISSE adverse pregnancy outcomes (APOs) and severe neonatal outcomes were higher among women with not-planned than planned pregnancies (43% vs 0% p = 0.003; 70% vs 30% p = 0.06). CONCLUSION This study identifies pregnancy intention as a potentially modifiable risk factor for poor outcomes in women with lupus. It highlights a unique population of women with lupus at high risk for pregnancy and infant complications: those ambivalent about pregnancy. These women may not be effectively engaging in health behaviors that prevent pregnancy nor those that will prepare for a safe pregnancy. With effective pregnancy planning and contraception guidance, we may decrease their risk for maternal-fetal morbidity and mortality.
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22
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Gipson JD, Bornstein M, Berger A, Rocca CH. Desire to avoid pregnancy and contraceptive use among female methadone patients in Los Angeles. Contraception 2021; 103:322-327. [PMID: 33567322 DOI: 10.1016/j.contraception.2021.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Opioid use disorder (OUD) is increasing among U.S. women. Research indicates higher levels of unintended pregnancy among women with OUD as compared to the general population. Following formative in-depth research documenting the complexity of considerations around pregnancy in this population, we collected information on pregnancy preferences and contraceptive use among women attending methadone treatment. STUDY DESIGN We surveyed women attending methadone clinics in Los Angeles in 2018. We used the Desire to Avoid Pregnancy (DAP) Scale, a 14-item instrument (0-4; 4 = highest desire to avoid pregnancy) to capture pregnancy preferences across 3 domains: cognitive desires, affective feelings, and anticipated consequences. We conducted factor analysis, descriptive analyses, and linear and logistic regressions to assess the DAP scale and to examine relationships between pregnancy preferences, sociodemographic characteristics, and contraceptive use. RESULTS Women (n = 46) expressed the full range of pregnancy preferences (DAP score range: 0.4-4.0; mean: 2.24, standard deviation: 1.02; Cronbach's α = 0.92). Overall, 40% used contraception at last sex. Women who reported a greater preference to avoid pregnancy were marginally more likely to use contraception at last sex as compared to women who were more open to pregnancy (odds ratio = 1.73; p = 0.09). CONCLUSIONS Similar to findings from other populations, responses to the Desire to Avoid Pregnancy scale among a sample of women with OUD revealed a broad range of pregnancy preferences. Pregnancy preferences were marginally associated with contraceptive use in this sample suggesting that the DAP may provide useful insights on pregnancy preferences that may facilitate contraceptive and preconception counseling in this population. IMPLICATIONS Given the complexity of considerations around pregnancy for women with opioid use disorder, the DAP scale may be a valuable tool to identify women's pregnancy and childbearing preferences and to facilitate alignment of women's sexual and reproductive health desires with appropriate services.
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Affiliation(s)
- Jessica D Gipson
- University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, United States.
| | - Marta Bornstein
- University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, United States
| | - Agatha Berger
- Department of Obstetrics and Gynecology, Christiana Care Health System, Center for Women's OB-Gyn and Reproductive Health, Newark, DE, United States
| | - Corinne H Rocca
- University of California, San Francisco Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), Oakland, CA, United States
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23
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Song B, White VanGompel E, Wang C, Guzman S, Carlock F, Schueler K, Stulberg DB. Effects of clinic-level implementation of One Key Question® on reproductive health counseling and patient satisfaction. Contraception 2020; 103:6-12. [PMID: 33130107 DOI: 10.1016/j.contraception.2020.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We evaluated the effect of clinic level implementation of the One Key Question (OKQ) intervention, including physician and staff training and workflow adjustments, on reproductive counseling and patient satisfaction in primary care and ob/gyn. STUDY DESIGN We implemented the OKQ intervention in one primary care and one ob/gyn practice, while observing another primary care and ob/gyn practice that each provided usual care (control practices). We surveyed separate patient cohorts at two time points: 26 before and 33 after the primary care practice implemented OKQ, 38 before and 36 after the ob/gyn practice implemented OKQ, 26 and 37 at the primary care control practice, and 31 and 37 at the ob/gyn control practice. We used chi square tests to assess OKQ's effects on counseling rates and patient satisfaction, comparing intervention to control practices across time points. RESULTS In primary care, from before to after implementation, the intervention practice did not significantly increase reproductive counseling (69-76%, p = 0.58), but increased patient satisfaction (81-97%, p = 0.04) while the control practice demonstrated a decrease in patient satisfaction over the same time periods. In the ob/gyn clinics, no significant change in reproductive counseling or patient satisfaction was seen in the intervention practice, while the control practice demonstrated a decrease in patient satisfaction. CONCLUSIONS Implementing OKQ appears to increase patient satisfaction. Larger studies are needed to assess whether this clinic-level intervention may increase reproductive counseling. IMPLICATIONS Further studies of the impact of clinic-level implementation of OKQ are needed.
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Affiliation(s)
- Bonnie Song
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Emily White VanGompel
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA; Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., MC 7110, Chicago, IL 60637, USA; NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Chi Wang
- NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Suzette Guzman
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Kellie Schueler
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Debra B Stulberg
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA; Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., MC 7110, Chicago, IL 60637, USA.
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