Evaluating fertility preservation interventions for alignment with ASCO Guidelines for reproductive aged women undergoing cancer treatment: a systematic review

PURPOSE

While cancer treatment advancements have increased the number of reproductive-aged women survivors, they can harm reproductive function. Despite national guidelines, oncofertility service uptake remains low. This review explores interventions for fertility preservation alignment with American Society of Clinical Oncology (ASCO) guidelines and consideration of a multilevel framework.

METHODS

We systematically reviewed literature from 2006 to 2022 across four databases. Identified interventions were assessed and scored for quality based on CONSORT and TREND statement checklists. Results were synthesized to assess for intervention alignment with ASCO guidelines and four multilevel intervention framework characteristics: targeted levels of influence, conceptual clarity, methodologic pragmatism, and sustainability.

RESULTS

Of 407 articles identified, this review includes nine unique interventions. The average quality score was 7.7 out of 11. No intervention was guided by theory. Per ASCO guidelines, most (n=8) interventions included provider-led discussions of treatment-impaired fertility. Fewer noted discussions on fertility preservation approaches (n=5) and specified discussion timing (n=4). Most (n=8) referred patients to reproductive specialists, and few (n=2) included psychosocial service referrals. Most (n=8) were multilevel, with five targeting three levels of influence. Despite targeting multiple levels, all analyses were conducted at the individual level. Intervention strategies included: educational components (n=5), decision aids (n=2), and nurse navigators (n=2). Five interventions considered stakeholders' views. All interventions were implemented in real-world contexts, and only three discussed sustainability.

CONCLUSIONS

This review identifies key gaps in ASCO guideline-concordant fertility preservation that could be filled by updating and adhering to standardized clinical practice guidelines and considering multilevel implementation frameworks elements.

Normative range of various serum hormonal parameters among Indian women of reproductive age: ICMR-PCOS task force study outcome

Background

The hormonal profile varies considerably with age, gender, ethnicity, diet or physiological state of an individual. Limited population-specific studies have studied the variations in hormonal parameters among apparently healthy women. We aimed to analyse the biological reference interval for various hormonal parameters in the reproductive-aged healthy Indian women.

Methods

Out of 3877 participants that were clinically evaluated, 1441 subjects were subjected to laboratory investigations. All participants underwent a detailed clinical, biochemical and hormonal profiling. The hormone analysis was carried out at a single centre using a uniform methodology. Among the participants evaluated for biochemical and hormonal parameters, subjects that presented any abnormal profile or had incomplete investigations (n = 593) were excluded for further analysis.

Findings

The mean age (±SD) of the subjects retained in the final analysis (n = 848) was 29.9 (±6.3) years. In the present study, the biological reference interval (2.5th-97.5th centile) observed were: serum T4: μg/dL (5.23-12.31), TSH: μg/mL (0.52-4.16) and serum prolactin: ng/mL (5.13-37.35), LH: mIU/mL (2.75-20.68), FSH: mIU/mL 2.59-15.12), serum total testosterone: ng/mL (0.06-0.68), fasting insulin: mIU/mL (1.92-39.72), morning cortisol: μg/dL (4.71-19.64), DHEAS:μg/dL (50.61-342.6) and SHBG: nmol/L (21.37-117.54). Unlike T4, TSH, LH, and E2, the biological reference interval for prolactin, FSH, testosterone, C-peptide insulin and DHEAS varied when the subjects were stratified by age (p < 0.05). The comparative analysis showed marginal differences in the normative ranges for the hormones analysed among different populations.

Interpretation

Our first large composite data on hormonal measures will benefit future endeavours to define biological reference intervals in reproductive-aged Indian women.

Funding

The study was financially supported by the grant-in-aid from ICMR vide file No:5/7/13337/2015-RBMH.

Knowledge and attitude of reproductive-aged women towards planned oocyte cryopreservation in the United Arab Emirates

BACKGROUND

Delayed conception is associated with a decline in oocyte number and quality. Oocyte cryopreservation techniques are used for medical or non-medical (elective) reasons. We aim to assess the knowledge and attitudes towards planned oocyte cryopreservation (POC) among reproductive-aged women in the United Arab Emirates (UAE) and to investigate the factors interfering with their decisions.

METHODS

A cross-sectional study on 422 women (18-38 years) living in the UAE, using an online questionnaire with three sections: sociodemographic, knowledge, and attitudes towards POC.

RESULTS

91.2% of participants have heard of POC, 84.1% hold a bachelor's degree or higher, 65.4% with medical background, 54.3% employed, and 79.2% live in Sharjah and Dubai. Consideration of POC was significantly associated with age (p = 0.011), employment (p = 0.002), the Emirates they live (p < 0.001), and if they have heard of POC (p = 0.036). Mean knowledge score was 44.44%, which was significantly higher among those considering POC (49.66% vs. 40.55%), and social media was their main source of information. About 57% will not consider POC, mainly due to cost, cultural issues, and safety. Determinants of knowledge score were marital status (B = 0.44; 95%CI: 0.09-0.79; p value = 0.014) and education level (B = 0.35; 95%CI: 0.13-0.58; p value = 0.002), and after adjustment, only the education level remained significantly associated with knowledge score (B = 0.24; 95%CI: 0.01-0.47; p value = 0.042).

CONCLUSION

Despite many participants being motivated to undergo POC, majority had poor knowledge, and cost was the main barrier. The main determinant of the knowledge score was education level. Awareness among couples of consequences of delaying childbearing and comprehensive information from medical practitioners are highly needed.

Chronic non-communicable disease burden among reproductive-age women in India: evidence from recent demographic and health survey

BACKGROUND

Chronic disease burden among women leads to various detrimental consequences, impacting women's health throughout their life course and off-springs. The present study explores the chronic disease profile among reproductive-aged women and analyzes the effects of various covariates on multimorbidity among reproductive-aged women in India. Here, multimorbidity is defined as an individual suffering from two or more chronic conditions.

METHODS

The present study employed the most recent National Family Health Survey round, 2019-2021. The study utilized information on 695,707 non-pregnant women aged 15-49 years. The study used descriptive, bivariate, and multivariable ordered logistic regression analysis to explore the burden of chronic non-communicable diseases and multimorbidity.

RESULTS

The mean age of women with single chronic condition-related morbidity is 30 years, whereas it was 35 years for those with multimorbidity. Approximately 28% of urban women suffered from multimorbidity. Further, significant factors that affect multimorbidity include age, educational attainment, working status, marital status, parity, menopause, religion, region, wealth index, tobacco use, alcohol consumption, and dietary patterns.

CONCLUSIONS

The present study hints that women in the reproductive age group are at very high risk of developing multimorbidity in India. Most of the programs and policies are focused on the elderly population in terms of awareness and facilitating them with better health services. However, right now, one should also prioritize the emerging chronic condition related to chronic conditions other than hypertension, diabetes, and cancer among the study population, which is escalating as soon as women reach 30 years of age.

Multilevel exploration of individual- and community-level factors contributing to overweight and obesity among reproductive-aged women: a pooled analysis of Bangladesh Demographic and Health Survey, 2004-2018

OBJECTIVES

Overweight and obesity have been related to a variety of adverse health outcomes. Understanding the overweight and obesity epidemic in Bangladesh, particularly among reproductive-aged women, is critical for monitoring and designing effective control measures. The purpose of this study was to determine the prevalence of overweight and obesity in reproductive-aged women and to identify the risk factors of overweight and obesity.

DESIGN

A total of 70 651 women were obtained from the five most recent and successive Bangladesh Demographic and Health Surveys (BDHS). The multilevel logistic regression model was used to explore the individual- and community-level factors of overweight and obesity.

SETTING

Five most recent nationally representative household surveys across all regions.

PARTICIPANTS

Reproductive-aged (15-49 years) non-pregnant women.

RESULTS

Approximately 35·2 % (95 % CI: 34·9-35·6 %) of women were either overweight or obese in Bangladesh. At the individual- and community-level, higher age (adjusted odds ratio (aOR) = 5·79, 95 % CI: 5·28-6·34), secondary or higher education (aOR = 1·69 [1·60-1·78]), relatively wealthiest households (aOR = 4·41 [4·10-4·74]), electronic media access (aOR = 1·32 [1·26-1·37]) and community high literacy (aOR = 1·10 [1·04-1·15]) of women were significantly positively associated with being overweight or obese. Whereas, rural residents (aOR = 0·79 [0·76-0·82]) from larger-sized households (aOR = 0·80 [0·73-0·87]) and have high community employment (aOR = 0·92 [0·88-0·97]) were negatively associated with the probability of being overweight or obese.

CONCLUSION

Individual- and community-level factors influenced the overweight and obesity of Bangladeshi reproductive-aged women. Interventions and a comprehensive public health plan aimed at identifying and addressing the growing burden of overweight and obesity should be a top focus.

Association between sleep quality and central obesity among southern Chinese reproductive-aged women

BACKGROUND

The connections between sleep quality and central obesity among reproductive-aged women are not clear. The study aimed to explore the association between sleep quality and central obesity among Chinese reproductive-aged women and identify the independent contributions of sociodemographic characteristics, health-related factors, and sleep quality to central obesity.

METHODS

In this cross-sectional survey, the minimal sample sizes were 2404 subjects; 2449 Chinese women aged 18-49 participated in this study. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Central obesity as the outcome of interest was a binary variable; women were categorized as with versus without central obesity measured by waist circumference (WC). The independent contribution of sociodemographic characteristics (Cluster 1), health-related variables (Cluster 2), and sleep quality (Cluster 3) to central obesity was derived from the corresponding R² change (individual R² change/total R² × 100%), using clustered multiple logistic regression analyses.

RESULTS

The risk of central obesity increased significantly with poor sleep quality (assessed by global PSQI score) [adjusted odds ratio (OR) = 2.20 per SD increase; 95% confidence interval (CI) = 1.28-3.78; P = 0.004], increased sleep disturbance score (adjusted OR = 1.11 per SD increase; 95% CI = 1.01-1.22; P = 0.042) and decreased subjective sleep quality score (adjusted OR = 0.81 per SD increase; 95% CI = 0.73-0.90; P < 0.001). The independent contribution of sleep quality was 9.9%, less than those of sociodemographic (73.3%) and health-related (16.8%) variables. Among complaints related to sleep disturbance, the inability to breathe comfortably, and having bad dreams showed significant associations with central obesity.

CONCLUSIONS

There exists some degree of correlation between sleep quality and central obesity among Chinese reproductive-aged women. These findings underscore the need for future public health guidelines to formulate some detailed strategies to improve sleep quality, such as preventing and intervening risk factors that influence sleep quality and suggesting optimal sleep duration, which might effectively reduce the incidence of central obesity in this population group.

Demographic and socio-cultural factors influencing contraceptive uptake among women of reproductive age in Tamale Metropolis, Northern Region, Ghana

Background

This study assessed some demographic and socio-cultural factors that influence contraceptive uptake among reproductive-aged women in Tamale Metropolis of the Northern Region, Ghana.

Design

This was a cross-sectional study conducted from February to March 2015.

Setting

All three sub Metropolis in Tamale.

Participants

All community members and women of reproductive age (15-49 years).

Intervention

The study used cluster sampling to recruit women who were interviewed using a structured questionnaire. Nine focus group discussions (FGDs) were also held among community members who were purposively selected.

Main outcome measures

contraceptive uptake (use of contraceptive).

Results

The mean age of the women was 26 years. The prevalence of contraceptive uptake among reproductive-age women was 36.8% (165/448). Women with secondary school education [AOR=4.4(95%CI:1.6-12.4)], and those in homes where decisions on having children were made by both partners [AOR=2.1(95%CI:1.1-04.42)] were more likely to use contraceptives. Unemployed women [AOR=0.3(95%CI:0.1-0.8)], women whose husbands were unaware of their contraceptive use [AOR=0.4(95%CI:0.2-0.9)] and those having a culture or religion that frowns on contraceptive use [AOR=0.4(95%CI:0.2-0.8)] were less likely to use contraceptive among women in the Tamale Metropolis.

Conclusion

The study found a contraceptive prevalence rate (CPR) in Tamale Metropolis, Northern Ghana to be 36.8%. Education and living in a home where childbearing decisions are made together were identified as positive factors influencing contraceptive uptake.

Funding

This work was funded by the authors.

Exposure to DDT from indoor residual spraying and biomarkers of inflammation among reproductive-aged women from South Africa

BACKGROUND

Evidence from animal studies suggests that DDT and DDE can adversely affect immuno-competence while human data are less conclusive. We aimed to assess the association of plasma concentrations of DDT and DDE with biomarkers of inflammation among reproductive-aged women residing in homes sprayed with DDT through Indoor Residual Spraying (IRS).

METHODS

This study included 416 women from the Study of Women and Babies, South Africa (2010-2011). DDT, DDE, and biomarkers of inflammation (immunoglobulins A, G and M, interleukins 1β, 6, and 8, tumor necrosis factor-α, C-reactive protein, serum amyloid-A, intercellular adhesion molecule-1, vascular cell adhesion molecule-1) were quantified in plasma. Linear regression was used to assess associations of DDT and DDE with each natural log-transformed biomarker. Models were adjusted for age, body mass index, parity, income, and season; beta estimates were expressed as percent differences.

RESULTS

Compared to women with the lowest plasma concentrations of DDT and DDE, those with the highest concentrations of both compounds had higher levels IL-1β, IL6, and TNF- α. While associations were statistically significant for both DDT and DDE, the magnitude of the associations was slightly stronger for DDT. Compared to women in the lowest quintile of DDT, women in the highest quintile were estimated to have 53.0% (95%CI: 21.7%, 84.4%), 28.1% (95%CI: 6.4%, 49.8%), and 26.6% (95%CI: 12.0%, 41.1%) higher levels of IL-1β, IL6, and TNF- α, respectively.

CONCLUSIONS

Our results suggest that increased plasma concentrations of DDT and DDE resulting from exposure to IRS may increase concentrations of pro-inflammatory biomarkers among reproductive-aged women in South Africa.

Prevalence of type 2 diabetes mellitus compared between lean and overweight/obese patients with polycystic ovarian syndrome: a 5-year follow-up study

PURPOSE

To investigate the prevalence of type 2 diabetes mellitus (T2DM) at the 5-year follow-up after polycystic ovarian syndrome (PCOS) diagnosis compared between lean and overweight/obese groups.

METHODS

This retrospective cohort study included 400 prediabetes PCOS women who attended our clinic. Participants were divided into either the lean group (body mass index [BMI]: < 23 kg/m²) or the overweight/obese group (BMI: ≥ 23 kg/m²). Patient demographic, clinical characteristics, metabolic profiles, and laboratory values were collected and compared between groups at baseline and during follow-up for 5 years.

RESULTS

At the end of the follow-up, overweight/obese group had a higher risk for developing T2DM than lean group (11.5% vs. 0.5%, p < 0.001). Lean group had a lower incidence of hypertension (3% vs. 38.5%, p < 0.001) and dyslipidemia (35% vs. 53.5%, p < 0.001) than overweight/obese group. The factors found to be independently associated with increased risk for developing T2DM were BMI ≥ 23 kg/m² (odds ratio [OR]: 1.075, p = 0.047), non-use of oral combined contraceptive pills (OR: 0.312, p = 0.028), and impaired fasting glucose at baseline (OR: 38.167, p < 0.001).

CONCLUSIONS

Overweight/obese PCOS patients were found to be at significantly higher risk for developing T2DM than lean PCOS patients. Higher BMI, IFG at baseline, and non-use of oral contraceptive pills found to be independent predictors of T2DM in PCOS.

Predisposing, enabling and need factors associated with skilled delivery care utilization among reproductive-aged women in Kersa district, eastern Ethiopia

Background

Skilled delivery care utilization in Ethiopia is still very low compared with the goal set by the global community for countries with the highest maternal mortality. As a result, the country is overburdened with high maternal morbidity and mortality. We aimed to explore the predisposing, enabling, and need factors associated with skilled delivery care utilization among reproductive-aged women in Kersa district, eastern Ethiopia.

Methods

A community-based cross-sectional study was conducted with a total of 1294 women. The participants were selected using systematic sampling techniques. An interviewer-administered structured questionnaire aided by an electronic survey tool was used to collect data. Univariate analyses were conducted to describe the study sample. Bivariate and multivariate logistic regression analyses were carried out to elicit the association of predisposing, enabling, and need factors associated with skilled delivery care utilization. Separate multivariate models were fitted for primiparous and multiparous women categories. Odds ratios with 95% confidence intervals were used to assess statistical significance.

Results

More than a quarter (30.8%) of the women surveyed used skilled delivery care for their most recent birth. Significant predisposing factors were as follows: presence of educated family member; receiving education on maternal health; previous use of skilled delivery care; and best friend’s use of maternal care. Place of residence was the enabling factor that predicted skilled delivery care use. Antenatal care attendance and pregnancy intention were significant need factors associated with skilled delivery care utilization.

Conclusion

The findings of the study highlight the need for a concerted effort to establish community-based peer education programs; improve access to family planning services (to reduce unintended pregnancies); increase antenatal care uptake; and facilitate access to skilled delivery care in rural areas.

Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana'a city, Yemen

BACKGROUND

In Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women.

METHODS

A cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests.

RESULTS

Vaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16-3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09-2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31-0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33-8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC.

CONCLUSIONS

More than a third of non-pregnant reproductive-aged women seeking PHC in Sana'a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.

Increased risk of phthalates exposure for recurrent pregnancy loss in reproductive-aged women

Recurrent pregnancy loss (RPL) is the termination of pregnancies, usually before 20 weeks of gestation, and is defined as the loss of two or more pregnancies. In Taiwan, after 2011 di-2-ethylhexyl phthalate (DEHP) exposure episode, more reproductive-aged women still expose to high levels of DEHP and di-butyl phthalate (DBP) than have women of other age groups. Phthalates might be involved in the RPL pathogenesis. This study assessed the association of phthalate exposure with RPL risk in reproductive-aged Taiwanese women. This study recruited 103 patients diagnosed by a physician with RPL of unknown etiology and 76 controls from the Department of Obstetrics and Gynecology at a medical center in southern Taiwan between August 2013 and August 2017. Urine samples were analyzed for 11 phthalate metabolites through liquid chromatography-tandem mass spectrometry; subsequently, principal component analysis (PCA) and hierarchical clustering analysis were performed to determine the main sources of phthalate exposure. Finally, multivariate logistic regression was used to determine the RPL risk. The creatinine-unadjusted median levels of mono-iso-butyl phthalate (MiBP), mono-n-butyl phthalate (MnBP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP) in RPL/control were 9.8/5.3, 27.2/13.1, 11.4/8.1, and 12.9/9.5 ng/mL, respectively; furthermore, ΣDBPm and ΣDEHPm in RPL/control were 0.18/0.10 and 0.15/0.12 nmol/mL, respectively. PCA revealed three primary components of phthalate exposure: diethyl phthalates (DEP), DEHP, and DBP. Plastic food container use and medication were identified as the main phthalate exposure sources. After adjustment for potential confounding factors (urinary creatinine, age, age at menarche, education, and plastic food container use), we found that the urinary level of ΣDBPm was significantly associated with elevated risk for RPL (OR = 2.85, p = 0.045). Our findings supported the hypothesis that exposure to phthalates increases RPL risk. The development of a strategy to reduce phthalate exposure among reproductive-aged women should be emphasized.

Modern contraceptive use among reproductive-aged women in Ghana: prevalence, predictors, and policy implications

Background

Modern contraceptive use remains an important public health intervention and a cost-effective strategy to reduce maternal mortality, avert unintended pregnancies and to control population explosion, especially in developing countries. Despite these benefits, there are reports of low usage among reproductive-aged women in most developing countries. This study examined the prevalence and predictors of use of modern contraceptive among reproductive-aged women in an urban center with a high density population in Ghana.

Methods

A cross-sectional, interviewer-administered survey was conducted with 217 randomly selected reproductive-aged women. Data was analyzed with STATA. Logistic regression was performed to identify factors influencing modern contraceptive use.

Results

Although we found high levels of knowledge and awareness (98%; n = 213) of modern contraception use, only 21% of participants were using modern contraceptives. Marital status, partner consent and support, and religious beliefs strongly predicted usage.

Conclusion

Usage of modern contraceptives among reproductive-aged women in the Ledzokuku Krowor Municipality is lower than the national target. A multilevel family planning intervention program that primarily focuses on promoting inclusive participation of husbands, targets the unmarried and non-literates reproductive-aged women, and dispels misconceptions, misinformation and religious myths about modern contraceptives has been discussed.

The relationship among preconception depression, anxiety, and social support of the reproductive-aged women in China

The reproductive-aged women have to face physiological and psychological challenges as long as they plan to conceive. However, most previous studies focused on depression and anxiety during pregnancy. This study aimed to investigate the association among preconception depression, anxiety, and social support of the Chinese reproductive-aged women. Nine-hundred five reproductive-aged women who planned to conceive for the first or second time in the next three months were recruited through the Maternity and Child Healthcare Hospital and Obstetrics and Gynecology Hospital from three provinces in China. Social Support Rating Scale, Self-Rating Depression Scale, and Self-Rating Anxiety Scale were used in this study. The hierarchical regression model was employed to examine the prediction effect of the three sub-dimensions of social support on preconception depression and anxiety. Of the reproductive-aged women, 25.86 and 13.04% had preconception depression and anxiety symptoms. Nearly all reproductive-aged women had moderate and high social support before pregnancy. The significant differences in depression and anxiety among different levels of occupation and monthly income were found. For depression and anxiety, objective support, support availability, and subjective support simultaneously entered into the model still could significantly explain 5.9 and 6.7% of variations after controlling for the demographic variables, respectively. According to this study, there were significant correlations among preconception depression, anxiety, and social support. And objective support, support availability, and subjective support could negatively predict preconception depression and anxiety. Attaching importance to the preconception mental health and social support can provide effective scientific support for helping women fully understand and effectively use the social resources, and scientifically prepare for pregnancy.

Determination of factors affecting relapse of vaginitis among reproductive-aged women: An experimental study

INTRODUCTION

Vaginitis is a common problem for women, especially in reproductive-aged women. It is a worldwide health problem with many side effects but could be prevented by a health-promoting lifestyle related to vagina health. The aim of this study was to determine the factors affecting relapse of vaginitis.

METHODS

In this experimental study, 350 reproductive-aged women with vaginitis were selected from 10 health centers in Kermanshah (Iran) during 2015 and were equally included in the intervention and control groups. To collect data, a researcher-created questionnaire, which included sociodemographic and health-promoting lifestyle questions, was used. The educational intervention was performed over 20 sessions, each lasting 25-35 minutes. An intervention group was educated by face-to-face education, pamphlets, phone contacts, text messages, and social media. Another group continued the routine clinic education and treatment without contacting the intervention group. Data were analyzed through chi-square and a logistics regression model using IBM-SPSS version 20.

RESULTS

The results of the study indicated a significant relation between sociodemographic characteristics such as women and their husbands' literacy, job, family size, income, area for each member of family, tendency of pregnancy, body mass index (BMI), and caesarean experience (p<0.001) and vaginitis. In addition, significant relationships between health-promoting lifestyle dimensions and prevention of vaginitis were identified. Relapse after intervention in the intervention group was 27.7% and 72.3% in the control group. According to the logistic regression analysis, chance for relapse of vaginitis in the group that did not receive intervention was more than the same chance in the intervention group (OR=5.14).

CONCLUSION

Health-promoting lifestyle intervention influences prevention of vaginitis. Health-promoting lifestyle, literacy promotion, prevention of caesarian, and obesity are beneficial to improvement in lifestyle dimensions associated with vagina health could be implemented as a successful prevention method. Therefore, it seems that applying a health-promoting lifestyle is essential for a healthy vagina and prevention of vaginitis.

Preconception care and reproductive planning in primary care

Preconception care is designed to identify and reduce biomedical, behavioral, and social risks to the health of a woman or her baby before pregnancy occurs. Few women present requesting preconception care; however, 1 in 10 US women of childbearing age will become pregnant each year. As primary care physicians (PCPs) care for reproductive-aged women before, between, and after their pregnancies, they are ideally positioned to help women address health risks before conception, including optimizing chronic conditions, to prevent adverse pregnancy and longer-term health outcomes. PCPs can help women make informed decisions both about preparing for pregnancy and about using effective contraception when pregnancy is not desired.

Preterm birth and long-term maternal cardiovascular health

PURPOSE

To investigate whether preterm birth (PTB) is associated with greater cardiovascular disease (CVD) risk in a longitudinal cohort.

METHODS

We examined differences in systolic blood pressure (SBP), diastolic blood pressure, insulin resistance (Homeostatic model assessment of insulin resistance), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein, triglycerides, C-reactive protein, and interleukin 6 at 3 years postpartum between women who delivered preterm (gestation <37 weeks; n = 54) versus term (≥37 weeks; n = 751) using multivariable linear regression. We also assessed relations with body mass index, weight change from prepregnancy, and waist circumference at 3 and 7 years postpartum.

RESULTS

Median age at enrollment was 33.9 years (range: 16.4-44.9). After adjusting for age, race, prepregnancy body mass index, parity, marital status, education, and SBP during early pregnancy, women with PTB had 3.99 mm Hg (95% confidence interval, 0.82-7.16) higher SBP and 7.01 mg/dL (1.54-12.50) lower HDL than those who delivered at term. The association with SBP was attenuated after accounting for hypertension before or during pregnancy (2.78 mm Hg [-0.30 to 5.87]). PTB was not related to other postpartum outcomes.

CONCLUSIONS

PTB is related to greater CVD risk by 3 years postpartum as indicated by higher SBP and lower HDL. Although these associations may be due to preexisting conditions exacerbated during pregnancy, PTB may flag high-risk women for more vigilant CVD monitoring and lifestyle interventions.