Contraception最新文献

{"title":"Estetrol/Drospirenone safety in a population with cardiovascular risk factors","authors":"Mitchell D. Creinin ,&nbsp;Jean Michel Foidart ,&nbsp;Kristina Gemzell-Danielsson ,&nbsp;Nina C. Flerin ,&nbsp;Ali Kubba ,&nbsp;Ulysse Gaspard ,&nbsp;Jonathan Douxfils","doi":"10.1016/j.contraception.2025.110861","DOIUrl":"10.1016/j.contraception.2025.110861","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate cardiovascular safety outcomes in estetrol 15 mg/drospirenone 3 mg users with cardiovascular risk factors.</div></div><div><h3>Study design</h3><div>We performed a secondary analysis of two open-label contraceptive phase-3 trials that enrolled participants 16 to 50 years to use estetrol/drospirenone for up to 13 cycles. Study exclusion criteria included &gt;35 years and smoking, body mass index &gt;35 kg/m², and baseline blood pressure (BP) &gt;140/90 mmHg. We compared adverse event rates in participants with and without cardiovascular risk factors and assessed discontinuation rates for cardiovascular adverse events.</div></div><div><h3>Results</h3><div>Of 3417 participants, 1410 (41.3%) had one or more, and 309 (9.0%) had two or more cardiovascular risk factors. We found no difference in discontinuation for any adverse events in participants with and without cardiovascular risk factors. Six (0.18%) participants discontinued for a cardiovascular complaint including four with risk factors: three (0.09%) due to hypertension (all had baseline BP ≥130/85 mmHg and one or more additional risk factors) and one due to venous thrombosis (BP ≥130/85 mmHg). Of 375 participants with baseline BP ≥130/85 mmHg, 0.8% (95% CI 0%–1.7%) discontinued for hypertension while among the 192 participants with baseline BP ≥130/85 mmHg and one or more additional cardiovascular risk factors, 1.6% (95% CI 0%–3.3%) discontinued for hypertension.</div></div><div><h3>Conclusions</h3><div>Among &gt;1400 study participants with cardiovascular risk factors using estetrol/drospirenone, only three (0.2%) discontinued for hypertension, all of whom had high-normal baseline BP and at least one other risk cardiovascular risk factor.</div></div><div><h3><strong>Implications</strong></h3><div>Estetrol/drospirenone use demonstrates excellent cardiovascular tolerance in study participants with normal and high-normal blood pressure, even in those with cardiovascular risk factors. The very low rate of hypertension, even when cardiovascular risk factors were present, provides evidence to warrant clinical trials of estetrol/drospirenone in patients with hypertension desiring contraception.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110861"},"PeriodicalIF":2.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with severe pain during medication abortion at ≤9 weeks’ gestation: A secondary analysis of a multicenter, randomized, placebo-controlled trial","authors":"Kelsey B. Loeliger ,&nbsp;Monica V. Dragoman ,&nbsp;Nathalie Kapp ,&nbsp;Anand Tamang ,&nbsp;Tshegofatso Bessenaar ,&nbsp;Duong Lan Dung ,&nbsp;Jageshwor Gautam ,&nbsp;Jean-Louis Yoko ,&nbsp;Nguyen Hong Minh ,&nbsp;Daniel Grossman","doi":"10.1016/j.contraception.2025.110859","DOIUrl":"10.1016/j.contraception.2025.110859","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to identify covariates other than pain management regimen associated with severe pain during medication abortion at ≤9 weeks’ gestation.</div></div><div><h3>Study design</h3><div>This is a secondary analysis of a randomized trial in Vietnam, Nepal, and South Africa investigating two prophylactic pain management regimens during medication abortion. We used multivariable logistic regression models to identify factors associated with severe pain within 8 hours after taking misoprostol.</div></div><div><h3>Results</h3><div>During June 2016 to October 2017, 273 of 556 (49.1%) participants experienced severe pain (score ≥8 out of 10). In multivariable analyses, controlling for study center and prophylactic treatment arm, multiparity (odds ratio [OR] 0.35, 95% CI 0.23–0.53) was associated with reduced odds of severe pain, while dysmenorrhea (OR 1.16, 95% CI 1.07–1.26) and higher gestational duration (OR 1.05, 95% CI 1.01–1.09) were associated with increased odds of pain. Higher anticipated pain score (OR 1.10, 95% CI 0.99–1.23) was marginally associated with severe pain. Among multiparous patients, history of cesarean delivery (OR 3.49, 95% CI 1.24–9.77), severe pain in childbirth (OR 2.36, 95% CI 1.03–5.42), and dysmenorrhea (OR 1.22, 95% CI 1.08–1.39) were significantly associated with severe pain. Higher gestational duration (OR 1.05, 95% CI 0.99–1.11) trended toward an association with severe pain. Sociodemographic variables, including younger age, marital status, financial stability, and anxiety or depression, were not associated with pain.</div></div><div><h3>Conclusions</h3><div>Beyond known risk factors of nulliparity, dysmenorrhea, and gestational duration, this analysis demonstrates that severe pain during medication abortion is significantly associated with history of cesarean delivery and severe pain in childbirth. Depression and anxiety were not associated with severe pain. These findings can inform counseling for patients seeking medication abortion.</div></div><div><h3>Implications</h3><div>Education and counseling prior to medication abortion should include information about the range of factors associated with increased pain. This information can help individuals make informed decisions about their abortion method and, for those choosing medication abortion, better prepare for and optimize their pain management.</div></div><div><h3>Clinical Trial Registration Number</h3><div>ACTRN126130 0 0 017729</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110859"},"PeriodicalIF":2.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pennsylvania Medicaid policy and rural hospital implementation of immediate postpartum contraception","authors":"Sarah Horvath ,&nbsp;Emma G. Guare ,&nbsp;Grace Ferguson ,&nbsp;Cynthia H. Chuang","doi":"10.1016/j.contraception.2025.110858","DOIUrl":"10.1016/j.contraception.2025.110858","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess the importance of Pennsylvania Medicaid immediate postpartum long-acting reversible contraception (IPLARC) reimbursement policy changes for hospital implementation of IPLARC by rurality.</div></div><div><h3>Study design</h3><div>We surveyed clinician leaders at 51 of 82 (62.2%) Pennsylvania hospitals with labor and delivery units in 2022, including 10 of 51 (19.6%) rural and 17 of 51 (33.3%) academic.</div></div><div><h3>Results</h3><div>Six years after Pennsylvania Medicaid began covering IPLARC outside the obstetrical care bundle, only 3 of 10 (30.0%) rural and 18 of 41 (43.9%) nonrural labor and delivery units had implemented IPLARC.</div></div><div><h3>Conclusions</h3><div>Fewer than half of delivering hospitals in Pennsylvania offered access to IPLARC, even after favorable Medicaid reimbursement policy changes. Nonrural hospitals are more likely to offer IPLARC than rural hospitals.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110858"},"PeriodicalIF":2.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interest in Rh testing and Rh immunoglobulin treatment among patients obtaining telehealth medication abortion","authors":"Linda J. Shin ,&nbsp;Leah R. Koenig ,&nbsp;Jennifer Ko ,&nbsp;Karen Meckstroth ,&nbsp;Ushma D. Upadhyay","doi":"10.1016/j.contraception.2025.110856","DOIUrl":"10.1016/j.contraception.2025.110856","url":null,"abstract":"<div><h3>Objective</h3><div>Despite an absence of evidence that Rhesus (Rh) immunoglobulin is necessary before first-trimester medication abortion, many providers require routine Rh testing and Rh immunoglobulin. We sought to assess knowledge of blood type, receipt of Rh immunoglobulin, and interest in Rh testing and Rh immunoglobulin among patients seeking direct-to-patient telehealth medication abortion care and who may not otherwise need to travel to a clinic.</div></div><div><h3>Study design</h3><div>We used data from the California Home Abortion by Telehealth (CHAT) Study, which included patients who sought medication abortion through telehealth in 20 states and Washington, D.C., in 2021–2022. We analyzed data from two CHAT study samples: survey data from three virtual clinics and electronic medical records (EMRs) obtained from one of those clinics. Patients were counseled on low risk of Rh sensitization at early pregnancy durations and referred for testing or treatment as preferred.</div></div><div><h3>Results</h3><div>Among 1779 survey participants and 2803 patients with EMR records, 51% and 52% respectively knew their blood type, of which 21% and 18% were Rh-negative. Among 189 Rh-negative survey participants, six (0.4%) obtained Rh immunoglobulin. In the EMR sample, among 1341 patients with unknown blood type, 3% indicated interest in Rh testing, and 10% of the 263 Rh-negative patients indicated interest in receiving Rh immunoglobulin.</div></div><div><h3>Conclusions</h3><div>Most patients who choose telehealth services for medication abortion opt out of Rh testing and treatment. Guidelines that mandate Rh testing and Rh immunoglobulin for first-trimester abortions should consider low patient interest alongside the lack of demonstrated clinical necessity.</div></div><div><h3>Implications</h3><div>There is low patient interest in Rh testing and Rh immunoglobulin treatment for first-trimester medication abortion through telehealth. There is a need for clinical guidelines to incorporate patient preferences. Guidelines that do not require Rh testing and treatment following first-trimester abortion are consistent with evidence-based patient-centered abortion care.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110856"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contraception and nonalcoholic fatty liver disease in women with prior gestational diabetes mellitus","authors":"Supatsri Sethasine ,&nbsp;Sasiwan Suthasmalee ,&nbsp;Siriwan Tangjitgamol ,&nbsp;Chadakarn Phaloprakarn","doi":"10.1016/j.contraception.2025.110860","DOIUrl":"10.1016/j.contraception.2025.110860","url":null,"abstract":"<div><h3>Objectives</h3><div>Nonalcoholic fatty liver disease (NAFLD) is an increasing concern among women with a history of gestational diabetes mellitus (GDM). Hormonal contraceptives may affect liver metabolism, potentially increasing NAFLD risk. This study examined the association between different contraceptive methods and NAFLD risk approximately one year postpartum in women with prior GDM.</div></div><div><h3>Study design</h3><div>We conducted a prospective cohort study involving 130 women with prior GDM. We categorized these women into three groups based on their contraceptive use: no contraception or non-hormonal methods (<em>n</em> = 86); progestin-only contraceptives (POCs), including progestin-only pills (POPs), depot medroxyprogesterone acetate (DMPA), and implants (<em>n</em> = 29); and combined oral contraceptives (COCs) (<em>n</em> = 15). At 1 year postpartum, we measured the controlled attenuation parameter to assess hepatic steatosis and diagnose NAFLD. We used multivariable logistic regression analyses to evaluate the association between contraceptive methods and NAFLD risk.</div></div><div><h3>Results</h3><div>The POC group had the highest median controlled attenuation parameter (307<!--> <!-->dB/m) and NAFLD prevalence (55.2%), followed by the no contraception or non-hormonal group (237<!--> <!-->dB/m; 30.2%), with the lowest values in the COC group (213<!--> <!-->dB/m; 13.3%). POCs, particularly POPs and DMPA, significantly increased the risk of NAFLD compared to no contraception or non-hormonal methods (adjusted odds ratio 4.28, 95% confidence interval 1.55–11.85). In contrast, COCs did not show a significant association with NAFLD risk.</div></div><div><h3>Conclusions</h3><div>POCs, particularly POPs and DMPA, significantly increased NAFLD risk, whereas COCs showed no such association. These findings have important implications for contraceptive counseling in women with prior GDM.</div></div><div><h3>Implications</h3><div>Healthcare providers should be cautious about the increased nonalcoholic fatty liver disease risk associated with progestin-only contraceptives, especially progestin-only pills and depot medroxyprogesterone acetate. These findings could guide contraceptive options for women with a history of gestational diabetes mellitus.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"145 ","pages":"Article 110860"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Race-ethnicity and sex disparities in the use of pregnancy prevention methods among U.S. high school students","authors":"Jamille Nagtalon-Ramos ,&nbsp;Tyshaneka L. Saffold ,&nbsp;Nancy Pontes ,&nbsp;Manuel Pontes","doi":"10.1016/j.contraception.2025.110857","DOIUrl":"10.1016/j.contraception.2025.110857","url":null,"abstract":"<div><h3>Objective</h3><div>To examine race-ethnicity and sex differences in the reported use of pregnancy prevention methods at the last sexual encounter among sexually active high school students.</div></div><div><h3>Study design</h3><div>Three waves of cross-sectional data from the nationally representative Youth Risk Behavior Survey (2015–2019) were used to analyze sexually active students who exclusively had sex with opposite-sex partners. R, with its survey package, was used to estimate average marginal percentages, risk differences, and confidence intervals.</div></div><div><h3>Results</h3><div>Results showed significant sex differences in the use of contraceptives. Females (52.4%) were significantly less likely to report condom use than males (61.4%). Females were significantly more likely than males to report the use of oral contraceptive pills (23.2% vs 19.1%) or long-acting reversible contraception (11.8% vs 5.4%). Black (23.2%), Hispanic (21.0%), and Asian (23.0%) females were significantly less likely than White (45.6%) females to use oral contraceptive pills or long-acting reversible contraception. There were significant race-ethnicity differences in not using pregnancy prevention or a reliable pregnancy prevention method. About 37% of Asian female students did not use condoms or any reliable form of contraception.</div></div><div><h3>Conclusions</h3><div>Overall, the use of contraceptives among U.S. female high school students was low. Except for condom use, male high school students underreported the use of contraceptives. Black, Hispanic, and Asian female students are significantly less likely to use reliable contraception compared to White students.</div></div><div><h3>Implications</h3><div>Efforts are needed to close the race-ethnicity gap in contraceptive use and increase contraceptive use among all sexually active students.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110857"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving hemostasis with the JADA system after induced abortion at 12 weeks: A case report","authors":"Serena Ly ,&nbsp;Sheeva Yazdani ,&nbsp;Nicole Economou","doi":"10.1016/j.contraception.2025.110855","DOIUrl":"10.1016/j.contraception.2025.110855","url":null,"abstract":"<div><div>The JADA system is safe and effective for control of abnormal postpartum bleeding and hemorrhage at gestational ages (GA) greater than 34 weeks. This report describes successful use of the JADA to control significant uterine atony and hemorrhage in a patient undergoing procedural abortion at 12 weeks 3 days gestation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110855"},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The International Contraceptive Access Foundation’s model for improving access to the hormonal intrauterine device","authors":"Lorna Begg ,&nbsp;James Sailer ,&nbsp;Kai Risse ,&nbsp;Kendal Danna ,&nbsp;Joanna Holopainen ,&nbsp;Milly Kaggwa ,&nbsp;Anne Pfitzer ,&nbsp;Saumya Ramarao ,&nbsp;Juhani Syrjala ,&nbsp;Nahla Tawab ,&nbsp;Marcel Van Valen ,&nbsp;Maria Mercedes Vivas ,&nbsp;Carolyn Westhoff ,&nbsp;Frank Strelow","doi":"10.1016/j.contraception.2025.110854","DOIUrl":"10.1016/j.contraception.2025.110854","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110854"},"PeriodicalIF":2.8,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcervical foley balloon versus osmotic dilators for cervical preparation","authors":"Patrice Trowbridge,&nbsp;Mitchell D. Creinin","doi":"10.1016/j.contraception.2025.110841","DOIUrl":"10.1016/j.contraception.2025.110841","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110841"},"PeriodicalIF":2.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dilation and evacuation in the setting of trachelectomy and abdominal cerclage: A case report and review of the literature","authors":"Megan Masten ,&nbsp;Cosette Kathawa ,&nbsp;Tsion Shiferaw ,&nbsp;Cara Clure ,&nbsp;Nancy Fang","doi":"10.1016/j.contraception.2025.110840","DOIUrl":"10.1016/j.contraception.2025.110840","url":null,"abstract":"<div><div>This is a patient with a history of radical trachelectomy and abdominal cerclage who underwent an uncomplicated dilation and evacuation at 15 weeks gestation with mifepristone preparation. Dilation and evacuation may be attempted and safely completed for patients in the early second trimester with this history.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"146 ","pages":"Article 110840"},"PeriodicalIF":2.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}