Journal of women's health最新文献

{"title":"Racial and Ethnic Disparities in the Incidence and Treatment of Urinary Tract Infection During Pregnancy.","authors":"Sandra McAteer, Paige Wartko, Anjum Hajat, Sharon Fuller, Susan M Shortreed, Anne Butler, Daniel A Enquobahrie, Robin Garcia, Sascha Dublin","doi":"10.1089/jwh.2024.0940","DOIUrl":"10.1089/jwh.2024.0940","url":null,"abstract":"<p><p><b><i>Background:</i></b> Urinary tract infections (UTIs) occur in 10-18% of United States pregnancies and may lead to maternal and neonatal complications. We examined differences in the incidence and treatment of UTI during pregnancy by race and ethnicity. <b><i>Methods:</i></b> We conducted a cohort study within an integrated health care system, including members aged 15-49 years with live births, stillbirths, spontaneous abortions, or terminations between January 2011 and August 2023. Self-reported race and ethnicity were documented in the electronic health record (EHR). UTIs were defined from diagnosis, medication, and laboratory data. We used modified poisson regression to estimate the cumulative incidence and adjusted risk ratios ([aRR]; with non-Hispanic [NH] White individuals as a reference) of the first UTI per pregnancy, adjusted for maternal age. <b><i>Results:</i></b> Among 63,029 pregnancies across eight racial and ethnic categories, 5,083 (8.1%) individuals experienced UTI during pregnancy. Cohort mean maternal age was 30.4 years and 75.9% of birth outcomes were live or stillbirths. UTI risk ranged from 7.2% among NH White individuals to 14.3% among NH Native Hawaiian/Pacific Islander [NHPI] individuals. Compared to NH White individuals, UTI risk was elevated among NH NHPI (aRR 1.80, 95% confidence interval [CI] 1.50-2.15), NH Black (aRR 1.32, 95% CI 1.19-1.46), NH Asian (aRR 1.13, 95% CI 1.04-1.24), and Hispanic (aRR 1.45, 95% CI 1.32-1.59) individuals. We observed no differences in UTI treatment by race or ethnicity. <b><i>Conclusion:</i></b> UTI burden during pregnancy is greater among racially minoritized groups, suggesting a need for more focus on upstream risk factors, screening, and alleviating the influence of structural racism on infection risk.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measles: A Reemerging Threat to Women's Health.","authors":"Haben Debessai, RaMae A Norton, Kevin A Ault","doi":"10.1089/jwh.2025.0230","DOIUrl":"https://doi.org/10.1089/jwh.2025.0230","url":null,"abstract":"","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Distress and Cognitive Function in Women: Exploring Potential Mediation by Use of Opiates, Sleep Aids, or Minor Tranquilizers.","authors":"Laura Sampson, Rebecca B Lawn, Audrey R Murchland, Jiaxuan Liu, Camille I D Marquez, Arielle A J Scoglio, Shaili C Jha, Jennifer A Sumner, Andrea L Roberts, Jae H Kang, Lori B Chibnik, Karestan C Koenen, Laura D Kubzansky","doi":"10.1089/jwh.2024.0991","DOIUrl":"https://doi.org/10.1089/jwh.2024.0991","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> Distress, including posttraumatic stress disorder (PTSD) and depression, is associated with lower cognitive function and higher use of medications, including sleep aids, opiate pain relievers, and minor tranquilizers. Whether use of these medications is linked to lower cognitive function, and whether such medication use might partially explain the relationship between distress and cognition remains unclear. Using data from 10,653 women in the Nurses' Health Study II, we assessed associations between distress and past-month medication use; medication use and cognitive function; and whether medication use mediates the distress-cognitive function relationship. <b><i>Methods:</i></b> Distress was defined using validated measures of PTSD and depression. To consider possible joint effects of experiencing both forms of distress, we derived a continuous, standardized distress score including symptoms of both PTSD and depression, and a six-level categorical variable indicating the presence/absence of trauma, PTSD, and depression. Past-month medication use was self-reported. Cognitive function was measured with the Cogstate Brief Battery, yielding composite score measures of psychomotor speed/attention and learning/working memory. We fit linear regression models for continuous outcomes, logistic regression for dichotomous outcomes, and conducted causal mediation analysis using a counterfactual framework. <b><i>Results:</i></b> Higher distress was associated with use of all three medications (e.g., a 1-standard-deviation higher continuous distress score was associated with 1.5 times the adjusted odds of past-month opiate use [95% confidence interval: 1.40, 1.60]). Associations between past-month medication use and cognitive function were mixed. <b><i>Conclusion:</i></b> We did not find clear evidence of mediation by medication use, suggesting that distress may influence cognitive function <i>via</i> other pathways.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Steps Forward but Miles to Go: Examining \"Improved but Insufficient\" Legislation to Mandate Insurance Coverage for Medical Fertility Preservation.","authors":"Nina Francis-Levin","doi":"10.1089/jwh.2025.0142","DOIUrl":"https://doi.org/10.1089/jwh.2025.0142","url":null,"abstract":"","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Care Clinician Perspectives on Barriers to Postpartum Transition to Primary Care.","authors":"Ka'Derricka Davis, Kaitlin Huennekens, Abigail M Filicko, Brigid M Dolan, Brittney R Williams, Joe Feinglass, William A Grobman, Michelle A Kominiarek, Lynn M Yee","doi":"10.1089/jwh.2024.0353","DOIUrl":"https://doi.org/10.1089/jwh.2024.0353","url":null,"abstract":"<p><p><b><i>Background:</i></b> The transition from obstetric to primary care is often suboptimal, particularly for individuals with barriers to accessing care. We aimed to understand experiences of primary care clinicians regarding provision of care and their perceptions of barriers to the transition of care in this critical period. <b><i>Methods:</i></b> We conducted focus groups with primary care clinicians recruited from diverse, urban health care settings, including an academic medical center, private practice, and federally qualified health centers. Groups were conducted in person or virtually (December 2019 to February 2021) using a semi-structured approach. Data were analyzed using the constant comparative method to identify themes regarding barriers to providing primary care to postpartum individuals. <b><i>Results:</i></b> The study included 28 primary care clinicians (26 physicians and two advanced practice providers) who participated in eight focus groups. Clinicians identified multiple barriers to the successful transition from obstetric to primary care in the postpartum period. Clinician-based barriers included the lack of a clear hand-off from the obstetric care team and limited capacity to adequately address social determinants of health. Clinician perceptions of patient-based barriers included adverse social determinants of health such as lack of childcare and financial and transportation limitations, challenges addressing ongoing health needs (such as persistence of postpartum medical conditions), and limited health care engagement. <b><i>Conclusions:</i></b> Our results illustrate multiple complex and interrelated challenges to providing optimal primary care during and after the postpartum period that are related to a fragmented health care system, suboptimal support for complex social needs, and insufficient communication between obstetric and primary care clinicians.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Maternal Morbidity and Other Perinatal Complications Among Black, Hispanic, and White Birthing Persons With and Without Physical Disabilities.","authors":"Willi Horner-Johnson, Bharti Garg, Jonathan M Snowden, Aaron B Caughey, Jaime Slaughter-Acey, Ilhom Akobirshoev, Monika Mitra","doi":"10.1089/jwh.2024.0694","DOIUrl":"10.1089/jwh.2024.0694","url":null,"abstract":"<p><p><b><i>Background:</i></b> People with physical disabilities are at increased risk of adverse perinatal outcomes, including severe maternal morbidity (SMM). Risks may be even greater for disabled people in minoritized racial or ethnic groups, but little is known about this intersection. <b><i>Methods:</i></b> We analyzed linked hospital discharge and vital records data from California, 2008-2020. We identified physical disabilities using diagnosis codes for maternal congenital anomalies, major injuries, musculoskeletal disorders, or nervous system disorders. We compared birthing persons in five groups (Black and Hispanic with and without physical disabilities, White with physical disabilities) to a reference group of non-Hispanic Whites without disabilities. We used Poisson regression to assess associations with SMM and other outcomes, with and without adjusting for sociodemographic and clinical covariates. <b><i>Results:</i></b> Disabled Black and Hispanic birthing persons had particularly high relative risks (RRs) of SMM (Black disabled RR = 6.13, 95% confidence interval [CI]: 4.94, 7.61; Hispanic disabled RR = 3.67, 95% CI: 3.29, 4.10) as compared with nondisabled White persons. These risks were greater than those for nondisabled Black (RR = 2.05, 95% CI: 1.99, 2.11), nondisabled Hispanic (RR = 1.36, 95% CI: 1.34, 1.39), and disabled White birthing persons (RR = 2.44, 95% CI: 2.16, 2.77). For most other outcomes, risks were also largest for disabled Black birthing persons, followed by disabled Hispanic birthing persons. <b><i>Conclusions:</i></b> Black and Hispanic people with physical disabilities are highly likely to experience SMM and are at increased risk for other complications and adverse outcomes. Efforts are needed to understand underlying causes of these disparities and develop policies and practices to eliminate them.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"590-600"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Policy Variation in Implementation of Federal Drug and Child Abuse Laws and Stigmatization of Pregnant and Postpartum Individuals with Opioid Use Disorder.","authors":"MacKenzie R Peltier, Destiny D Pegram, Geetanjali Chander, Constance M Weisner, Sherry A McKee, Hendree E Jones, Grace Chang","doi":"10.1089/jwh.2024.0638","DOIUrl":"10.1089/jwh.2024.0638","url":null,"abstract":"<p><p><b><i>Importance:</i></b> Despite increased initiatives and funding to improve access to evidence-based treatments for opioid use disorder (OUD), including medications for OUD (mOUD), pregnant/postpartum individuals have significant obstacles to accessing these life-saving medications. <b><i>Observations:</i></b> Current legislation, specifically the <i>Comprehensive Addiction and Recovery Act (CARA)</i>, mandates that the Governor of each state has systems in place to identify and address the needs of substance-exposed infants. However, this legislation removed the word \"illegal\" when defining substance use and left other important words in the law up to each individual state to define. These changes resulted in pregnant/postpartum individuals with OUD who were receiving legally prescribed mOUD, being subject to legal actions. In many states, such notifications result in investigation and punitive actions, which may include the removal of children from the care of postpartum individuals. These state policies have created additional barriers to accessing mOUD for pregnant and/or postpartum individuals. Research has demonstrated that pregnant individuals delay and/or avoid recommended prenatal care or decide to stop taking mOUD altogether, to prevent potential legal and child welfare-related consequences. This situation is problematic as it places individuals at risk of overdose and death and infants at risk of health complications. Importantly, such policies are subject to bias and disproportionately impact individuals of color and those from lower socioeconomic backgrounds. <b><i>Conclusions and Relevance:</i></b> The need to address and change the criminalization of pregnant/postpartum substance use laws to not penalize individuals adhering to the recommended standard of evidence-based care is urgent. Specific recommendations include: not relying on toxicology testing, reinstating \"illegal/non-prescribed\" language in legislation, implementing Plans of Safe Care, use of a two \"track\" reporting system, and federal support for states complying with Child Abuse Prevention and Treatment Act Reauthorization of 2010 (CAPTA) laws, increasing resources to improve outcomes for infants/postpartum individuals with OUD, and additional mandated training to educate key individuals, such as hospital/outpatient clinic providers and child-welfare workers.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"613-621"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological, Clinical, and Sociobehavioral Factors Associated with Disproportionate Burden of Bacterial Vaginosis in the United States: A Comprehensive Literature Review.","authors":"Eren Watkins, Jay Lin, Melissa Lingohr-Smith, Candice Yong, Krishna Tangirala, Kevin Collins","doi":"10.1089/jwh.2024.0583","DOIUrl":"10.1089/jwh.2024.0583","url":null,"abstract":"<p><p><b><i>Background:</i></b> Bacterial vaginosis (BV), a common gynecological infection characterized by reduced lactic acid-producing bacteria and increased anerobic bacteria in the vaginal microbiome, is associated with adverse health outcomes. <b><i>Methods:</i></b> A PubMed search for English-language articles about BV in the USA and factors contributing to disparities in BV risk, with an emphasis on the role of the vaginal microbiome, published from August 2012 to August 2022, identified 760 articles. <b><i>Results:</i></b> Among the 52 articles meeting the prespecified criteria, BV prevalence varied among different populations and disproportionately impacted Black women (49-51%), Hispanic ethnicity (32-43%), and women of reproductive age (30%). Differences in microbial ecology and host genetics were important factors underlying these disparities. Colonization of BV-associated bacteria was more common in women of color than in non-Hispanic White women. Other factors linked with disproportionate burden included multiple/same-sex partners, obesity, immunosuppression, and C-section birth. <b><i>Conclusions:</i></b> BV prevalence was multifactorial, with some populations having higher prevalence rates and distinctive microbiome profiles that may predispose them to the condition. BV treatment and recurrence prevention were challenging due to the complex interplay of biological, clinical, and sociobehavioral factors. Understanding these disparate risk factors is critical to reducing BV burden.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"644-652"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in Postpartum Visit and Contraception Rates Pre-COVID-19 to Post-Lockdown in Six U.S. Federally Qualified Health Centers.","authors":"Rebecca K Campbell, Emma Gray, Rachel Caskey, Cristina Barkowski, Jena Wallander Gemkow, Nivedita Mohanty, Kristin Rankin, Sadia Haider","doi":"10.1089/jwh.2024.0691","DOIUrl":"10.1089/jwh.2024.0691","url":null,"abstract":"<p><p><b><i>Background:</i></b> Postpartum care, including contraception, benefits maternal health and decreases mortality, which increased in the United States with COVID-19. Pandemic disruptions to postpartum health care access in vulnerable populations are not well understood. We utilize electronic health record (EHR) data for prenatal patients (<i>n</i> = 2,265) at six urban Federally Qualified Health Centers (FQHCs) from one year prepandemic (January 1, 2019) through one year after the first stay-at-home orders (\"lockdown\") (March 31, 2021). <b><i>Objective:</i></b> We investigated (1) changes in rates of postpartum visit (PPV) and postpartum contraception receipt in the post-lockdown versus prepandemic periods and (2) characteristics predictive of differential changes in PPV and contraception rates. <b><i>Materials and Methods:</i></b> Visit and prescription records from EHR were used to classify if patients received PPV and most/moderately effective contraception within 60 days postpartum, analyzed separately and as a composite variable: PPV and contraception, PPV only, or no PPV. Risk differences comparing post-lockdown with pre-COVID-19 pandemic were estimated using binomial regression and generalized logistic regression models adjusted for age, race/ethnicity, language, and clinical site. Effect modification by sociodemographic and clinical covariates was examined. <b><i>Results:</i></b> Total patient volume fell 21% in the post-lockdown versus pre-COVID-19 period. Rates of PPV decreased in absolute terms by 9.6 (95% confidence interval: -13.6, -5.6) and contraception by 8.1 (-13.3, -2.8) percentage points. After adjustment, PPV and contraception decreased by 9.3 percentage points (-13.1, -5.4), while PPV only was stable (-0.4 [-4.3, 3.6]). <b><i>Conclusions:</i></b> These findings suggest a substantial impact of the COVID-19 pandemic on postpartum care in FQHCs and community health centers. Supply and demand drivers require further examination to inform strategies to improve postpartum care access and subsequent maternal health outcomes.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"704-714"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female Athlete Triad Knowledge and the Risk of Low Energy Availability and Disordered Eating in Recreationally Active and Competitive Adult Females.","authors":"Samantha J Goldenstein, Lenka H Shriver, Laurie Wideman","doi":"10.1089/jwh.2024.0855","DOIUrl":"10.1089/jwh.2024.0855","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To examine and compare the knowledge related to the female athlete triad and the signs and symptoms of low energy availability (LEA) and disordered eating (DE) in competitive (CO) and recreationally active (RA) females. <b><i>Methods:</i></b> Premenopausal females (<i>n</i> = 631, age 25 ± 7 years) completed an electronic survey that assessed female athlete triad knowledge and risk for LEA and DE. Participants self-selected as CO (<i>n</i> = 123) or RA (<i>n</i> = 508). Logistic regression examined the associations between membership in RA versus CO (reference group) and knowledge related to the female athlete triad. Linear regression assessed the association of group membership as predictor variables with LEA and DE risk scores. <b><i>Results:</i></b> Only 22% of participants were familiar with the female athlete triad term and almost half the total participants were at risk for LEA (45%) and/or DE (45%). The RA group was less likely to be familiar with the female athlete triad than CO (odds ratio = 0.34, confidence interval [CI]: 0.22, 0.53, <i>p</i> < 0.001), yet group membership did not predict risk for LEA (β = -0.57, CI: -1.42, 0.28, <i>p</i> = 0.19) or DE (β = 1.34, CI: -1.72, 4.39, <i>p</i> = 0.39). <b><i>Conclusion:</i></b> There is a lack of knowledge related to the female athlete triad, coupled with a relatively high prevalence of LEA and DE risk among physically active females, regardless of athletic status (CO vs. RA). Given the high prevalence of LEA and DE risk found in our study, expanding nutrition education and awareness of the health consequences of the female athlete triad to all physically active females is warranted.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"677-684"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}