Journal of women's health最新文献

{"title":"Diagnostic Performance of a Type III Portable Monitoring Device for Obstructive Sleep Apnea in Pregnant Women: A Prospective Validation Study.","authors":"Sofía Romero-Peralta, Miguel Alonso, Olga Mediano, María Cerdà Moncadas, Ainhoa Álvarez Ruiz De Larrinaga, Mercedes Codina Marcet, María Paloma Giménez Carrero, Mónica de la Peña, José Antonio Peña Zarza, Francisco García-Río, Alberto Alonso-Fernández","doi":"10.1089/jwh.2024.1033","DOIUrl":"https://doi.org/10.1089/jwh.2024.1033","url":null,"abstract":"<p><p><b><i>Rationale:</i></b> Obstructive sleep apnea (OSA) during pregnancy is linked to negative maternal and neonatal outcomes. Diagnosing OSA in this population is particularly challenging. Portable monitoring devices (PMD) present a potential alternative to polysomnography (PSG), but their effectiveness in pregnant women is uncertain. <b><i>Objective:</i></b> To evaluate diagnostic accuracy of a PMD to detect OSA in pregnant women. <b><i>Methods:</i></b> A prospective study of 136 middle-aged pregnant women (34 ± 4 years) in their third trimester of pregnancy (34 ± 3 weeks) who underwent laboratory type III PMD and PSG simultaneously. <b><i>Results:</i></b> Using an apnea-hypopnea index (AHI) ≥5 event/h by PSG, OSA was diagnosed in 10.3% of women (mild OSA: 86%; moderate OSA: 14%). An acceptable positive correlation was found between both tests in the AHI (<i>r</i> = 0.787; <i>p</i> < 0.001) and oxygen desaturation index (ODI) (<i>r</i> = 0.806; <i>p</i> < 0.001). The agreement limits between PSG and type III PMD were -4.1 to 5.4 for AHI and -6.0 to 4.5 for ODI. The sensitivity and specificity of type III PMD for an AHI ≥5 events/h were 57.1% and 99.2%, respectively, with a positive predictive value (PPV) of 88.9% and a negative predictive value (NPV) of 95.3%. On a receiver operating characteristic curve, the best cutoff point of AHI by type III PMD to identify OSA according to PSG criteria was 2.25 events/h. The sensibility and specificity for this point were 85.7% and 88.5%, respectively, with a PPV of 46.2% and NPV of 98.2%. <b><i>Conclusions:</i></b> A type III PMD with an AHI cutoff of 5 events/h could be a good alternative for OSA diagnosis in pregnant women. Additionally, an AHI ≥2.25 event/h demonstrates good diagnostic performance, but its low positive predictive value suggests that it is more appropriate as a screening tool. Further studies are needed to validate this sleep study tool in pregnant women, particularly in home settings.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449340","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":"The Association Between Urological Conditions Across the Life Course and Provoked Vulvodynia.","authors":"Bernard L Harlow, Hanna Mühlrad, Jane Yan, Donghao Lu, Nina Bohm-Starke","doi":"10.1089/jwh.2024.0933","DOIUrl":"https://doi.org/10.1089/jwh.2024.0933","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Vulvodynia is a condition characterized by chronic pain and discomfort in the vulvar region often accompanied with physical and psychological comorbidities. Interstitial cystitis (IC)/bladder pain syndrome (BPS), a chronic condition characterized by bladder pain and urinary urgency, has repeatedly been shown to comorbidly be present in a large proportion of women with vulvodynia. However, recent studies have shown that women with vulvodynia experienced additional bladder-related symptoms beyond that of just IC/BPS. <b><i>Materials and Methods:</i></b> Using Swedish National Registry data, we assessed the association between urological symptoms in the presence and absence of IC/BPS in women with vulvodynia/vaginismus relative to women with no vulvar pain history. <b><i>Results:</i></b> After adjustment for birth year, parity, education, and residential location, women with vulvar pain had a 2.2-fold greater risk of cystitis or urethritis as expected (95% confidence interval [CI] 1.9-2.6). However, when women with cystitis codes were excluded, those with urethra disorders or other urinary symptoms codes were 1.9 times more likely to be vulvar pain cases (95% CI 1.7-2.1). <b><i>Conclusions:</i></b> These findings support the belief that vulvodynia is not limited to being comorbid with IC/BPS but may also likely be associated with a wide range of urological disorders.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433350","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":"Advanced Maternal Age and Pregnancy Outcomes in Oocyte Donation and Spontaneous Pregnancies: A Large Population-Based Cohort Study.","authors":"Roni Rahav-Koren, Hila Shalev-Ram, Einat Haikin-Herzberger, Mattan Levi, Amir Wiser, Netanella Miller","doi":"10.1089/jwh.2024.0552","DOIUrl":"https://doi.org/10.1089/jwh.2024.0552","url":null,"abstract":"<p><p><b><i>Background:</i></b> Data regarding pregnancy and perinatal outcomes of oocyte donation (OD) recipients older than age 45 are limited. <b><i>Materials and Methods:</i></b> A total of 459,528 singleton pregnancies with 946 OD pregnancies and 458,582 spontaneous pregnancies were grouped according to maternal age ≥45 years and <45 years. <b><i>Results:</i></b> The mean maternal age of the OD recipients was 47.6 for patients >45 and 40.7 for patients ≤45 (<i>p</i> < 0.001). Among the spontaneous conceptions, the mean maternal age was 47.8 years for patients >45 and 31.1 for patients ≤45 (<i>p</i> < 0.001). Multivariable logistic regression for preterm birth (PTB) <37 weeks and for small gestational age (SGA) among the OD recipients demonstrated that age >45 is a protective factor for PTB <37 weeks (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.4-0.9, <i>p</i> = 0.03) and for SGA (OR: 0.3, 95% CI: 0.1-0.7, <i>p</i> = 0.006, respectively). Among the spontaneous group, age >45 is a risk factor for PTB <37 weeks (OR: 3.2, 95% CI: 2.7-3.9, <i>p</i> < 0.001), PTB <34 weeks (OR: 4.7, 95% CI: 3.4-6.4, <i>p</i> < 0.001), SGA (OR: 1.6, 95% CI: 1.2-2.1, <i>p</i> < 0.001), and pregnancy-induced hypertension (OR: 3.1, 95% CI: 2.1-4.7, <i>p</i> < 0.001). Other obstetric complications were comparable between the age-groups of the oocyte recipients but were higher among patients >45 years who conceived spontaneously. <b><i>Conclusions:</i></b> As opposed to spontaneous pregnancies, OD pregnancies of recipients >45 are not associated with higher rates of obstetric or perinatal morbidity compared with younger recipients.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433349","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":"Self-Reported Psychological, Somatic, and Vasomotor Symptoms at Different Stages of the Menopause for Autistic and Non-autistic People.","authors":"Rebecca A Charlton, Francesca G Happé, Alanna J Shand, William Mandy, Gavin R Stewart","doi":"10.1089/jwh.2024.0784","DOIUrl":"https://doi.org/10.1089/jwh.2024.0784","url":null,"abstract":"<p><p><b><i>Background:</i></b> There is growing awareness that the experiences of neurodivergent people during menopause are not well understood. Menopause may be particularly challenging for autistic people due to common co-occurring conditions such as depression and differences in sensory processing. The few (mostly qualitative) studies to explore autism and menopause suggest that autistic traits may be exacerbated. <b><i>Methods:</i></b> In an online cross-sectional survey, we examined self-reported menopause symptoms of 342 people (autistic, <i>n</i> = 242 and non-autistic, <i>n</i> = 100) at different stages of their reproductive life (premenopausal [∼20% of sample], menopausal [∼30%], postmenopausal [∼50%]). <b><i>Results:</i></b> Autistic people reported significantly higher rates of bothersome psychological and somatic menopause symptoms than non-autistic people, but no differences were observed for vasomotor symptoms. Results indicated different patterns of psychological, somatic, and vasomotor symptoms between the autistic and non-autistic groups. People in the menopause and postmenopause groups reported negative changes in symptoms, but non-autistic women reported these as more negative than autistic women. Whether this finding is related to the observation that autistic people report more bothersome psychological and somatic symptoms before the menopause requires further investigation. <b><i>Conclusion:</i></b> This cross-sectional analysis suggests that autistic people may experience more bothersome symptoms during menopause compared with non-autistic people. Longitudinal studies examining change are required to fully understand the variables that impact individual experiences for autistic people.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441190","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":"Patient Preferences for Provider Specialization for Induced Abortion and Miscarriage Care.","authors":"Colleen Judge-Golden, Sydney Sheffield, Lucero Hernandez, Norma Davis, Rebecca Fairchild, Jonas J Swartz","doi":"10.1089/jwh.2024.0884","DOIUrl":"https://doi.org/10.1089/jwh.2024.0884","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> Most induced abortions are provided by abortion specialists, despite knowledge and skills overlap with other disciplines, particularly general obstetrics and gynecology (OB/GYN). We evaluated patient preferences for abortion and miscarriage care from a family planning specialist versus other providers, and perceptions of a general OB/GYN's ability to provide safe miscarriage and abortion care. <b><i>Materials and Methods:</i></b> We conducted a cross-sectional survey among individuals aged 18-44 receiving induced abortion (<i>n</i> = 54) or nonabortion gynecological care (<i>n</i> = 111) in North Carolina hospital-based gynecology or family planning clinics between April and October 2023. The primary predictor was appointment type. The primary outcome was preference for induced abortion from a family planning specialist versus other providers; secondary outcomes were provider specialty preference for miscarriage care and patient perceptions of a general OB/GYN's scope of practice. We evaluated associations between appointment type, outcomes, and participant characteristics. <b><i>Results:</i></b> This was a racially diverse population with half (50.3%) using public health insurance. Most (73.0%) felt abortion is \"morally acceptable and should be legal.\" Over half (53.1%) preferred induced abortion from a specialist provider, compared with one-third (32.7%) for miscarriage (<i>p</i> < 0.001), with no differences by appointment type. Educational attainment (<i>p</i> = 0.03) and Democratic party affiliation (<i>p</i> = 0.02) were independently associated with abortion specialist preference, but not significant in multivariable analysis. More participants believed a general OB/GYN can provide medications for miscarriage management compared with induced abortion (94.5% versus 86.6%, <i>p</i> = 0.01). Both medical and surgical first trimester induced abortions were more often identified as within-scope for a general OB/GYN than the ability to perform a hysterectomy (69.8%, <i>p</i> < 0.01). Most (78.8%) believed OB/GYNs should be required to train in abortion care. <b><i>Conclusions:</i></b> Participants were more likely to prefer a family planning specialist for induced abortion care versus miscarriage; however, nearly half preferred nonspecialist care. Incorporation of induced abortion into general practice settings may meet patient preferences while expanding access.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414220","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":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","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":"Improving Access to Expanded Genetic Carrier Screening Through Multimodal Interventions.","authors":"Lauren N Meiss, Shefali Pathy, Sarah E Baxley","doi":"10.1089/jwh.2024.0894","DOIUrl":"https://doi.org/10.1089/jwh.2024.0894","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The American College of Obstetricians and Gynecologists recommends offering genetic carrier screening (GCS) to all patients desiring pregnancy or who currently are pregnant. At our urban academic center, we observed that not all appropriate patients were offered GCS. This study aimed to target identified barriers, including health care provider comfort in offering GCS and lack of standardized resources, ultimately increasing the number of patients offered this testing. <b><i>Methods:</i></b> This project was implemented in an urban academic medical center's obstetrics and gynecology (OBGYN) clinic. A needs assessment was performed to determine the baseline comfort level of OBGYN providers regarding expanded GCS and identify barriers. Interventions, including a didactic educational session and template changes in the electronic medical record, were tailored to address the identified concerns. The impact of these interventions was evaluated using a postdidactic evaluation, statistical analyses, and tracked documentation of GCS counseling. <b><i>Results:</i></b> The average mean number of visits with documentation of GCS preference in the initial obstetric visit in the preintervention period (August to November 2020) was 38%. Preintervention needs assessment revealed limited provider comfort with offering expanded GCS. Evaluations following the didactic session demonstrated a significant increase in providers' comfort levels, particularly regarding pre- and post-GCS test counseling. The average number of visits documenting carrier screening preference substantially increased during and after the study period. Statistical analyses confirmed the significance of these improvements. <b><i>Conclusions:</i></b> Despite identified challenges and limitations, targeted educational interventions proved effective in improving provider confidence and increasing the number of visits with documentation of GCS preference.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391163","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":"Asthma and Asthma Symptoms Associated with Endometriosis and Dysmenorrhea in a Nordic-Baltic Population.","authors":"Sanjay Gyawali, Cecilie Svanes, Anders Flataker Viken, Svein Magne Skulstad, Eva Lindberg, Nils Oskar Jõgi, Mathias Holm, Vivi Schlunssen, Elin Helga Thorarinsdottir, Francisco Gómez Real, Marianne Lønnebotn","doi":"10.1089/jwh.2024.0170","DOIUrl":"https://doi.org/10.1089/jwh.2024.0170","url":null,"abstract":"<p><p><b><i>Background:</i></b> Endometriosis, dysmenorrhea, and respiratory symptoms affect large numbers of women. A possible association between asthma and endometriosis has been suggested; however, this relationship is unclear. Dysmenorrhea is very common, and potential associations with asthma symptoms are not known. <b><i>Aim:</i></b> To study asthma symptoms associated with endometriosis and dysmenorrhea in women. <b><i>Methods:</i></b> We used data from the main and women's questionnaires of the Respiratory Health in Northern Europe study, which included data from women (aged 39-65 years) from Aarhus, Gothenburg, Umeå, Uppsala, Reykjavik, Tartu, and Bergen. Current asthma status was defined by asthma medication usage or asthma attacks in the past 12 months. Asthma symptoms were defined as having ≥3 asthma symptoms in the last 12 months. The data were analyzed using logistic regressions adjusted for age, body mass index, and smoking status. <b><i>Results:</i></b> Among 4778 study participants, 201 had endometriosis, and 2154 had dysmenorrhea. Current asthma and asthma symptoms were reported by 14.9% and 12.9%, respectively, of women with endometriosis compared with 9.1% and 9.2%, respectively, of women without endometriosis. The associations of current asthma and asthma symptoms with endometriosis were statistically significant (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.25-2.81; and OR: 1.56, 95% CI: 1.01-2.39, respectively). Similar associations were found for dysmenorrhea (current asthma: OR: 1.48, 95% CI: 1.21-1.81; ≥3 asthma symptoms: OR: 1.61, 95% CI: 1.31-1.97). <b><i>Conclusion:</i></b> Our study revealed that asthma symptoms were associated with both endometriosis and dysmenorrhea. The associations with dysmenorrhea, which affects a large proportion of women, were almost as strong as the associations with diagnosed endometriosis.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391161","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":"The Privacy of Reproductive Health Care Data: A Critical Health Insurance Portability and Accountability Act of 1996 Update.","authors":"Eli Y Adashi, Daniel P O'Mahony, I Glenn Cohen","doi":"10.1089/jwh.2025.0036","DOIUrl":"https://doi.org/10.1089/jwh.2025.0036","url":null,"abstract":"<p><p>On April 26, 2024, the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) issued a Final Rule titled \"HIPAA Privacy Rule to Support Reproductive Health Care Privacy.\"¹ As per the attendant Federal Register, the Final Rule was to become effective on June 25, 2024.¹ In so doing, HHS was complying with President Biden's Executive Order 14076 the sole focus of which was \"Securing Access to Reproductive and Other Healthcare Services.\"² The newly (announced Final Rule bolsters the Health Insurance Portability and Accountability Act of 1996 [HIPAA; Public Law No: 104-191) which \"provides penalties\" for \"wrongful disclosure of individually identifiable health information.\"¹ Among its leading objectives, the Final Rule seeks to protect women who cross state lines in search of an abortion.¹ Data reported by the Guttmacher Institute suggest that nearly one in five abortion patients sought out-of-state care during the first 6 months of 2023, a two-fold increase when compared with the same period in 2020.³ The Final Rule also protects those who provide or facilitate lawful reproductive health care who might otherwise be targeted by state prosecutors with criminal probes or lawsuits in mind.¹ The administration and enforcement of the newly issued Final Rule will be the designated responsibility of the OCR.¹ In a clear reference to Dobbs v. Jackson Women's Health Organization, HHS Secretary Xavier Becerra made note of the reality that \"with reproductive health under attack by some lawmakers, these protections are more important than ever.\"⁴ It is the objective of this Commentary to review the multiple facets of the reproductive privacy imperative and the projected oversight thereof.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365212","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":"Inequities and Missed Opportunities: A National Analysis of Emergency Department Visits for Pregnant Individuals with Mental Health and Substance Use Disorder.","authors":"Austin M Spitz, Megan E Deichen Hansen, Samantha S Goldfarb, Jeffrey S Harman","doi":"10.1089/jwh.2024.0223","DOIUrl":"https://doi.org/10.1089/jwh.2024.0223","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study aims to identify whether there are inequities in care for pregnant individuals with mental health or substance use disorders (MH/SUDs) seeking treatment in emergency departments (EDs) for pregnancy-related concerns. Considering their risk for poor maternal and infant outcomes, we sought to examine their experiences in EDs to target future interventions and institute referrals to integrated care systems. <b><i>Methods:</i></b> This retrospective, exploratory analysis identified ED visits for pregnancy-related concerns using the National Hospital Ambulatory Medical Care Survey database from 2016 to 2020 (<i>n</i> = 1,233) to compare experiences of care by pregnant people with (<i>n</i> = 149) and without MH/SUD (<i>n</i> = 1,084). <b><i>Results:</i></b> 11.9% (95% confidence interval [CI]: 9.8 - 15.1%) of ED visits for pregnancy-related concerns were cross-coded for MH/SUD. Compared to visits by pregnant individuals without MH/SUD, visits by pregnant people with MH/SUD were 70% less likely to be asked to return to the ED for follow-up treatment (<i>p</i> = 0.027), had 3.8 times greater odds of leaving the ED prior to completing care (<i>p</i> = 0.005), and received 40% more medication upon discharge (<i>p</i> = 0.049) after controlling for demographic variables. Of those visits by pregnant people with MH/SUD, only 6.8% were given a toxicology screen and only 1.2% were seen by an MH provider. <b><i>Conclusion:</i></b> This nationally representative analysis of ED visits for pregnancy-related concerns identified multiple opportunities to address care inequities that affect health outcomes. Special training and processes are needed within EDs to engage pregnant people with MH/SUD to provide effective, evidence-based care interventions and referrals.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365196","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}