Journal of women's health最新文献

{"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}

{"title":"A Decade of Oocyte Cryopreservation: New Horizons in Patients Accessing Care.","authors":"Keri Bergin, Carlie Wiseman, Isabelle Levin, Morgan Baird, Carlos Hernandez-Nieto, Joseph Lee, Alan B Copperman, Lucky Sekhon","doi":"10.1089/jwh.2024.0960","DOIUrl":"https://doi.org/10.1089/jwh.2024.0960","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Utilization of fertility preservation treatments has increased since the American Society for Reproductive Medicine lifted the \"experimental\" label for oocyte cryopreservation in 2012. This study characterizes changes in insurance coverage, clinical outcomes, and live birth probabilities over a span of a decade (2012-2022) in patients who underwent planned oocyte cryopreservation. <b><i>Methods:</i></b> Retrospective analysis of planned oocyte cryopreservation cycles using vitrification from 2012 to 2022. Medically indicated cycles were excluded. Age, anti-mullerian hormone (AMH), number of mature oocytes vitrified, and insurance coverage were evaluated by year of procedure. Comparative statistics were performed using Kruskal-Wallis and chi-square analysis. Linear regression models and Cochran-Armitage trend test were performed to determine the relationships between each variable and time. <b><i>Result(s):</i></b> A total of 4,544 planned oocyte cryopreservation cycles were included. Mean age at egg retrieval decreased significantly over time (37.9 ± 2.9 years versus 34.9 ± 3.3, <i>p</i> < 0.0001). Mature oocytes frozen per cycle rose significantly over time (10.7 ± 7.4 in 2012 versus 13.3 ± 8.6 in 2022, <i>p</i> ≤ 0.0001). Cycles with insurance coverage significantly increased, 0% covered in 2012 versus 46.9% covered in 2022 (<i>p</i> ≤ 0.0001). <b><i>Conclusions:</i></b> Since 2012, patient age at time of egg freezing has decreased, coinciding with a mean increase in AMH and number of mature oocytes frozen per cycle. Younger participation in extending fertility is likely driven by a boost in social awareness regarding reproductive aging, cryopreservation technologies, and improved access to treatment. Modern oocyte cryopreservation includes more access to insurance coverage, shown by nearly half of current cycles benefiting from plan support. Shifts in patient demographics and insurance coverage, paired with updates to stimulation protocols that optimize oocyte yield, are expected to improve the overall prognosis and future fertility of patients who utilize thawed oocytes.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053009","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 Rural Maternity Care Crisis: A State of Peril.","authors":"Eli Y Adashi, Daniel P O'Mahony, I Glenn Cohen","doi":"10.1089/jwh.2024.1142","DOIUrl":"https://doi.org/10.1089/jwh.2024.1142","url":null,"abstract":"","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007665","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":"Health Care Utilization Among Post-Stroke Women: Associations with Perceived Racism.","authors":"Molly Jacobs, Angela Miles, Charles Ellis","doi":"10.1089/jwh.2024.0944","DOIUrl":"https://doi.org/10.1089/jwh.2024.0944","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Post-stroke health care is crucial for recovery and preventing complications. This study explored the association between perceived racism and health care utilization among post-stroke women, highlighting the disparate utilization patterns of marginalized racial/ethnic women. <b><i>Methods:</i></b> The 2022 Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System Survey was used to characterize health care utilization among women with stroke diagnoses across different racial groups: White, Black, Hispanic, and Asian/Asian, Islander, Alaska Native/Other/Multiracial. Logistic regression analysis characterized the association between three types of health care utilizations-having a health insurance plan, a health care provider, and receiving a routine checkup-and perceived race-based treatment in the medical sector. <b><i>Results:</i></b> The sample included 10,184 post-stroke women: 75.01% White, 12.42% Black, 6.77% Hispanic, and 5.80% Asian/AIAN/Other/multiracial. Only 2.95% of White women reported worse treatment, compared with 10.74% of Black, 13.19% of Asian/AIAN/Other/multiracial, and 8.85% of Hispanic women. Regression analysis revealed that Hispanic women (odds ratio [OR] = 0.61, confidence interval [CI] = 0.17, 0.84) were less likely to have a health plan, though those receiving similar or better treatment had higher odds (OR = 1.55, CI = 1.62, 3.90). Black women were less likely to have a routine checkup (OR = 0.51, CI = 0.14, 0.77), but those receiving similar or better treatment had higher odds (OR = 2.72, CI = 1.64, 11.63). Women from other racial/ethnic groups, Black, and Hispanic women had lower odds of having a personal provider (ORs ranging from 0.17 to 0.69), though those receiving similar or better treatment had higher odds (ORs ranging from 1.79 to 3.39). <b><i>Conclusions:</i></b> Perceived differences in treatment in the medical sector among marginalized post-stroke women were significantly associated with lower health care utilization.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971463","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":"Prenatal and Postpartum Home Visits and Postpartum Contraceptive Use: A Cross-Sectional Analysis.","authors":"Sydney R Archer, Kristin M Wall, Melissa J Kottke","doi":"10.1089/jwh.2023.1115","DOIUrl":"10.1089/jwh.2023.1115","url":null,"abstract":"<p><p><b><i>Background:</i></b> The postpartum period is a time of unmet contraceptive need for many women. Home visits by a health care worker during pregnancy or after delivery could increase postpartum contraceptive use and decrease barriers to accessing postpartum care. This study investigated the association between prenatal or postpartum home visits and postpartum contraceptive use using a large sample of U.S. women from 41 states. <b><i>Subjects and Methods:</i></b> We conducted a cross-sectional analysis using weighted survey data from the 2012-2015 Phase 7 Pregnancy Risk Assessment and Monitoring Systems Core and Standard Questionnaires. Descriptive statistics and multivariate logistic regression models estimated the association between having a prenatal or postpartum home visit and self-reported postpartum contraceptive use. <b><i>Results:</i></b> Of 141,296 women, approximately 21% received prenatal or postpartum home visits and 79% used postpartum contraception. After controlling for sociodemographic, reproductive, and health-related factors, women who received prenatal or postpartum home visits had a higher odds of postpartum contraception use (adjusted odds ratio 1.08, 95% confidence interval 1.02-1.15, <i>p</i> = 0.009). Women who were older, were minority race, had less than a high school education, received inadequate prenatal care, experienced partner abuse during pregnancy, or experienced multiple stressors during pregnancy had a lower odds of postpartum contraception use in adjusted analyses controlling for home visitation. <b><i>Conclusion:</i></b> Given the benefits of recommended interpregnancy intervals to both the mother and the baby, adding formal contraceptive counseling and offering a variety of postpartum contraceptive methods in the home could further strengthen home visitation programs in the United States and may support women in achieving their reproductive goals.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"85-94"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288223","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":"Making Progress on Regionalized Maternal Risk-Appropriate Care.","authors":"Jennifer Vanderlaan","doi":"10.1089/jwh.2024.0889","DOIUrl":"10.1089/jwh.2024.0889","url":null,"abstract":"","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"8-9"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503019","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":"Trends in Pregnancy Outcomes in People with Sickle Cell Disease and Medicaid Insurance (2006-2018).","authors":"Sarah H O'Brien, Joseph R Stanek, Andrea House, Robert M Cronin, Susan E Creary, Andrea H Roe, Sara K Vesely","doi":"10.1089/jwh.2023.1109","DOIUrl":"10.1089/jwh.2023.1109","url":null,"abstract":"<p><p><b><i>Background:</i></b> Although the risk of pregnancy-related morbidity and mortality in people with sickle cell disease (SCD) is well established, limitations in data sources and heterogeneity in outcome reporting hinder the ability to make meaningful comparisons between historical and contemporary populations. This study used a national administrative claims database to compare pregnancy outcomes in people with SCD between 2006-2011 and 2012-2018. <b><i>Materials and Methods:</i></b> Pregnant females aged 16-44 years with SCD were identified from the Centers for Medicare and Medicaid Service Analytic eXtract, along with a control cohort of pregnant people. People were followed from first identified pregnancy until one year postpartum. Outcomes of interest were identified with ICD-9 or 10 codes. <b><i>Results:</i></b> We included 6,388 people with SCD and 17,278 controls in analyses. Preeclampsia/eclampsia, hypertension, thrombosis, poor fetal growth, preterm delivery, and postpartum hemorrhage were all more common in people with SCD compared with controls. Maternal death occurred in 0.5% of people with SCD versus <0.1% in those without SCD (<i>p</i> < 0.001). When comparing infant deliveries in 2006-2011 to those occurring in 2012-2018, all pregnancy-related complications except preterm delivery, including maternal death, occurred at similar or higher frequencies in more recent years. <b><i>Conclusions:</i></b> Between 2006 and 2018, maternal death occurred in approximately 1 out of every 200 publicly insured people with SCD in the year following infant delivery. Our work confirms, on a national-level, that pregnancy-related outcomes in people with SCD in the United States have not improved with time, and that some complications have in fact increased in frequency.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"21-26"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546235","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 <i>Right to Contraception Act</i>: A Present-Day Imperative.","authors":"Eli Y Adashi, Daniel P O'Mahony, I Glenn Cohen","doi":"10.1089/jwh.2024.0983","DOIUrl":"10.1089/jwh.2024.0983","url":null,"abstract":"","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"164-165"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770133","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":"Racial and Ethnic Disparities in Cervical Insufficiency, Cervical Cerclage, and Preterm Birth.","authors":"Hayley E Miller, Jonathan A Mayo, Ravali A Reddy, Stephanie A Leonard, Henry C Lee, Sanaa Suharwardy, Deirdre J Lyell","doi":"10.1089/jwh.2024.0088","DOIUrl":"10.1089/jwh.2024.0088","url":null,"abstract":"<p><p><b><i>Background:</i></b> The frequency of cervical insufficiency differs among the major racial and ethnic groups, with limited data specific to Asian American and Native Hawaiian/Pacific Islander (AANHPI) subpopulations. We assessed cervical insufficiency diagnoses and related outcomes across 10 racial and ethnic groups, including disaggregated AANHPI subgroups, in a large population-based cohort. <b><i>Study Design:</i></b> We performed a retrospective cohort study of all singleton births between 20-42 weeks' gestation in California from 2007 to 2018. Logistic regression models were performed to estimate the odds of cervical insufficiency and, among people with cervical insufficiency, the odds of cerclage and preterm birth according to self-reported race and ethnicity. <b><i>Results:</i></b> Among 5,114,470 births, 38,605 (0.8%) had a diagnosis code for cervical insufficiency. Compared with non-Hispanic White people, non-Hispanic Black people had the highest odds of cervical insufficiency (adjusted odds ratio [aOR] 3.07; 95% confidence interval [CI], 2.97, 3.18), for cerclage placement and higher odds for preterm birth. Disaggregating AANHPI subgroups showed that Indian people had the highest odds (aOR 1.94; 95% CI, 1.82, 2.07) of cervical insufficiency and had significantly higher odds of cerclage without increased odds of preterm birth; Southeast Asian people had the highest odds of preterm birth. <b><i>Conclusion:</i></b> Within a large, diverse population-based cohort, non-Hispanic Black people experienced the highest rates of cervical insufficiency, and among those with cervical insufficiency, had among the highest rates of cerclage and preterm birth. Among AANHPI subgroups specifically, Indian people had the highest rates of cervical insufficiency and cerclage placement, without increased rates of preterm birth; Southeast Asian people had the highest rates of preterm birth, without increased rates of cerclage. Disaggregating AANHPI subgroups identifies important differences in obstetric risk factors and outcomes.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"70-77"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Describing Adverse Pregnancy Events and Pregnancy-Associated Death Among Veterans.","authors":"Deirdre A Quinn, Florentina E Sileanu, Maria K Mor, Lisa S Callegari, Sonya Borrero","doi":"10.1089/jwh.2023.1046","DOIUrl":"10.1089/jwh.2023.1046","url":null,"abstract":"<p><p><b><i>Background:</i></b> Veterans who use VA pregnancy benefits may be at high risk for adverse pregnancy outcomes; however, little is known about rates of adverse pregnancy events or pregnancy-associated death among Veterans. <b><i>Methods:</i></b> We conducted a retrospective cohort study using VA national administrative data for Veterans ages 18-45 with at least one pregnancy outcome between October 2009 and September 2016 and a VA primary care visit within one year prior to pregnancy. We identified adverse events during pregnancy and up to 42 days after pregnancy and all-cause mortality within one year of pregnancy and compared prevalence of adverse events by Veteran race/ethnicity using adjusted logistic regression. <b><i>Results:</i></b> Pregnancies among Black Veterans had 69% higher odds of any adverse event than those among White Veterans (aOR = 1.69, 95% CI: 1.43, 2.00). All-cause mortality during pregnancy or within one year of pregnancy was recorded for 18 pregnancies, resulting in an estimated overall pregnancy-associated mortality rate of 76 deaths per 100,000 live births. <b><i>Conclusions:</i></b> We identified high overall rates of adverse pregnancy events and pregnancy-associated death among Veterans using VA benefits. As in non-VA populations, there were stark racial disparities in adverse pregnancy events among Veterans.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":"166-175"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290182","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}