Womens Health Issues最新文献

{"title":"The “Birth-Centered Outcomes Research Engagement (B-CORE) in Medi-Cal” Project: Community-Generated Recommendations to Decrease Maternal Mortality and Severe Maternal Morbidity","authors":"Priya Batra MD, MS, FACOG ,&nbsp;Gabriela Alvarado MD, MSc, MA, MPhil ,&nbsp;Chloe E. Bird PhD, FAAAS, FAAHB","doi":"10.1016/j.whi.2023.03.012","DOIUrl":"10.1016/j.whi.2023.03.012","url":null,"abstract":"<div><h3>Background</h3><p><span>Through applied research and health care quality improvement<span>, California has achieved a maternal mortality (MM) rate significantly lower than that measured nationally. However, Medicaid (Medi-Cal)-insured births in the state continue to experience disproportionate shares of MM and severe </span></span>maternal morbidity (SMM), which often precedes death. Failure to engage the Medi-Cal community in this work may impede efforts to increase equity.</p></div><div><h3>Methods</h3><p>This community engagement project used deliberative democracy<span><span> methods to engage stakeholders with lived experience in California's Medi-Cal </span>perinatal care system to generate an actionable and specific agenda of recommendations to decrease MM and SMM in the Medi-Cal population.</span></p></div><div><h3>Findings</h3><p>A total of 37 Medi-Cal stakeholders—representing birthing people, providers, health plan administrators, and advocates—participated in longitudinal co-learning sessions on the topics of MM/SMM in Medi-Cal. Most of these stakeholders (75.7%) then participated in deliberation sessions. Deliberation recommendations fell into five distinct categories: Medi-Cal perinatal covered benefits, data collection and dissemination, patient experience and its link to care quality, Medi-Cal reimbursement rates, and accountability with respect to racism in perinatal care. Stakeholders identified the Medi-Cal system actors best positioned to implement specific recommendations to directly impact MM/SMM.</p></div><div><h3>Conclusions</h3><p>This project demonstrates the feasibility and success of using deliberative democracy methods to generate local and community-generated solutions to critical problems in health equity. Active and engaged stakeholders were keen to identify both immediate actions and long-term research and quality improvement paradigm shifts to support birth equity in Medi-Cal.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 474-480"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10184269","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":"Risk of Severe Maternal Morbidity in Birthing People With Opioid Use Disorder","authors":"Godwin K. Osei-Poku MD, DrPH ,&nbsp;Julia C. Prentice PhD ,&nbsp;Mary Peeler MD, MPH ,&nbsp;Sarah N. Bernstein MD ,&nbsp;Ronald E. Iverson MD, MPH ,&nbsp;Davida M. Schiff MD, MSc","doi":"10.1016/j.whi.2023.06.002","DOIUrl":"10.1016/j.whi.2023.06.002","url":null,"abstract":"<div><h3>Introduction</h3><p><span>We examined severe maternal morbidity (SMM) among </span>birthing people with opioid use disorder (OUD) and evaluated the extent to which differences in SMM exist by race and ethnicity.</p></div><div><h3>Methods</h3><p>We performed a retrospective cohort study<span> using hospital discharge<span> data for all Massachusetts births between 2016 and 2020. SMM rates for all SMM indicators, except transfusions, were computed for those diagnosed with and without OUD. Multivariable logistic regression was used to examine the association between OUD and SMM after adjusting for patient and hospital characteristics, including race and ethnicity.</span></span></p></div><div><h3>Results</h3><p>Among 324,012 childbirths, the SMM rate was 148 (95% confidence interval [CI]. 115–189) per 10,000 childbirths among birthing people with OUD compared with 88 (95% CI, 85–91) for those without. In adjusted models, both OUD and race/ethnicity were significantly associated with SMM. Birthing people with OUD had 2.12 (95% CI, 1.64–2.75) times the odds of experiencing an SMM event compared with those without. Non-Hispanic Black and Hispanic birthing people were at 1.85 (95% CI, 1.65–2.07) and 1.26 (95% CI, 1.13–1.41) higher odds of experiencing SMM compared with non-Hispanic White birthing people. Among birthing people with OUD, the odds of SMM were not significantly different between birthing people of color and non-Hispanic White individuals.</p></div><div><h3>Conclusions</h3><p>Birthing people with OUD are at an elevated risk of SMM, underscoring the need for improved access to OUD treatment and increased support. Perinatal quality improvement collaboratives should measure SMM in bundles aimed at improving outcomes for birthing people with OUD.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 524-531"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10185466","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":"Variation in Outpatient Postpartum Care Use in the United States: A Latent Class Analysis","authors":"Jamie R. Daw PhD ,&nbsp;Nina R. Joyce PhD ,&nbsp;Erika F. Werner MD ,&nbsp;Katy B. Kozhimannil PhD ,&nbsp;Maria W. Steenland SD","doi":"10.1016/j.whi.2023.05.001","DOIUrl":"10.1016/j.whi.2023.05.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite efforts to improve postpartum health care<span> in the United States, little is known about patterns of postpartum care beyond routine postpartum visit attendance. This study aimed to describe variation in outpatient postpartum care patterns.</span></p></div><div><h3>Methods</h3><p><span>In this longitudinal cohort study of national commercial claims data, we used </span>latent class analysis<span> to identify subgroups of patients (classes) with similar outpatient postpartum care patterns (defined by the number of preventive, problem, and emergency department outpatient visits in the 60 days after birth). We also compared classes in terms of maternal sociodemographics and clinical characteristics measured at childbirth, as well as total health spending and rates of adverse events (all-cause hospitalizations and severe maternal morbidity) measured from childbirth to the late postpartum period (61–365 days after birth).</span></p></div><div><h3>Results</h3><p><span><span>The study cohort included 250,048 patients hospitalized for childbirth in 2016. We identified six classes with distinct outpatient postpartum care patterns in the 60 days after birth, which we classified into three broad groups: no care (class 1 [32.4% of the total sample]); </span>preventive care<span> only (class 2 [18.3%]); and problem care (classes 3–6 [49.3%]). The prevalence of clinical risk factors at childbirth increased progressively from class 1 to class 6; for example, 6.7% of class 1 patients had any chronic disease compared with 15.5% of class 5 patients. Severe </span></span>maternal morbidity was highest among the high problem care classes (classes 5 and 6): 1.5% of class 6 patients experienced severe maternal morbidity in the postpartum period and 0.5% in the late postpartum period, compared with less than 0.1% of patients in classes 1 and 2.</p></div><div><h3>Conclusions</h3><p>Efforts to redesign and measure postpartum care should reflect the current heterogeneity in care patterns and clinical risks in the postpartum population.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 508-514"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10191418","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":"Prenatal Alcohol Counseling Among American Indian and Alaska Native Women and Non-Hispanic White Women in the Pregnancy Risk Assessment Monitoring System","authors":"Luciana E. Hebert PhD ,&nbsp;Melissa R. Vera PhD ,&nbsp;Michelle C. Sarche PhD","doi":"10.1016/j.whi.2023.06.003","DOIUrl":"10.1016/j.whi.2023.06.003","url":null,"abstract":"<div><h3>Objective</h3><p>Universal screening and counseling are recommended for alcohol use during pregnancy, but no prior study has examined differences in prenatal counseling by race or ethnicity. We used Pregnancy Risk Assessment Monitoring System (PRAMS) data to assess differences in provision of counseling on prenatal alcohol use between American Indian/Alaska Native (AI/AN) and non-Hispanic White (NHW) women during prenatal care.</p></div><div><h3>Methods</h3><p><span>We analyzed data from 2014–2015 from the four PRAMS states with the highest number of births to AI/AN women: Alaska, New Mexico, Oklahoma, and Washington. We estimated the prevalence of prenatal alcohol use, associated risk factors, and prenatal alcohol prevention counseling for AI/AN (</span><em>n</em> = 1,805) and NHW (<em>n</em><span> = 5,641) women. We then conducted multivariable logistic regression modeling stratified by race to estimate factors associated with receipt of prenatal alcohol prevention counseling. All analyses were weighted and accounted for the complex sampling design of PRAMS.</span></p></div><div><h3>Results</h3><p>Results showed that AI/AN women were counseled on prenatal alcohol use more often than NHW women (77% vs. 67%, <em>p</em><span> &lt; .05), although the likelihood of any prenatal alcohol use was the same in both groups. The likelihood of prenatal drinking increased with age, education, and income in both groups. Higher education levels were significantly associated with lower risk of prenatal alcohol counseling receipt among AI/AN women. Compared with those with less than a high school diploma, AI/AN women with a college degree or more had 39% reduced risk of receiving counseling (adjusted risk ratio [aRR] = 0.61; 95% confidence interval [CI]: 0.45–0.83). Among NHW women, living at 100% to 199% of the Federal Poverty Level was associated with lower risk (aRR = 0.88; 95% CI: 0.79–0.98) of counseling receipt compared with women living below the federal poverty line. Higher parity was significantly associated with lower risk of counseling for both groups of women.</span></p></div><div><h3>Conclusion</h3><p>Although race was not associated with prenatal alcohol use, AI/AN women were more likely than NHW women to be counseled about prenatal alcohol exposure. Factors associated with counseling receipt differed between the two groups. These findings suggest that receipt of counseling is associated with sociodemographic characteristics, and that counseling is not universally provided. More efforts to provide universal counseling are warranted.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 515-523"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10197192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Inclusive Biomedicine: Are New Policies Increasing Rigor and Reproducibility?","authors":"Donna L. Maney PhD ,&nbsp;Janet W. Rich-Edwards ScD, MPH","doi":"10.1016/j.whi.2023.03.004","DOIUrl":"10.1016/j.whi.2023.03.004","url":null,"abstract":"","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 461-464"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10563564","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":"Mapping Long-acting Reversible Contraceptive Interventions to the Social Ecological Model: A Scoping Review","authors":"Ghasi Phillips-Bell ScD, MS ,&nbsp;Maria Roque MPH ,&nbsp;Lisa Romero DrPH, MPH","doi":"10.1016/j.whi.2023.06.005","DOIUrl":"10.1016/j.whi.2023.06.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Long-acting reversible contraception (LARC) is one option for preventing unintended pregnancies and short interpregnancy intervals. Efforts to increase access to contraception may benefit from applying the social ecological model (SEM), a framework that considers individual, interpersonal, organizational, community, and policy influences on behavior. We aimed to summarize findings from interventions on LARC use and map interventions to SEM levels.</p></div><div><h3>Methods</h3><p>We conducted a scoping review of the 2010–2020 literature in PubMed/MEDLINE and Embase<span> databases to summarize interventions that did and did not increase LARC use. Although increasing LARC use is not an appropriate goal from a reproductive autonomy standpoint, it is the stated goal of much of the research conducted to date and typically indicates an improvement in access. We mapped these interventions to SEM levels and categorized their strategies: cost support, patient counseling, administrative support, provider training, and other.</span></p></div><div><h3>Results</h3><p>Of 27 interventions reviewed, 17 (63%) increased LARC use. We observed a greater proportion of interventions that increased LARC uptake among those with strategies implemented at policy (8/10 [80%]) or organizational (14/19 [74%]) SEM levels compared with interventions implemented at other SEM levels. When both individual and organizational SEM-level components were implemented, five of six interventions (83%) increased uptake. All five interventions with both organizational- and policy-level components increased LARC use. Among the 27 interventions, patient counseling (<em>n</em> = 12) and cost support (<em>n</em> = 12) were common strategies. Five of 12 interventions (42%) involving patient counseling and 11 of 12 (92%) involving cost support increased LARC use.</p></div><div><h3>Conclusions</h3><p>Organizational and policy SEM components and cost support strategies were most prevalent in interventions that increased LARC use. Future interventions to improve access to contraception, while respecting patient autonomy, could incorporate more than one SEM level.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 497-507"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10195699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intention to Initiate HIV Pre-exposure Prophylaxis Among Cisgender Women in a High HIV Prevalence U.S. City","authors":"Rachel K. Scott MD, MPH ,&nbsp;Shawnika J. Hull PhD ,&nbsp;Jim C. Huang PhD ,&nbsp;Peggy P. Ye MD, MPH ,&nbsp;Pamela Lotke MD, MPH ,&nbsp;Jason Beverley NP ,&nbsp;Patricia Moriarty BS ,&nbsp;Dhikshitha Balaji BS ,&nbsp;Allison Ward MD ,&nbsp;Jennifer Holiday MD ,&nbsp;Ashley R. Brant DO, MPH ,&nbsp;Rick Elion MD ,&nbsp;Adam J. Visconti MD, MPH ,&nbsp;Megan Coleman DNP","doi":"10.1016/j.whi.2023.05.009","DOIUrl":"10.1016/j.whi.2023.05.009","url":null,"abstract":"<div><h3>Objective</h3><p>Our objective was to identify the individual, interpersonal, community, health-system, and structural factors that influence HIV pre-exposure prophylaxis (PrEP) initiation among cisgender women seeking sexual and reproductive health care in a high HIV prevalence community to inform future clinic-based PrEP interventions.</p></div><div><h3>Methods</h3><p>We collected anonymous, tablet-based questionnaires from a convenience sample of cisgender women in family planning and sexual health clinics in the District of Columbia. The survey used the lens of the socio-ecological model to measure individual, interpersonal, community, institutional, and structural factors surrounding intention to initiate PrEP. The survey queried demographics, behavioral exposure to HIV, perceived risk of HIV acquisition, a priori awareness of PrEP, intention to initiate PrEP, and factors influencing intention to initiate PrEP.</p></div><div><h3>Results</h3><p>A total of 1437 cisgender women completed the survey. By socio-ecological level, intention to initiate PrEP was associated with positive attitudes toward PrEP (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.13–2.15) and higher self-efficacy (OR, 1.32; 95% CI, 1.02–1.72) on the individual level, perceived future utilization of PrEP among peers and low fear of shame/stigma (OR, 1.65; 95% CI, 1.33–2.04) on the community level, and having discussed PrEP with a provider (OR. 2.39; 95% CI, 1.20–4.75) on the institutional level.</p></div><div><h3>Conclusion</h3><p>Our findings highlight the importance of multilevel, clinic-based interventions for cisgender women, which promote sex-positive and preventive PrEP messaging, peer navigation to destigmatize PrEP, and education and support for women's health medical providers in the provision of PrEP services for cisgender women.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 541-550"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10552685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10546141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on Alternative Models of Medication Abortion Provision Among Abortion Patients in the United States","authors":"Katherine Ehrenreich MSc,&nbsp;C. Finley Baba MPH,&nbsp;Sarah Raifman MSc,&nbsp;Daniel Grossman MD","doi":"10.1016/j.whi.2023.03.007","DOIUrl":"10.1016/j.whi.2023.03.007","url":null,"abstract":"<div><h3>Objective</h3><p>Restrictions on the availability of medication abortion are a barrier to accessing early abortion. People seeking medication abortion may be interested in obtaining the medications through alternative models. The purpose of this study was to explore patient perspectives on obtaining abortion medications in advance of pregnancy or over the counter (OTC).</p></div><div><h3>Study Design</h3><p>Between October 2017 and August 2018, we conducted 30 in-depth interviews with abortion patients who indicated support for alternative models. We recruited patients from 10 abortion clinics in states with a range of policy environments. We analyzed interviews using inductive and deductive iterative techniques.</p></div><div><h3>Results</h3><p>Participants identified logistical benefits of these alternative models, including eliminating travel to a clinic and multiple appointments, and increased privacy around decision-making. Participants were interested in advance provision for its convenience and the sense of preparedness that would come with having the pills available at home, yet some had concerns about the pills being found or stolen. Privacy was the key factor considered for OTC access, including both the privacy benefits of avoiding a clinic and the concern of having one's privacy compromised within the community if purchasing the medications in public.</p></div><div><h3>Conclusions</h3><p>People who have previously had a medication abortion are interested in alternative methods of provision for reasons concerning convenience, privacy, and avoiding burdens related to hostile policy environments, such as long travel distances to clinics and multiple appointments. Concerns around these models were primarily safety concerns for young people. Further research is needed to evaluate the safety, effectiveness, acceptability, and feasibility of these alternative models of providing medication abortion.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 481-488"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10190892","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":"Understanding Health Behaviors, Weight Perceptions, and Body Appreciation of Young Adult Women Engaged in the Body Positivity Movement","authors":"Kristie Rupp PhD ,&nbsp;Stephanie M. McCoy PhD, MPH","doi":"10.1016/j.whi.2023.05.004","DOIUrl":"10.1016/j.whi.2023.05.004","url":null,"abstract":"<div><h3>Background</h3><p>The body positivity movement on social media is thought to foster body appreciation, but pervasive societal concern persists about the body positivity movement and the body image, health behaviors, and “normalization of obesity” of young adult women.</p></div><div><h3>Purpose</h3><p>This study explored the relationship between engagement in the body positivity movement on social media and weight status, body appreciation, body dissatisfaction, and the health behaviors of intuitive eating and physical activity in young adult women (18–35 years).</p></div><div><h3>Methods</h3><p>Participants (<em>N</em><span> = 521; ∼64% engaged in body positivity content on social media) were recruited using Qualtrics online panels for this cross-sectional survey during February 2021. Outcomes included weight status, weight consideration, weight perception, body appreciation, body dissatisfaction, physical activity, and intuitive eating. Logistic and linear regression<span> models adjusted for age, race, ethnicity, education level, and household income were used to assess the association between engagement in the body positivity movement and specified outcomes.</span></span></p></div><div><h3>Results</h3><p>Engagement with body positivity content was associated with greater body dissatisfaction (β = 2.33, t(519) = 2.90 <em>p</em> = .017), body appreciation (<em>β</em> = 0.26, t(519) = 2.90 <em>p</em> = .004), and greater likelihood of reporting high amounts of physical activity (odds ratio = 2.28; <em>p</em> &lt; .05) relative to nonengaged peers; these associations remained significant after further adjustment for weight status. Body positivity engagement was not associated with weight status, weight perception, or intuitive eating.</p></div><div><h3>Conclusions</h3><p>Engagement in the body positivity movement is associated with higher body dissatisfaction and body appreciation in young adult women, which suggests they may be drawn to and engage in the body positivity movement as a protective or coping mechanism for body dissatisfaction.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"33 5","pages":"Pages 551-559"},"PeriodicalIF":3.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10194612","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":"Musculoskeletal Pain During Pregnancy Among Veterans: Associations With Health and Health Care Utilization","authors":"Aimee Kroll-Desrosiers PhD ,&nbsp;Kate F. Wallace MPH ,&nbsp;Diana M. Higgins PhD ,&nbsp;Steve Martino PhD ,&nbsp;Kristin M. Mattocks PhD, MPH","doi":"10.1016/j.whi.2023.07.004","DOIUrl":"10.1016/j.whi.2023.07.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Musculoskeletal (MSK) pain is more likely to be diagnosed in veterans compared with the general population; however, MSK pain during pregnancy has not been studied in veterans. This study examined health and health care use differences between pregnant veterans with and without MSK pain (MSK–).</p></div><div><h3>Methods</h3><p>Veterans who delivered a newborn before June 1, 2021, were identified from an existing cohort (<em>n</em> = 1,181). Survey and Veterans Health Administration (VA) electronic health record data were obtained on participants. Veterans meeting inclusion criteria were identified as those with MSK pain (MSK+) and were compared with MSK– participants. We examined differences between primary outcomes of VA health care engagement (including mental health diagnoses, health care visits, receipt of prescription opioids, and complementary and integrative health use) and secondary outcomes (including postpartum variables) between MSK pain groups. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.</p></div><div><h3>Results</h3><p>There were 172 veterans (14.6%) who met MSK pain eligibility criteria. In adjusted models, MSK+ veterans were more likely to be diagnosed with major depressive disorder (aOR, 1.76; 95% CI, 1.22–2.53) and post-traumatic stress disorder (aOR, 1.79; 95% CI, 1.21–2.64) during pregnancy compared with MSK– veterans. The use of VA mental health care (aOR, 1.52; 95% CI, 1.09–2.12) and the odds of receiving an opioid prescription during pregnancy (aOR, 2.76; 95% CI, 1.53–5.00) was higher in MSK+ veterans compared with MSK– veterans. Only a small proportion (3.6%) of our entire cohort used complementary and integrative health approaches during pregnancy. MSK+ veterans were more likely to deliver by cesarean section compared with MSK– veterans (36% vs. 26%).</p></div><div><h3>Conclusions</h3><p>MSK+ veterans were more likely to be diagnosed with mental health conditions and to use VA mental health care during pregnancy compared with MSK– veterans. Because veterans receive their obstetrical care in the community, understanding the unique needs of pregnant MSK+ veterans in comparison with MSK– veterans is important to provide comprehensive care during the perinatal period.</p></div>","PeriodicalId":48039,"journal":{"name":"Womens Health Issues","volume":"34 1","pages":"Pages 90-97"},"PeriodicalIF":3.2,"publicationDate":"2023-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1049386723001329/pdfft?md5=25288b3fd0f31da66afd3571e990f163&pid=1-s2.0-S1049386723001329-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9997325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}