Archive for the ‘reproductive health’ Category

Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections

August 10, 2012 Comments off

Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections
Source: Morbidity and Mortality Weekly Report (CDC)

Gonorrhea is a major cause of serious reproductive complications in women and can facilitate human immunodeficiency virus (HIV) transmission (1). Effective treatment is a cornerstone of U.S. gonorrhea control efforts, but treatment of gonorrhea has been complicated by the ability of Neisseria gonorrhoeae to develop antimicrobial resistance. This report, using data from CDC’s Gonococcal Isolate Surveillance Project (GISP), describes laboratory evidence of declining cefixime susceptibility among urethral N. gonorrhoeae isolates collected in the United States during 2006–2011 and updates CDC’s current recommendations for treatment of gonorrhea (2). Based on GISP data, CDC recommends combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days as the most reliably effective treatment for uncomplicated gonorrhea. CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections. If cefixime is used as an alternative agent, then the patient should return in 1 week for a test-of-cure at the site of infection.

Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011

July 26, 2012 Comments off

Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011
Source: Morbidity and Mortality Weekly Report (CDC)

One of the three primary goals of the National HIV/AIDS Strategy for the United States is to reduce the number of persons who become infected with human immunodeficiency virus (HIV) (1). In 2009, persons aged 15–29 years comprised 21% of the U.S. population but accounted for 39% of all new HIV infections (2). Sexual intercourse, sexual intercourse with multiple partners, sexual intercourse without using a condom, and injection drug use are behaviors that increase risk for HIV infection. To describe trends in the prevalence of HIV-related risk behaviors among high school students, CDC analyzed data from the biennial national Youth Risk Behavior Survey (YRBS) for the period 1991–2011. The results of that analysis indicated that, although the percentage of students overall who had ever had sexual intercourse decreased significantly from 54.1% in 1991 to 47.4% in 2011, the prevalence of ever having had sexual intercourse did not change significantly after reaching 45.6% in 2001. Similarly, although the percentage of students who had four or more sex partners decreased significantly from 18.7% in 1991 to 15.3% in 2011, the prevalence of having four or more sex partners did not change significantly after reaching 14.2% in 2001. Condom use at most recent sexual intercourse among students currently having sexual intercourse increased from 46.2% in 1991 to 60.2% in 2011. However, the prevalence of condom use did not change significantly beginning in 2003 (63.0%). The prevalence of injection drug use among students overall did not change significantly from 1995 (2.1%) to 2011 (2.3%). The results suggest that progress in reducing some HIV-related risk behaviors among high school students overall and in certain populations stalled in the past decade. To reduce the number of young persons who become infected with HIV, renewed educational efforts and other risk reduction interventions are warranted.

Alcohol Mixed with Energy Drink Use and Sexual Risk-Taking: Casual, Intoxicated, and Unprotected Sex

July 26, 2012 Comments off

Alcohol Mixed with Energy Drink Use and Sexual Risk-Taking: Casual, Intoxicated, and Unprotected Sex (PDF)
Source: Journal of Caffeine Research (via University of Buffalo)

This study examined the confluence of several behaviors common to U.S. young adults: caffeinated
energy drink use, alcohol use, and sexual risk-taking. The author examined relationships between the use of energy drinks mixed with alcohol (AmEDs) and three sexual risk behaviors: casual sex (i.e., intercourse with a nonexclusive and/or nonromantic partner), intoxicated sex (i.e., intercourse while under the influence of alcohol and/or illicit drugs), and unprotected sex (i.e., intercourse without use of a condom).

Logistic regression analyses were employed to analyze data from a cross-sectional survey of 648 sexually
active undergraduate students at a large public university.

After controlling for risk-taking norms and frequency of noncaffeinated alcohol use, AmED use was
associated with elevated odds of casual sex and intoxicated sex but not unprotected sex.

Although further studies are needed to test for event-level relationships, AmED use should be considered a possible risk factor for potentially health-compromising sexual behaviors.

See: Study links alcohol/energy drink mixes with casual, risky sex (EurekAlert!)

Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping

July 24, 2012 Comments off

Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping
Source: Commonwealth Fund

An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States—both with and without health insurance— are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.

Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010

July 23, 2012 Comments off

Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Alcohol use during pregnancy is a leading preventable cause of birth defects and developmental disabilities. Alcohol-exposed pregnancies (AEPs) can lead to fetal alcohol syndrome and other fetal alcohol spectrum disorders (FASDs), which result in neurodevelopmental deficits and lifelong disability (1). In 2005, the Surgeon General issued an advisory urging women who are pregnant or who might become pregnant to abstain from alcohol use (2). Healthy People 2020 set specific targets for abstinence from alcohol use (MICH-11.1) and binge drinking (MICH-11.2) for pregnant women (3). To estimate the prevalence of any alcohol use and binge drinking in the past 30 days among women aged 18–44 years, CDC analyzed 2006–2010 Behavioral Risk Factor Surveillance System (BRFSS) data. Based on their self-reports, an estimated 51.5% of nonpregnant women used alcohol, as did 7.6% of pregnant women. The prevalence of binge drinking was 15.0% among nonpregnant women and 1.4% among pregnant women. Among pregnant women, the highest prevalence estimates of reported alcohol use were among those who were aged 35–44 years (14.3%), white (8.3%), college graduates (10.0%), or employed (9.6%). Among binge drinkers, the average frequency and intensity of binge episodes were similar, approximately three times per month and six drinks on an occasion, among those who were pregnant and those who were not. Clinical practices that advise women about the dangers associated with drinking while pregnant, coupled with community-level interventions that reduce alcohol-related harms, are necessary to mitigate AEP risk among women of childbearing age and to achieve the Healthy People 2020 objectives.

Shackling of pregnant women and girls in correctional systems

July 21, 2012 Comments off

Shackling of pregnant women and girls in correctional systems (PDF)
Source: National Council on Crime and Delinquency

Contrary to official records and statistics, a large number of girls involved in the justice system have been pregnant. In a study of girls in Florida, according to case review data, 8% reported pregnancy in their lifetime. However, when girls were interviewed, 24% reported they had been pregnant (Acoca & Dedel, 1998). Other studies corroborate these findings and demonstrate that of the almost 30% of girls who reported lifetime pregnancy, 16% had been pregnant while incarcerated. Teen pregnancy presents a number of challenges, which increase exponentially for females who are incarcerated. One of the most archaic and dangerous practices includes the shackling of pregnant girls and women. Though outlawed in several states, there exists no legislation to prohibit the use of physical restraints on pregnant women even when in the third trimester in the State of Florida. Twenty-nine percent of girls reported that they had been shackled at the ankles and wrists while pregnant (Acoca, 2004). This practice should be banned for all females who are in custody.

Use of Highly Effective Contraceptive Methods Increases Substantially, but Remains Low Among Women at Highest Risk of Unplanned Pregnancy

July 18, 2012 Comments off

Use of Highly Effective Contraceptive Methods Increases Substantially, but Remains Low Among Women at Highest Risk of Unplanned Pregnancy
Source: Guttmacher Institute

The proportion of women using highly effective long-acting reversible contraceptive methods—namely, the implant and intrauterine device (IUD)—increased significantly between 2002 and 2009, growing from 2.4% to 8.5%. This finding comes from a newly released study, “Changes In Use of Long-Acting Contraceptive Methods in the United States, 2007–2009,” by Lawrence B. Finer et al. of the Guttmacher Institute, which also found that use of these methods increased among almost every demographic group. This increase occurred simultaneously with a decline in both sterilization and the use of less effective short-term methods such as condoms and the birth control pill. Despite this overall increase, use of long-acting methods in the United States remains substantially lower than in other developed countries such as the United Kingdom (11%), France (23%) and Norway (27%).

The authors analyzed data from the 2006–2010 National Survey of Family Growth, and found that the highest use of long-acting methods was among women aged 25–39 and among women who had already had at least one child. Notably, just 2% of women with no children had used these methods, compared with 15% of women with one or two children. The authors speculate that low levels of use among young women and among those who have not yet had children could be related to the high up-front costs of these methods, as well as provider misperceptions about who is an appropriate candidate for use.

Nurse Practitioners and Sexual and Reproductive Health Services: An Analysis of Supply and Demand

July 16, 2012 Comments off

Nurse Practitioners and Sexual and Reproductive Health Services: An Analysis of Supply and Demand
Source: RAND Corporation

Use of Sexual and Reproductive Health (SRH) services is projected to grow between 10 and 20 percent from 2006 to 2020. This growth is driven largely by changes in the racial/ethnic make-up of the population of women of reproductive age and an increase in the number of people with insurance coverage because of new health care legislation.

Trends in supply and demand for SRH services, particularly for low-income individuals, suggest demand will outstrip supply in the next decade. Nurse Practitioners (NPs) with a women’s health focus are key providers of SRH care in Title X-funded clinics, which deliver a significant proportion of U.S. family planning and SRH services to low-income populations. This report looks at why numbers of women’s health NPs (WHNPs) have been declining, and are projected to continue to decline, despite significant growth in total numbers of NPs. Barriers to increasing the supply of NPs competent in SRH care — such as reduced funding for WHNP training, increased funding for primary care and geriatric NP training, and a shrinking proportion of WHNPs choosing to work in public health, clinics, and family planning — are identified.

From the standpoint that the evolution of the health care delivery system may serve as an opportunity to optimize the delivery of SRH services in the United States, a comprehensive set of options spanning education, federal and state regulations, and emerging models of care delivery are explored to reverse this trend of too few WHNPs, particularly for servicing Title X facilities and their patients.

New Study Finds Little Progress in Meeting Demand for Contraception in the Developing World

July 11, 2012 Comments off

New Study Finds Little Progress in Meeting Demand for Contraception in the Developing World
Source: Guttmacher Institute

A new study by the Guttmacher Institute and UNFPA, the United Nations Population Fund, finds that the number of women in developing countries who want to avoid pregnancy but are not using modern contraception declined only slightly between 2008 and 2012, from 226 to 222 million. However, in the 69 poorest countries—where 73% of all women with unmet need for modern contraceptives reside—the number actually increased, from 153 to 162 million women.

The report, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, finds that 645 million women of reproductive age (15–49 years) in the developing world are now using modern contraceptive methods, 42 million more than in 2008. However, about half of the increase is due to population growth rather than to a higher rate of contraceptive use. Disturbingly, the increase in the number of modern contraceptive users between 2008 and 2012, roughly 10 million per year, was much lower than the annual increase between 2003 and 2008, which was approximately 20 million per year.

The overall proportion using a modern method among married women–who comprise 92% of all modern method users—remained virtually unchanged between 2008 and 2012, at 56–57%. However, there were significant regional variations. Substantial increases occurred in Eastern Africa (from 20% to 27%) and Southeast Asia (from 50% to 56%), while there was little change in Western Africa and Middle Africa, regions where fewer than 10% of married women use modern contraceptives.

The Millennium Development Goals Report 2012

July 9, 2012 Comments off

The Millennium Development Goals Report 2012 (PDF)
Source: United Nations

This year’s report on progress towards the Millennium Development Goals (MDGs) highlights several milestones. The target of reducing extreme poverty by half has been reached five years ahead of the 2015 deadline, as has the target of halving the proportion of people who lack dependable access to improved sources of drinking water. Conditions for more than 200 million people living in slums have been ameliorated—double the 2020 target. Primary school enrolment of girls equalled that of boys, and we have seen accelerating progress in reducing child and maternal mortality

These results represent a tremendous reduction in human suffering and are a clear validation of the approach embodied in the MDGs. But, they are not a reason to relax. Projections indicate that in 2015 more than 600 million people worldwide will still be using unimproved water sources, almost one billion will be living on an income of less than $1.25 per day, mothers will continue to die needlessly in childbirth, and children will suffer and die from preventable diseases. Hunger remains a global challenge, and ensuring that all children are able to complete primary education remains a fundamental, but unfulfilled, target that has an impact on all the other Goals. Lack of safe sanitation is hampering progress in health and nutrition, biodiversity loss continues apace, and greenhouse gas emissions continue to pose a major threat to people and ecosystems.

The goal of gender equality also remains unfulfilled, again with broad negative consequences, given that achieving the MDGs depends so much on women’s empowerment and equal access by women to education, work, health care and decision-making. We must also recognize the unevenness of progress within countries and regions, and the severe inequalities that exist among populations, especially between rural and urban areas.

Achieving the MDGs by 2015 is challenging but possible. Much depends on the fulfilment of MDG-8—the global partnership for development. The current economic crises besetting much of the developed world must not be allowed to decelerate or reverse the progress that has been made. Let us build on the successes we have achieved so far, and let us not relent until all the MDGs have been attained.

Youth Risk Behavior Surveillance — United States, 2011

June 25, 2012 Comments off

Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.

Reporting Period Covered: September 2010–December 2011.

Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.

Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.

Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.

Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.

Estimated Pregnancy Rates and Rates of Pregnancy Outcomes for the United States, 1990–2008

June 21, 2012 Comments off

Estimated Pregnancy Rates and Rates of Pregnancy Outcomes for the United States, 1990–2008 (PDF)
Source: National Center for Health Statistics

This report presents detailed pregnancy rates for 1990–2008, updating a national series of rates extending since 1976.

Tabular and graphical data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described.

In 2008, an estimated 6,578,000 pregnancies resulted in 4,248,000 live births, 1,212,000 induced abortions, and 1,118,000 fetal losses. The 2008 pregnancy rate of 105.5 pregnancies per 1,000 women aged 15–44 is 9 percent below the 1990 peak of 115.8. The teen pregnancy rate dropped 40 percent from 1990 to 2008, reaching a historic low of 69.8 per 1,000 women aged 15–19. Pregnancy rates have declined significantly for non-Hispanic white, non-Hispanic black, and Hispanic teenagers. Rates in 2008 for non-Hispanic black and Hispanic teenagers were two to three times higher than the rates for non-Hispanic white teenagers. Pregnancy rates for women in their early 20s declined to the lowest level in more than three decades, although the declines have been more modest than for teenagers. Pregnancy rates for women aged 25–29 have changed relatively little since 1990, while rates for women in their 30s and early 40s increased.

A decade of change for newborn survival, policy and programmes (2000–2010): A multi-country evaluation of prog ress towards scale

June 14, 2012 Comments off

A decade of change for newborn survival, policy and programmes (2000–2010): A multi-country evaluation of progress towards scale

Source: Health Policy & Planning

Special issue; open access articles.

From EurekAlert!:

The report, "A Decade of Change for Newborn Survival," was published in Health Policy and Planning today.

The world has achieved remarkable progress on reducing child deaths—from 12.4 million in 1990 to 7.6 million in 2010—but that progress isn’t reaching newborn babies at the same pace, the report shows. As a result, more than 40 percent of child deaths now occur in the newborn period, or first month of life. However, the new report finds that globally only 0.1 percent of official development assistance for maternal and child health exclusively targets newborns, and only 6 percent mentions newborns at all—despite 3.1 million newborn babies dying each year.

The report shows political will to reach the poorest families with the most effective interventions for newborn health has had dramatic results in low-income countries such as Bangladesh, Malawi and Nepal. All three are on track to meet the 2015 target of Millennium Development Goal 4 of reducing child deaths by two thirds since 1990, and all have reduced newborn deaths at about double the rate of neighboring countries.

African families have the highest risk of newborn deaths and it would take 150 years at current rates of progress to achieve newborn death rates on par with the United States and Europe.

Other report findings include:

  • Maternal mortality is declining faster than before, but newborn mortality is declining at half that rate—showing that improved maternity services are not enough to combat threats to newborn survival. Declines in newborn mortality rates are also 30 percent slower than those of children under 5 who survive the newborn period.
  • From 2003 to 2008, official development assistance doubled for maternal, newborn and child health in the 68 countries with the most newborn deaths, but only 6 percent of this funding mentioned the word "newborn" and only 0.1 percent included specific newborn care interventions.
  • Family planning—i.e., increased access to voluntary contraception—has led to reductions in newborn deaths, which often relate to too short a time between births or the youth of a mother. Prime examples are Nepal and Bangladesh, where the average number of babies per woman has been reduced by 50 percent.
  • 10 countries—including India and Ethiopia—account for two-thirds of neonatal deaths.
  • While economic growth is often linked to improved newborn survival, some of the world’s poorest countries have achieved tremendous progress in both newborn and child survival. These include Malawi in Africa and Nepal in South Asia, both on track to meet MDG4, and Sri Lanka, which, despite conflict there, provides a dramatic example of halving deaths due to preterm birth.
  • The new report includes comprehensive analyses of how Bangladesh, Nepal and Malawi are leaders in reducing newborn deaths, how Uganda has made strides in policy change for newborns, and how in Pakistan national partnerships and champions have kept newborn health on the agenda despite challenges including earthquakes and floods.
  • More than 75 percent of newborn deaths could be prevented in 2015 with universal coverage of high-impact interventions like Kangaroo Mother Care (wrapping newborns in skin-to-skin contact with their mothers for warmth and improved breastfeeding), antibiotics for babies with infections, exclusive breastfeeding, and other basic care.

Shifts in color discrimination during early pregnancy

June 13, 2012 Comments off

Shifts in color discrimination during early pregnancy
Source: Evolutionary Psychology

The present study explores two hypotheses: a) women during early pregnancy should experience increased color discrimination ability, and b) women during early pregnancy should experience shifts in subjective preference away from images of foods that appear either unripe or spoiled. Both of these hypotheses derive from an adaptive view of pregnancy sickness that proposes the function of pregnancy sickness is to decrease the likelihood of ingestion of foods with toxins or teratogens. Changes to color discrimination could be part of a network of perceptual and physiological defenses (e.g., changes to olfaction, nausea, vomiting) that support such a function. Participants included 13 pregnant women and 18 non-pregnant women. Pregnant women scored significantly higher than non-pregnant controls on the Farnsworth-Munsell (FM) 100 Hue Test, an objective test of color discrimination, although no difference was found between groups in preferences for food images at different stages of ripeness or spoilage. These results are the first indication that changes to color discrimination may occur during early pregnancy, and is consistent with the view that pregnancy sickness may function as an adaptive defense mechanism.

Planned Vaginal Birth or Elective Repeat Caesarean: Patient Preference Restricted Cohort with Nested Randomised Trial

May 21, 2012 Comments off
Source:  PLoS Medicine
Uncertainty exists about benefits and harms of a planned vaginal birth after caesarean (VBAC) compared with elective repeat caesarean (ERC). We conducted a prospective restricted cohort study consisting of a patient preference cohort study, and a small nested randomised trial to compare benefits and risks of a planned ERC with planned VBAC.
Methods and findings
2,345 women with one prior caesarean, eligible for VBAC at term, were recruited from 14 Australian maternity hospitals. Women were assigned by patient preference (n = 2,323) or randomisation (n = 22) to planned VBAC (1,225 patient preference, 12 randomised) or planned ERC (1,098 patient preference, ten randomised). The primary outcome was risk of fetal death or death of liveborn infant before discharge or serious infant outcome. Data were analysed for the 2,345 women (100%) and infants enrolled.
The risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower for infants born in the planned ERC group compared with infants in the planned VBAC group (0.9% versus 2.4%; relative risk [RR] 0.39; 95% CI 0.19–0.80; number needed to treat to benefit 66; 95% CI 40–200). Fewer women in the planned ERC group compared with women in the planned VBAC had a major haemorrhage (blood loss ≥1,500 ml and/or blood transfusion), (0.8% [9/1,108] versus 2.3% [29/1,237]; RR 0.37; 95% CI 0.17–0.80).
Among women with one prior caesarean, planned ERC compared with planned VBAC was associated with a lower risk of fetal and infant death or serious infant outcome. The risk of major maternal haemorrhage was reduced with no increase in maternal or perinatal complications to time of hospital discharge. Women, clinicians, and policy makers can use this information to develop health advice and make decisions about care for women who have had a previous caesarean.

BRCA1/2 carriers: their childbearing plans and theoretical intentions about having preimplantation genetic diagnosis and prenatal diagnosis

May 21, 2012 Comments off
Source:  Genetics in Medicine
To assess the impact of BRCA1/2 test results on carriers’ reproductive decision-making and the factors determining their theoretical intentions about preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND).
Unaffected BRCA1/2 mutation carriers of childbearing age (N = 605; 449 women; 151 men) were included at least 1 year after the disclosure of their test results in a cross-sectional survey nested in a national cohort. Multivariate adjustment was performed on the data obtained in self-administered questionnaires.
Response rate was 81.0%. Overall, 32.5% and 50% said that they would undergo PGD/PND, respectively, at a theoretical next pregnancy, whereas only 12.1% found termination of pregnancy (TOP) acceptable. Theoretical intentions toward PGD did not depend on gender/age, but were higher among those with no future childbearing plans (adjusted odds ratio (AOR) 95% confidence interval (CI): 3.5 (1.9–6.4)) and those having fewer relatives with cancer (AOR 1.5 95% CI (1.0–2.3)). Greater TOP acceptability was observed among males and those with lower educational levels; 85.4% of respondents agreed that information about PGD/PND should be systematically delivered with the test results.
The closer to reproductive decision-making BRCA1/2 carriers are, i.e., when they are more likely to be making future reproductive plans, the less frequently they intend to have PGD. Carriers’ theoretical intentions toward PND are discussed further.

Full Paper (PDF)

Women’s Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007

May 20, 2012 Comments off
Source:  PLoS ONE
The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations’ Millennium Development Goals (MDGs).
Time series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957–2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques.
During the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women’s education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (−13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (−1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (−69.2%). The slope of the MMR did not appear to be altered by the change in abortion law.
Increasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women’s reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion.

Substance Use during Pregnancy Varies by Race and Ethnicity

May 10, 2012 Comments off

Substance Use during Pregnancy Varies by Race and Ethnicity (PDF)
Source: Substance Abuse and Mental Health Services Administration

When pregnant women use alcohol, tobacco, or other drugs, they incur an increased risk for experiencing health problems themselves and poor birth outcomes for their infants. It is important for doctors, nurses, and midwives to discuss the risks of substance use with all pregnant women. Data from the National Survey on Drug Use and Health (NSDUH) indicate that substance use during pregnancy varies by race and ethnicity and suggest that health care providers may consider delivering targeted messages to make their discussions more effective.

According to NSDUH data, among women aged 15 to 44, pregnant black women were more likely than pregnant white and Hispanic women to have used any illicit drugs in the past month (Figure). Pregnant black and white women were more likely than pregnant Hispanic women to have used alcohol in the past month. Pregnant white women were more likely than pregnant black women to have smoked cigarettes in the past month, and both groups were more likely than pregnant Hispanic women to have smoked. Health care providers may want to consider using this information to deliver relevant health education to their patients about risks associated with illicit drug, alcohol, and tobacco use.

See: More Than One in Five Pregnant White Women Smoke Cigarettes (Science Daily)

Sexual Experience and Contraceptive Use Among Female Teens — United States, 1995, 2002, and 2006–2010

May 9, 2012 Comments off

Sexual Experience and Contraceptive Use Among Female Teens — United States, 1995, 2002, and 2006–2010
Source: Morbidity and Mortality Weekly Report (CDC)

The 2010 U.S. teen birth rate of 34.3 births per 1,000 females reflected a 44% decline from 1990 (1). Despite this trend, U.S. teen birth rates remain higher than rates in other developed countries; approximately 368,000 births occurred among teens aged 15–19 years in 2010, and marked racial/ethnic disparities persist (1,2). To describe trends in sexual experience and use of contraceptive methods among females aged 15–19 years, CDC analyzed data from the National Survey of Family Growth collected for 1995, 2002, and 2006–2010 (3). During 2006–2010, 57% of females aged 15–19 years had never had sex (defined as vaginal intercourse), an increase from 49% in 1995. Younger teens (aged 15–17 years) were more likely not to have had sex (73%) than older teens (36%); the proportion of teens who had never had sex did not differ by race/ethnicity. Approximately 60% of sexually experienced teens reported current use of highly effective contraceptive methods (e.g., intrauterine device [IUD] or hormonal methods), an increase from 47% in 1995. However, use of highly effective methods varied by race/ethnicity, with higher rates observed for non-Hispanic whites (66%) than non-Hispanic black (46%) and Hispanic teens (54%). Addressing the complex issue of teen childbearing requires a comprehensive approach to sexual and reproductive health that includes continued promotion of delayed sexual debut and increased use of highly effective contraception among sexually experienced teens.

15 Million Babies Born Too Soon

May 4, 2012 Comments off

15 Million Babies Born Too Soon
Source: Save the Children

Each year, some 15 million babies in the world, more than one in 10 births, are born too early, according to Born Too Soon: The Global Action Report on Preterm Birth, released today by Save the Children, The March of Dimes Foundation, the Partnership for Maternal, Newborn & Child Health and The World Health Organization. More than one million of those babies die shortly after birth; countless others suffer some type of lifelong physical, neurological, or educational disability, often at great cost to families and society. The report, with contributions from more than 100 experts representing almost 50 agencies, universities, organizations, and parent groups, includes the first-ever country ranking of preterm birth rates.

+ Full Report (PDF)


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