Browsing by Subject "Postpartum period"
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Item Association between patient characteristics and HPV vaccination recommendation for postpartum patients: A national survey of Obstetrician/Gynecologists(Elsevier, 2022-04-20) Lake, Paige W.; Head, Katharine J.; Christy, Shannon M.; DeMaria, Andrea L.; Thompson, Erika L.; Vadaparampil, Susan T.; Zimet, Gregory D.; Kasting, Monica L.; Communication Studies, School of Liberal ArtsHuman papillomavirus (HPV) vaccination rates in the U.S. are relatively low. Provider recommendation rates for HPV vaccination often vary by patient age and relationship status. Obstetrician/gynecologists (OB/GYNs) represent a key provider group that can recommend the HPV vaccine. This study examined differences in OB/GYN recommendation of HPV vaccination for inpatient postpartum patients by age, parity, and marital status. Data were collected from OB/GYNs nationally via a cross-sectional survey. Participants were randomized to two vignette groups (23-year-old patient or 33-year-old patient). Within each group, participants received 4 vignettes that were identical except for patient marital status (married/not in a committed relationship) and number of children (first/third child), and were asked to indicate HPV vaccination recommendation likelihood on a scale of 0 (definitely would not) to 100 (definitely would). A 2 × 2 × 2 general linear model with repeated measures was used to examine main and interaction effects of patient age, relationship status, and parity. 207 OB/GYNs were included in the final analyses. Recommendation was high for 23-year-old patients (range: 64.5-84.6 out of 100). When marital status and parity were held constant, recommendation likelihood was higher for the younger vs. older patient and was also higher for patients not in a committed relationship, compared to married patients (all p-values < 0.001). Differences in recommendation exist when considering age and relationship status, which provides insight into OB/GYN clinical decision-making. Findings highlight the need to address barriers to HPV vaccination recommendation, including awareness of risk factors to consider when recommending the vaccine.Item Association of Comprehensive Immediate Postpartum Contraception with Infant Outcomes(American Medical Association, 2022) Wilkinson, Tracey A.; Peipert, Jeffrey F.; Pediatrics, School of MedicineItem Association of the Timing of Postpartum Intrauterine Device Insertion and Breastfeeding With Risks of Intrauterine Device Expulsion(American Medical Association, 2022-02-01) Armstrong, Mary Anne; Raine-Bennett, Tina; Reed, Susan D.; Gatz, Jennifer; Getahun, Darios; Schoendorf, Juliane; Postlethwaite, Debbie; Fassett, Michael J.; Peipert, Jeffrey F.; Saltus, Catherine W.; Merchant, Maqdooda; Alabaster, Amy; Zhou, Xiaolei; Ichikawa, Laura; Shi, Jiaxiao M.; Chiu, Vicki Y.; Xie, Fagen; Hunter, Shannon; Wang, Jinyi; Ritchey, Mary E.; Chillemi, Giulia; Im, Theresa M.; Takhar, Harpreet S.; Pisa, Federica; Asiimwe, Alex; Anthony, Mary S.; Obstetrics and Gynecology, School of MedicineImportance: Intrauterine device (IUD) expulsion increases the risk of unintended pregnancy; how timing of postpartum IUD insertion and breastfeeding are associated with risk of expulsion is relevant to the benefit-risk profile. Objective: To evaluate the association of postpartum timing of IUD insertion and breastfeeding status with incidence and risk of IUD expulsion. Design, setting, and participants: The Association of Perforation and Expulsion of Intrauterine Devices (APEX-IUD) cohort study included women aged 50 years or younger with an IUD insertion between 2001 and 2018. The breastfeeding analysis focused on a subcohort of women at 52 or fewer weeks post partum with known breastfeeding status. The study was conducted using data from electronic health records (EHRs) at 4 research sites with access to EHR: 3 Kaiser Permanente sites (Northern California, Southern California, Washington) and the Regenstrief Institute (Indiana). Data analysis was conducted from June to November 2019. Exposures: Timing of IUD insertion post partum was categorized into discrete time periods: 0 to 3 days, 4 days to 6 or fewer weeks, more than 6 weeks to 14 or fewer weeks, more than 14 weeks to 52 or fewer weeks, and non-post partum (>52 weeks or no evidence of delivery). Breastfeeding status at the time of insertion was determined from clinical records, diagnostic codes, or questionnaires from well-baby visits. Main outcomes and measures: Incidence rates and adjusted hazard ratios (aHRs) were estimated using propensity scores to adjust for confounding. Results: The full cohort included 326 658 women (mean [SD] age, 32.0 [8.3] years; 38 911 [11.9%] Asian or Pacific Islander; 696 [0.2%] Hispanic Black; 56 180 [17.2%] Hispanic other; 42 501 [13.0%] Hispanic White; 28 323 [8.7%] non-Hispanic Black; 137 102 [42.0%] non-Hispanic White), and the subcohort included 94 817 women. Most IUDs were levonorgestrel-releasing (259 234 [79.4%]). There were 8943 expulsions. The 5-year cumulative incidence of IUD expulsion was highest for insertions 0 to 3 days post partum (10.73%; 95% CI, 9.12%-12.61%) and lowest for insertions more than 6 weeks to 14 or fewer weeks post partum (3.18%; 95% CI, 2.95%-3.42%). Adjusted HRs using women with non-post partum IUD insertion as the referent were 5.34 (95% CI, 4.47-6.39) for those with postpartum insertion at 0 to 3 days; 1.22 (95% CI, 1.05-1.41) for those with postpartum insertion at 4 days to 6 or fewer weeks; 1.06 (95% CI, 0.95-1.18) for those with postpartum insertion at more than 6 to 14 or fewer weeks; and 1.43 (95% CI, 1.29-1.60) for those with postpartum insertion at more than 14 to 52 or fewer weeks. In the subcohort, 5-year cumulative incidence was 3.49% (95% CI, 3.25%-3.73%) for breastfeeding women and 4.57% (95% CI, 4.22%-4.95%) for nonbreastfeeding women; the adjusted HR for breastfeeding vs not breastfeeding was 0.71 (95% CI, 0.64-0.78). Conclusions and relevance: In this study of real-world data, IUD expulsion was rare but more common with immediate postpartum insertion. Breastfeeding was associated with lower expulsion risk.Item Health insurance coverage and poverty status of postpartum women in the United States in 2019: an ACS-PUMS population-based cross-sectional study(Springer Nature, 2023-11-08) Seo, Bojung; Turman, Jack Edward; Nan, Hongmei; Epidemiology, Richard M. Fairbanks School of Public HealthBackground: A quarter of United States (US) postpartum women still report unmet health care needs and health care unaffordability. We aimed to study associations between receipt of health insurance coverage and poverty status/receipt of government financial support and determine coverage gaps overall and by social factors among US postpartum women in poverty. Methods: This study design is a cross-sectional study using secondary data. We included women who gave birth within the last 12 months from 2019 American Community Survey Public Use Microdata Sample. Poverty was defined as having an income-to-poverty ratio of less than 100%. We explored Medicaid/government medical assistance gaps among women in poverty. To examine the associations between Medicaid/government medical assistance (exposures) and poverty/government financial support (outcomes), we used age-, race-, and multivariable-adjusted logistic regression models. We also evaluated the associations of state, race, citizenship status, or language other than English spoken at home (exposures) with receipt of Medicaid/government medical assistance (outcomes) among women in poverty through multivariable-adjusted logistic regression. Results: It was notable that 35.6% of US postpartum women in poverty did not have Medicaid/government medical assistance and only a small proportion received public assistance income (9.8%)/supplementary security income (3.1%). Women with Medicaid/government medical assistance, compared with those without the coverage, had statistically significantly higher odds of poverty [adjusted odds ratio (aOR): 3.15, 95% confidence interval (95% CI): 2.85-3.48], having public assistance income (aOR: 24.52 [95% CI: 17.31-34.73]), or having supplementary security income (aOR: 4.22 [95% CI: 2.81-6.36]). Also, among postpartum women in poverty, women in states that had not expanded Medicaid, those of Asian or other race, non-US citizens, and those speaking another language had statistically significantly higher odds of not receiving Medicaid/government medical assistance [aORs (95% CIs): 2.93 (2.55-3.37); 1.30 (1.04-1.63); 3.65 (3.05-4.38); and 2.08 (1.86-2.32), respectively]. Conclusions: Our results showed that the receipt of Medicaid/government medical assistance is significantly associated with poverty and having government financial support. However, postpartum women in poverty still had Medicaid/government medical assistance gaps, especially those who lived in states that had not expanded Medicaid, those of Asian or other races, non-US citizens, and other language speakers.Item Major Occupations and Private Insurance of Working Postpartum Women in Poverty in the United States, 2019(Mary Ann Liebert, 2023-10-18) Seo, Bojung; Nan, Hongmei; Epidemiology, School of Public HealthBackground: Although working postpartum women in poverty still have unmet medical needs, relevant research is lacking. Thus, we aimed to determine the five most frequent occupations of U.S. postpartum women in poverty and further examine whether the most frequent occupations are associated with poverty/being uninsured by an employer. Methods: This is a cross-sectional study. We included women who had a job and gave birth within the last 12 months from a 2019 American Community Survey Public Use Microdata Sample. To examine the associations between the most frequent occupations and being in poverty/uninsured through an employer/union, we used age- and race-adjusted and multivariable-adjusted logistic regression models. Results: A total of 14.3% of working postpartum women lived in poverty, and their most frequent major occupations were sales and related work, followed by food preparation and serving-related work, office and administrative support work, health care support work, and cleaning and ground maintenance. A total of 51.2% of women in the most frequent major occupations were uninsured through an employer/union. Compared with women in other occupations, women in the most frequent major occupations had fewer working hours and weeks that included paid leave. In particular, cleaners and ground maintenance workers and food preparation and serving-related workers were most likely to be in poverty and uninsured through an employer/union. Conclusions: Compared with other occupations, the most frequent occupations were more likely to be insecure and less likely to provide health insurance. Our U.S.-based study suggested that current policies regarding employee benefits needed to be improved especially for the most frequent major occupations.Item Outcomes Following Extracorporeal Membrane Oxygenation for Severe COVID-19 in Pregnancy or Post Partum(American Medical Association, 2023-05-01) Byrne, John J.; Shamshirsaz, Amir A.; Cahill, Alison G.; Turrentine, Mark A.; Seasely, Angela R.; Eid, Joe; Rouse, Caroline E.; Richley, Michael; Raghuraman, Nandini; Naqvi, Mariam; El-Sayed, Yasser Y.; Badell, Martina L.; Cheng, CeCe; Liu, James; Adhikari, Emily H.; Patel, Soha S.; O'Neil, Erika R.; Ramsey, Patrick S.; Obstetrics and Gynecology, School of MedicineImportance: Existing reports of pregnant patients with COVID-19 disease who require extracorporeal membrane oxygenation (ECMO) are limited, with variable outcomes noted for the maternal-fetal dyad. Objective: To examine maternal and perinatal outcomes associated with ECMO used for COVID-19 with respiratory failure during pregnancy. Design, setting, and participants: This retrospective multicenter cohort study examined pregnant and postpartum patients who required ECMO for COVID-19 respiratory failure at 25 hospitals across the US. Eligible patients included individuals who received care at one of the study sites, were diagnosed with SARS-CoV-2 infection during pregnancy or up to 6 weeks post partum by positive nucleic acid or antigen test, and for whom ECMO was initiated for respiratory failure from March 1, 2020, to October 1, 2022. Exposures: ECMO in the setting of COVID-19 respiratory failure. Main outcome and measures: The primary outcome was maternal mortality. Secondary outcomes included serious maternal morbidity, obstetrical outcomes, and neonatal outcomes. Outcomes were compared by timing of infection during pregnancy or post partum, timing of ECMO initiation during pregnancy or post partum, and periods of circulation of SARS-CoV-2 variants. Results: From March 1, 2020, to October 1, 2022, 100 pregnant or postpartum individuals were started on ECMO (29 [29.0%] Hispanic, 25 [25.0%] non-Hispanic Black, 34 [34.0%] non-Hispanic White; mean [SD] age: 31.1 [5.5] years), including 47 (47.0%) during pregnancy, 21 (21.0%) within 24 hours post partum, and 32 (32.0%) between 24 hours and 6 weeks post partum; 79 (79.0%) had obesity, 61 (61.0%) had public or no insurance, and 67 (67.0%) did not have an immunocompromising condition. The median (IQR) ECMO run was 20 (9-49) days. There were 16 maternal deaths (16.0%; 95% CI, 8.2%-23.8%) in the study cohort, and 76 patients (76.0%; 95% CI, 58.9%-93.1%) had 1 or more serious maternal morbidity events. The largest serious maternal morbidity was venous thromboembolism and occurred in 39 patients (39.0%), which was similar across ECMO timing (40.4% pregnant [19 of 47] vs 38.1% [8 of 21] immediately postpartum vs 37.5% postpartum [12 of 32]; P > .99). Conclusions and relevance: In this multicenter US cohort study of pregnant and postpartum patients who required ECMO for COVID-19-associated respiratory failure, most survived but experienced a high frequency of serious maternal morbidity.Item Outcomes of retained and disengaged pregnant women living with HIV in Uganda(Public Library of Science, 2021-05-21) Kiragga, Agnes N.; Twinomuhwezi, Ellon; Banturaki, Grace; Achieng, Marion; Nampala, Juliet; Bagaya, Irene; Kigozi, Joanita; Castelnuovo, Barbara; Musick, Beverly S.; Hazra, Rohan; Yiannoutsos, Constantin T.; Wools-Kaloustian, Kara K.; Medicine, School of MedicineIntroduction: Loss-to-follow-up among women living with HIV (WLWHIV) may lead to unfavorable outcomes for both mother and exposed infant. This study traced WLWHIV disengaged from care and their infants and compared their outcomes with those retained in care. Methods: The study included WLWHIV who initiated ART during pregnancy at six public clinics in Uganda. A woman was defined as disengaged (DW) if she had not attended her 6-week post-partum visit by 10 weeks after her estimated date of delivery. DW were matched with retained women (RW) by age and duration on ART. Nurse counselors traced all selected DW via telephone and community visits to assess vital status, infant HIV sero-status and maternal HIV viral load through blood draws. Results: Between July 2017 and July 2018, 734 women (359 DW and 375 RW) were identified for the study. Tracing was attempted on 349 DW and 160 (44.6%) were successfully located and enrolled in the study. They were matched with 162 RW. Among DW, 52 (32.5%) transferred to another health facility. Very few DW, 39.0% were HIV virally suppressed (<1000 copies/ml) compared to RW 89.5%, P<0.001). Among 138 babies born to DW, 4.3% tested positive for HIV compared to 1.4% among babies born to RW (P = 0.163). Conclusion: Pregnant and breastfeeding WLWHIV who disengage from care are difficult to find in urban environments. Many have detectable viral loads, leading to the potential for an increased risk of MTCT. Efforts to reduce disengagement from care are critical for the successful elimination of MTCT in resource-limited settings.Item Twelve-Month Outcomes of the First 1000 Days Program on Infant Weight Status(American Academy of Pediatrics, 2021) Taveras, Elsie M.; Perkins, Meghan E.; Boudreau, Alexy Arauz; Blake-Lamb, Tiffany; Matathia, Sarah; Kotelchuck, Milton; Luo, Mandy; Price, Sarah N.; Roche, Brianna; Cheng, Erika R.; Pediatrics, School of MedicineObjectives: To examine the effects of the First 1000 Days intervention on the prevalence of infant overweight and maternal postpartum weight retention and care. Methods: Using a quasi-experimental design, we evaluated the effects of the First 1000 Days program among 995 term, low-income infants and their mothers receiving care in 2 intervention community health centers and 650 dyads in 2 comparison health centers. The program includes staff training, growth tracking, health and behavioral screening, patient navigation, text messaging, educational materials, and health coaching. Comparison centers implemented usual care. Infant outcomes were assessed at 6 and 12 months, including weight-for-length z score and overweight (weight for length ≥97.7th percentile). We also examined maternal weight retention and receipt of care 6 weeks' post partum. Results: The mean birth weight was 3.34 kg (SD 0.45); 57% of infants were Hispanic; 66% were publicly insured. At 6 months, infants had lower weight-for-length z scores (β: -.27; 95% confidence interval [CI]: -.39 to -.15) and lower odds of overweight (adjusted odds ratio [OR]: 0.46; 95% CI: 0.28 to 0.76) than infants in comparison sites; differences persisted at 12 months (z score β: -.18; 95% CI: -.30 to -.07; adjusted OR for overweight: 0.60; 95% CI: 0.39 to 0.92). Mothers in the intervention sites had modestly lower, but nonsignificant, weight retention at 6 weeks' post partum (β: -.51 kg; 95% CI: -1.15 to .13) and had higher odds (adjusted OR: 1.50; 95% CI: 1.16 to 1.94) of completing their postpartum visit compared with mothers in the comparison sites. Conclusions: An early-life systems-change intervention combined with coaching was associated with improved infant weight status and maternal postpartum care.