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Objective: To assess whether there is a relationship between evening, night, and weekend births and severe unexpected neonatal morbidity in low-risk term singleton births.Methods: We conducted a population-based, cross-sectional analysis. Severe unexpected neonatal morbidity as defined by the National Quality Forum specification 0716 was derived from linked birth certificate and hospital discharge summaries for 1,048,957 low-risk singleton term Californian births during 2011 through 2013. The association between the nursing shift (7 am-3 pm vs 3-11 pm and 11 pm -7 am) and weekday compared with weekend birth and the risk of severe unexpected neonatal morbidity was estimated using mixed effects logistic regression models.Results: Severe unexpected neonatal morbidity was higher among births during the 3-11 pm evening shift (2.1%) and the 11 pm-7 am night shift (2.1%), compared with those during the 7 am-3 pm day shift (1.8%). The adjusted odds ratios (ORs) were 1.10 (95% CI 1.06-1.13) for the evening shift and 1.15 (1.11-1.19) for the night shift. The adjusted ORs of severe unexpected neonatal morbidity were increased only on Sunday, as compared with other days (adjusted OR 1.08, 95% CI 1.02-1.14). When our analysis was by perinatal region, the increase was seen in four of the nine perinatal regions.Conclusion: After risk adjustment, the risk of severe unexpected morbidity in the low-risk singleton California birth cohort was significantly increased on Sundays and births during evening and night shifts. These elevations were detected in only four of California's nine perinatal regions. Further analysis at the individual hospital level is warranted. [ABSTRACT FROM AUTHOR]

Objective: To synthesize evidence regarding the association between interpregnancy weight change and hypertensive disorders of pregnancy.Data Sources: MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were systematically searched from the databases' interception until April 2019. Search strategy included the terms: "interpregnancy," "intergestational," "hypertension" and "hypertensive disorders."Methods Of Study Selection: Studies that assessed the relationship between interpregnancy weight change and hypertensive disorders of pregnancy were included. Twelve studies and 415,605 women were included in this systematic review and meta-analysis. We used Mendeley reference manager during the review process. Odds ratios (ORs) for the most adjusted models reported by the included articles and the corresponding 95% CIs were calculated. The no weight change category defined by each study was used as the reference category.Tabulation, Integration, and Results: Overall, there was an increased risk of hypertensive disorders of pregnancy associated with interpregnancy weight gain (OR 1.37; 95% CI 1.21-1.53; I=62.1%; P<.001). Additionally, interpregnancy weight loss was associated with lower risk of developing hypertensive disorders of pregnancy (OR 0.87; 95% CI 0.75-0.99; I=54.9%; P=.01), Finally, meta-regression showed that interpregnancy weight gain was associated with a graded increase in the risk of hypertensive disorders of pregnancy.Conclusion: This systematic review and meta-analysis provides evidence that interpregnancy weight gain is associated with an increased risk of hypertensive disorders of pregnancy, gestational hypertension, and preeclampsia.Systematic Review Registration: PROSPERO, CRD42018103002. [ABSTRACT FROM AUTHOR]

Objective: To examine associations among interpregnancy interval, the duration from the preceding birth to the conception of the next-born index child, and adverse birth outcomes using designs that adjust for measured and unmeasured factors.Methods: In this prospective cohort study, we used population-based Swedish registries from 1973 to 2009 to estimate the associations between interpregnancy interval (referent 18-23 months) and adverse birth outcomes (ie, preterm birth [less than 37 weeks of gestation], low birth weight [LBW; less than 2,500 g], small for gestational age [SGA; greater than 2 SDs below average weight for gestational age]). Analyses included cousin and sibling comparisons and postbirth intervals (ie, the interval between secondborn and thirdborn offspring predicting secondborn outcomes) to address unmeasured familial confounding.Results: Traditional cohort-wide analyses showed higher odds of preterm birth (adjusted odds ratio [OR] 1.51, 99% CI 1.39-1.63, 5.99% preterm births]) and LBW (adjusted OR 1.25, 99% CI 1.13-1.39, 3.32% LBW) after a short interpregnancy interval (0-5 months) compared with offspring born after an interpregnancy interval of 18-23 months (3.21% preterm births, 1.92% LBW). Except for preterm birth (adjusted OR 1.72, 99% CI 1.26-2.35), associations were attenuated in cousin comparisons. A small association between a short interpregnancy interval and preterm birth remained in sibling comparisons (adjusted OR 1.22, 99% CI 1.11-1.35), but associations with LBW (adjusted OR 0.83, 99% CI 0.74-0.94) and SGA (adjusted OR 0.74, 99% CI 0.64-0.85) reversed direction. For pregnancy intervals of 60 months or more, odds of preterm birth (adjusted OR 1.51, 99% CI 1.43-1.60, 5.07% preterm births), LBW (adjusted OR 1.61, 99% CI 1.50-1.73, 3.43% low-birth-weight births), and SGA (adjusted OR 1.54, 99% CI 1.42-1.66, 2.49% SGA births) were also higher when compared with the reference interval (1.53% SGA). Associations between long interpregnancy interval and adverse birth outcomes remained through cousin and sibling comparisons. Postbirth interval analyses showed familial confounding is present for short interpregnancy intervals, but supported independent associations for long interpregnancy intervals.Conclusion: Familial confounding explains most of the association between a short interpregnancy interval and adverse birth outcomes, whereas associations with long interpregnancy intervals were independent of measured and unmeasured factors. [ABSTRACT FROM AUTHOR]

Objective: To assess whether interpregnancy interval length after a pregnancy loss is associated with risk of repeat miscarriage.Methods: This analysis includes pregnant women participating in the Right From the Start (2000-2012) community-based prospective cohort study whose most recent pregnancy before enrollment ended in miscarriage. Interpregnancy interval was defined as the time between a prior miscarriage and the last menstrual period of the study pregnancy. Miscarriage was defined as pregnancy loss before 20 weeks of gestation. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios and 95% CIs for the association between different interpregnancy interval lengths and miscarriage in the study pregnancy. Adjusted models included maternal age, race, parity, body mass index, and education.Results: Among the 514 study participants who reported miscarriage as their most recent pregnancy outcome, 15.7% had a repeat miscarriage in the study pregnancy (n=81). Median maternal age was 30 years (interquartile range 27-34) and 55.6% of participants had at least one previous livebirth (n=286). When compared with women with interpregnancy intervals of 6-18 months (n=136), women with intervals of less than 3 months (n=124) had the lowest risk of repeat miscarriage (7.3% compared with 22.1%; adjusted hazard ratio 0.33, 95% CI 0.16-0.71). Neither maternal race nor parity modified the association. Attempting to conceive immediately was not associated with increased risk of miscarriage in the next pregnancy.Conclusion: An interpregnancy interval after pregnancy loss of less than 3 months is associated with the lowest risk of subsequent miscarriage. This implies counseling women to delay conception to reduce risk of miscarriage may not be warranted. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the length of the interpregnancy interval after termination of pregnancy influences the risk of preterm birth, low birth weight, and small-for-gestational-age neonates in a subsequent pregnancy.Methods: In this register-based study, we included all women (N=19,894) who underwent termination of pregnancy between 2000 and 2009 and whose subsequent pregnancy ended in live singleton delivery. The women were divided into five groups depending on the interpregnancy interval between termination of pregnancy and subsequent conception: interpregnancy interval less than 6 months (n=2,956), 6 to less than 12 months (n=3,203), 12 to less than 18 months (n=2,623), 18 to less than 24 months (n=2,076), and 24 months or greater (n=9,036). The incidences and unadjusted and adjusted risks of preterm birth, low birth weight, and small-for-gestational-age neonates were calculated in relation to the different interpregnancy interval lengths, the reference group being that with an interpregnancy interval of 18 to less than 24 months.Results: There was a significant difference in the rate of preterm birth between the group with the interpregnancy interval less than 6 months and the reference group (5.6% compared with 4.0%, respectively, P=.008). After adjusting for nine background factors, an interpregnancy interval of less than 6 months was associated with an increased risk of preterm birth (adjusted odds ratio 1.35, 95% confidence interval 1.02-1.77). No such association emerged in longer interpregnancy interval groups or regarding other adverse events. The possibility of unmeasured confounding cannot be ruled out.Conclusion: Slightly but significantly increased estimated risk of preterm delivery in subsequent pregnancy was seen when the interpregnancy interval after termination of pregnancy was less than 6 months. These data emphasize the need for prompt initiation of effective contraception after termination and enable counseling the patient for optimal conception interval. [ABSTRACT FROM AUTHOR]

Objective: To examine recurrent preterm birth and early term birth in women's initial and immediately subsequent pregnancies.Methods: This retrospective cohort study included 163,889 women who delivered their first and second liveborn singleton neonates between 20 and 44 weeks of gestation in California from 2005 through 2011. Data from hospital discharge records and birth certificates were used for analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models adjusted for risk factors.Results: Shorter gestational duration in the first pregnancy increased the risk of subsequent preterm birth (both early, before 32 weeks of gestation, and later, from 32 to 36 weeks of gestation) as well as early term birth (37-38 weeks of gestation). Compared with women with a prior term birth, women with a prior early preterm birth (before 32 weeks of gestation) were at the highest risk for a subsequent early preterm birth (58/935 [6.2%] compared with 367/118,505 [0.3%], adjusted OR 23.3, 95% CI 17.2-31.7). Women with a prior early term birth had more than a twofold increased risk for subsequent preterm birth (before 32 weeks of gestation: 171/36,017 [0.5%], adjusted OR 2.0, 95% CI 1.6-2.3; from 32 to 36 weeks of gestation: 2,086/36,017 [6.8%], adjusted OR 3.0, 95% CI 2.9-3.2) or early term birth (13,582/36,017 [37.7%], adjusted OR 2.2, 95% CI 2.2-2.3).Conclusion: Both preterm birth and early term birth are associated with these outcomes in a subsequent pregnancy. Increased clinical attention and research efforts may benefit from a focus on women with a prior early term birth as well as those with prior preterm birth. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In order to improve patient care and education efforts, there is a need to have more insight into the attitudes, beliefs, and practices regarding contraception among refugee women. METHODS: We conducted a qualitative study among refugee women in California. All participants provided informed consent. The focus groups included questions about general women's health, prior experiences with health care professionals in the United States, and attitudes towards, as well as experience with, birth spacing and contraception. In addition, we asked refugee women to evaluate the appropriateness of MyPATH, a web-based reproductive goals decision-support tool. RESULTS: Sixty-two refugee participated in focus groups. Participants ranged from 20-50 years and came from Congo, Somalia, Sudan, Eritrea, Ethiopia, Kenya, Uganda, Iraq, and Syria. Limiting family size while in the United States was more important than in participants' home countries given economic burdens and lack of family support. Side effects, misconceptions that contraception contributes to cancer and infertility, and impact on menses were major concerns with utilizing contraception. Many participants desired in-person female interpreters for reproductive health visits. Participants were receptive to the web-based reproductive goals decision support tool MyPATH, but preferred being able to ask questions in person during low technology reproductive-health education sessions at community centers. CONCLUSION: The refugee women in this study were interested in using contraceptives to limit family size due to economic strain. Participants reported concerns about side effects that impacted their current contraception use. The women preferred contraceptive education in their community centers. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Providing contraception in the postpartum period is essential to prevent unintended pregnancies and optimize birth spacing. The Medicaid program funds the majority of public family planning expenditures and pays for half of births in the United States. To improve postpartum contraception use, Medicaid stakeholders have focused on long-acting reversible contraception (LARC), which includes intrauterine devices and the contraceptive implants. A key platform for improving postpartum LARC access has been the adoption of carve-out policies that increase reimbursement for immediate postpartum LARC (IPP-LARC) services outside of the standard global maternity payment provided by Medicaid. IPP-LARC is LARC insertion that occurs after childbirth but prior to hospital discharge. IPP-LARC carve-out policies may increase postpartum LARC use among Medicaid enrolled individuals. METHODS: This study used the U.S. Centers for Disease Control Prevention Pregnancy Risk Assessment and Monitoring System dataset from 2016-2018 to explore the association between IPP-LARC carve-out policies and the use of postpartum LARC versus another form of hormonal and/or nonhormonal contraception. The study was approved by the institutional review board (IRB) at George Washington University. RESULTS: The study included 24,807 Medicaid enrolled postpartum individuals from 26 states. Results suggest that IPP-LARC policies are positively associated with LARC use over other forms of contraception and state Medicaid expansion status and postpartum visit attendance modify the association. CONCLUSION: The findings support the growing body of evidence that IPP-LARC carve-out policies and Medicaid expansion positively influence postpartum LARC use. Widespread adoption and implementation of such policies may be a key strategy to improve postpartum contraception access for Medicaid enrollees. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the association between antenatal corticosteroid administration-to-birth interval and outcomes. METHODS: In this retrospective cohort study, data on singleton neonates born between 24 0/7 and 33 6/7 weeks of gestation and admitted to tertiary neonatal units in Canada during 2010-2012 were obtained from the Canadian Neonatal Network. Neonatal outcomes were compared among four groups based on the interval between antenatal corticosteroid administration and birth: no antenatal corticosteroids, partial antenatal corticosteroids (less than 24 hours before birth), antenatal corticosteroids 1-7 days before birth, and antenatal corticosteroids greater than 7 days before birth. Composite outcome was defined as any of neonatal mortality, bronchopulmonary dysplasia, grade 3-4 intraventricular hemorrhage, periventricular leukomalacia, or stage 3 or higher retinopathy. RESULTS: Of 6,870 eligible neonates, 1,378 (20%) received no antenatal corticosteroids; 1,473 (21%) received partial antenatal corticosteroids; 2,721 (40%) received antenatal corticosteroids 1-7 days before birth; and 1,298 (19%) received antenatal corticosteroids greater than 7 days before birth. The odds of the composite adverse outcome were significantly higher in all groups compared with neonates who received antenatal corticosteroids 1-7 days before birth (no antenatal corticosteroids: adjusted odds ratio [OR] 2.12, 95% confidence interval [CI] 1.69-2.65; partial antenatal corticosteroids: adjusted OR 1.48, 95% CI 1.22-1.80; and antenatal corticosteroids at greater than 7 days: adjusted OR 1.46, 95% CI 1.20-1.77). Similar findings were observed with respect to neonatal mortality (no antenatal corticosteroids: adjusted OR 2.56, 95% CI 1.83-3.59; partial antenatal corticosteroids: adjusted OR 1.59, 95% CI 1.16-2.18; and antenatal corticosteroids at greater than 7 days: adjusted OR 1.40, 95% CI 1.00-1.97). CONCLUSION: Antenatal corticosteroids had maximum benefit when given between 1 and 7 days before birth. [ABSTRACT FROM AUTHOR]

The author reflects on interpregnancy interval. Topics discussed include conception of the subsequent pregnancy after the end of one, modifications that improve the outcome of the subsequent pregnancy, and women who become pregnant again shortly after delivery. Also being discussed is the common flaw that cause the increased risk of short intervals between two pregnancies.

OBJECTIVE: To investigate the prevalence and correlates of short interpregnancy intervals in the United States. METHODS: We analyzed pregnancy data from a nationally representative sample of 12,279 women from the 2006-2010 National Survey of Family Growth. We limited our sample to second and higher-order births within 5 years of the interview. Interpregnancy intervals were calculated as the interval between the delivery date of the preceding live birth and the conception date of the index pregnancy, with short interpregnancy intervals defined as intervals less than 18 months. We used simple and multivariate logistic regression analyses to examine associations between short interpregnancy intervals and maternal demographic and childbearing characteristics, including pregnancy intention. RESULTS: Among the 2,253 pregnancies in our sample, one third (35%) were conceived within 18 months of a previous birth. After adjusting for sociodemographic and childbearing characteristics, women were significantly more likely to have a short interpregnancy interval if they were aged 15-19 years or married at the time of conception of the index pregnancy, initiated childbearing after age 30 years, or reported the pregnancy as unintended. Short interpregnancy intervals were more likely to be intended among more advantaged women (married, non-Hispanic white, college-educated, or non-Medicaid delivery). We estimate that preventing unintended pregnancies would reduce the proportion of short interpregnancy intervals from 35% to 23%. CONCLUSION: Providing counseling about the potential negative consequences of short interpregnancy intervals and improving women's contraceptive use to reduce rates of unintended pregnancy likely would reduce the proportion of short interpregnancy interval pregnancies in the United States. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study that examines the postpartum sexual health of women. Several factors that influence postpartum sexual function, including hormonal changes, family structure, changes in anatomy and partner relationships. It describes the theories that explain the female sexual response cycle and common postpartum sexual problems. Options for screening women for sexual dysfunction during and after pregnancy are discussed.

The article presents abstracts of research on obstetrics and gynecology. They include "Birth Spacing and Risk of Adverse Perinatal Outcomes: a Meta-Analysis", "Vitamins C and E and the Risks of Preeclampsia and Perinatal Complications" and "Venous Thrombosis and Conjugated Equine Estrogen in Women Without a Uterus."