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Objective To estimate the absolute and relative risk of venous thromboembolism (VTE) among women who initiate depot medroxyprogesterone acetate (DMPA) immediately postpartum compared with those who do not initiate hormonal contraception. Methods The IBM MarketScan Commercial Claims and Encounters databases were used to identify delivery hospitalizations among women aged 15-44 years during 2005 through 2014. Diagnosis, procedure, and drug codes were used to identify contraception, VTE, and potential confounding chronic or pregnancy-related conditions. Women who initiated DMPA during days 0 through 7 postpartum were compared with women who did not initiate hormonal contraception during days 0 through 7 postpartum. Women were followed from date of delivery through 12 weeks postpartum for the occurrence of VTE, with censoring at hormonal contraception initiation or prescription, hysterectomy, sterilization, or inpatient death. The incidence rate of VTE and 95% CIs were calculated within each group and the incidence rate ratio was calculated comparing the two groups. Results The unadjusted VTE incidence rate through 12 weeks postpartum was 0.42/10,000 women-days in the immediate postpartum DMPA group (34 events among 11,159 women contributing 805,999 days of follow-up) and 0.15/10,000 women-days in the control group (3,107 events among 3,102,011 women contributing 206,180,811 days of follow-up). The incidence rate ratio for VTE was 2.87 (95% CI 2.05-4.03) among women in the immediate postpartum DMPA group compared with women in the control group, adjusting for age alone. After adjusting for age and pregnancy-related and chronic conditions, the adjusted incidence rate ratio for VTE was 1.94 (95% CI 1.38-2.72) among women in the immediate postpartum DMPA group compared with women in the control group. Conclusion Initiation of DMPA immediately postpartum is associated with a low incidence but an increased relative risk of VTE compared with nonuse of hormonal contraception.

To examine whether there are associations between pregnancy intention (intended, unwanted, mistimed, or ambivalent) and negative birth and maternal outcomes: low birth weight (less than 2,500 g), preterm delivery (fewer than 37 weeks), small for gestational age, premature labor, hypertension, and other maternal outcomes.We analyzed data from the population-based Pregnancy Risk Assessment Monitoring System, including 87,087 women who gave birth between 1996 and 1999 in 18 states. Information on pregnancy outcomes was derived from birth certificate data and a self-administered questionnaire completed postpartum. We employed SUDAAN (RTI International, Research Triangle Park, NC) for univariable and logistical regression analyses.In analyses controlling for demographic and behavioral factors, women with unwanted pregnancies had an increased likelihood of preterm delivery (adjusted odds ratio [OR] 1.16, 95% confidence interval [CI] 1.01-1.33) and premature rupture of membranes (adjusted OR 1.37, 95% CI 1.01-1.85) compared with women with intended pregnancies. Women who were ambivalent toward their pregnancies had increased odds of delivering a low birth weight infant (adjusted OR 1.15, 95% CI 1.02-1.29); in contrast, women with mistimed pregnancies had a lower likelihood (adjusted OR 0.92, 95% CI 0.86-0.97).Pregnancy intention, specifically unwanted and ambivalent, may be an indicator of increased risk for some poor birth and maternal outcomes and should be considered in interventions aimed at improving the health of the mother and child.III.

To assess whether reproductive factors are associated with mortality after breast cancer diagnosis.We followed up 4,299 U.S. women enrolled between 1980 and 1982 at ages 20-54 years as incident breast cancer cases in a population-based, case-control study, the Cancer and Steroid Hormone Study. Vital status through 1997 for these cases was obtained by linking Cancer and Steroid Hormone Study data to Surveillance, Epidemiology, and End Results files. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for death associated with selected reproductive factors using proportional hazards models.During a median follow-up of 14.5 years, 1,847 deaths occurred. Women aged 20-45 years whose last birth occurred 12 months or less (age-adjusted HR = 1.62, 95% CI 1.10-2.37) and 13-48 months before breast cancer diagnosis (age-adjusted HR = 1.35, 95% CI 1.05-1.75) were at an increased risk for death compared with nulliparous women. After adjusting for additional factors including tumor stage, women whose last birth occurred 12 months or less before diagnosis remained at an increased risk for death (HR = 1.51, 95% CI 1.02-2.23). Fifteen-year survival was 38%, 51%, and 60% among women aged 20-45 years whose last birth was 12 months or less, 13-48 months, and more than 48 months before diagnosis, respectively, compared with 65% among nulliparous women. Mortality risk was not associated with age at first birth, parity, or breastfeeding duration among women aged 20-45 years or among women aged 46-54 years.A recent birth may be an adverse prognostic indicator among women diagnosed with breast cancer at ages 20-45 years.

Objective: To assess rates of visits to emergency departments for gynecologic disorders among women of reproductive age in the United States. Methods: Data from the National Hospital Ambulatory Medical Care Survey for 1992–1994 were analyzed to determine rates of visits to emergency departments among women, ages 15–44 years. Average annual rates per 1000 women were calculated using age, race, and region-specific population estimates. Rate ratios were used to compare rates among subgroups. Results: Approximately 1.4 million gynecologic visits were made to emergency departments annually, for an average annual rate of 24.3 visits per 1000 women, ages 15–44 years (95% confidence interval [CI] 22.0, 26.6). The most frequent diagnoses were pelvic inflammatory disease (average annual rate 5.8, 95% CI 5.0, 6.6), lower genital tract infections including sexually transmitted diseases (average annual rate 5.7, 95% CI 4.8, 6.6), and menstrual disorders (average annual rate 2.9, 95% CI 2.3, 3.5). Nearly half of all gynecologic visits resulted in diagnoses of genital tract infections. Younger women (ages 15–24 years) were 2.3 (95% CI 2.0, 2.6) times as likely as older women (ages 25–44 years), and black women were 3.6 (95% CI 2.9, 4.3) times as likely as white women, to visit emergency departments for gynecologic disorders. Rate ratios for genital tract infections were 10–20 times higher for younger black women than for older, white women. Conclusion: Almost half of gynecologic visits to emergency departments were related to genital tract infections, which largely are preventable. (Obstet Gynecol 1998;91:1007–12.)