Search

Objective: We sought to determine the prevalence of postpartum contraceptive use among women with postpartum depressive symptoms (PDS) and examine the association between PDS and contraceptive method., Study Design: We evaluated data from 16,357 postpartum women participating in the 2009-2011 Pregnancy Risk Assessment Monitoring System. PDS was defined as an additive score of ≥10 for three questions on depression, hopelessness, and feeling physically slowed. Contraceptive use was categorized as permanent, long-acting reversible contraception (LARC), user-dependent hormonal, and user-dependent non-hormonal. Logistic regression models compared postpartum contraceptive use and method by PDS status., Results: In total, 12.3% of women with a recent live birth reported PDS. Large percentages of women with (69.4%) and without (76.1%) PDS, used user-dependent or no contraceptive method. There were no associations between PDS and use of any postpartum contraception (adjusted Prevalence Ratio (aPR)=1.00, 95% CI 0.98-1.03) or permanent contraception (aPR=1.05, 95% CI 0.88-1.27). LARC use was elevated, but not significantly, among women with PDS compared to those without (aPR=1.16, 95% CI: 1.00-1.34)., Conclusions: Large percentages of women with and without PDS used user-dependent or no contraception. Since depression may be associated with misuse of user-dependent methods, counseling women about how to use methods more effectively, as well as the effectiveness of non-user dependent methods, may be beneficial., Implications: A large percentage of women with PDS are either not using contraception or using less effective user-dependent methods. Since depression may be associated with misuse of user-dependent contraceptive methods, counseling women about how to use methods more effectively, as well as non-user dependent options, such as LARC, may be beneficial., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The objective of the study was to evaluate the associations between postpartum contraception and having a recent preterm birth., Study Design: Population-based data from the Pregnancy Risk Assessment Monitoring System in 9 states were used to estimate the postpartum use of highly or moderately effective contraception (sterilization, intrauterine device, implants, shots, pills, patch, and ring) and user-independent contraception (sterilization, implants, and intrauterine device) among women with recent live births (2009-2011). We assessed the differences in contraception by gestational age (≤27, 28-33, or 34-36 weeks vs term [≥37 weeks]) and modeled the associations using multivariable logistic regression with weighted data., Results: A higher percentage of women with recent extreme preterm birth (≤27 weeks) reported using no postpartum method (31%) compared with all other women (15-16%). Women delivering extreme preterm infants had a decreased odds of using highly or moderately effective methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.6) and user-independent methods (adjusted odds ratio, 0.5; 95% confidence interval, 0.4-0.7) compared with women having term births. Wanting to get pregnant was more frequently reported as a reason for contraceptive nonuse by women with an extreme preterm birth overall (45%) compared with all other women (15-18%, P < .0001). Infant death occurred in 41% of extreme preterm births and more than half of these mothers (54%) reported wanting to become pregnant as the reason for contraceptive nonuse., Conclusion: During contraceptive counseling with women who had recent preterm births, providers should address an optimal pregnancy interval and consider that women with recent extreme preterm birth, particularly those whose infants died, may not use contraception because they want to get pregnant., (Published by Elsevier Inc.)

Objective: The objective of the study was to provide national prevalence, patterns, and correlates of marijuana use in the past month and past 2-12 months among women of reproductive age by pregnancy status., Study Design: Data from 2007-2012 National Surveys on Drug Use and Health, a cross-sectional nationally representative survey, identified pregnant (n = 4971) and nonpregnant (n = 88,402) women 18-44 years of age. Women self-reported marijuana use in the past month and past 2-12 months (use in the past year but not in the past month). χ(2) statistics and adjusted prevalence ratios were estimated using a weighting variable to account for the complex survey design and probability of sampling., Results: Among pregnant women and nonpregnant women, respectively, 3.9% (95% confidence interval [CI], 3.2-4.7) and 7.6% (95% CI, 7.3-7.9) used marijuana in the past month and 7.0% (95% CI, 6.0-8.2) and 6.4% (95% CI, 6.2-6.6) used in the past 2-12 months. Among past-year marijuana users (n = 17,934), use almost daily was reported by 16.2% of pregnant and 12.8% of nonpregnant women; and 18.1% of pregnant and 11.4% of nonpregnant women met criteria for abuse and/or dependence. Approximately 70% of both pregnant and nonpregnant women believe there is slight or no risk of harm from using marijuana once or twice a week. Smokers of tobacco, alcohol users, and other illicit drug users were 2-3 times more likely to use marijuana in the past year than respective nonusers, adjusting for sociodemographic characteristics., Conclusion: More than 1 in 10 pregnant and nonpregnant women reported using marijuana in the past 12 months. A considerable percentage of women who used marijuana in the past year were daily users, met abuse and/or dependence criteria, and were polysubstance users. Comprehensive screening, treatment for use of multiple substances, and additional research and patient education on the possible harms of marijuana use are needed for all women of reproductive age., (Published by Elsevier Inc.)

Objective: Achieving adequate gestational weight gain (GWG) is important for optimal health of the infant and mother. We estimate current population-based trends of GWG., Study Design: We analyzed data from the Pregnancy Risk Assessment Monitoring System for 124,348 women who delivered live infants in 14 states during 2000 through 2009. We examined prevalence and trends in GWG in pounds as a continuous variable, and within 1990 Institute of Medicine (IOM) recommendations (yes/no) as a dichotomous variable. We examined adjusted trends in mean GWG using multivariable linear regression and GWG within recommendations using multivariable multinomial logistic regression., Results: During 2000 through 2009, 35.8% of women gained within IOM GWG recommendations, 44.4% gained above, and 19.8% gained below. From 2000 through 2009, there was a biennial 1.0 percentage point decrease in women gaining within IOM GWG recommendations (P trend < .01) and a biennial 0.8 percentage point increase in women gaining above IOM recommendations (P trend < .01). The percentage of women gaining weight below IOM recommendations remained relatively constant from 2000 through 2009 (P trend = .14). The adjusted odds of gaining within IOM recommendations were lower in 2006 through 2007 (adjusted odds ratio, 0.90; 95% confidence interval, 0.85-0.96) and 2008 through 2009 (adjusted odds ratio, 0.90; 95% confidence interval, 0.85-0.96) relative to 2000 through 2001., Conclusion: Overall, from 2000 through 2009 the percentage of women gaining within IOM recommendations slightly decreased while mean GWG slightly increased. Efforts are needed to develop and implement strategies to ensure that women achieve GWG within recommendations., (Copyright © 2015. Published by Elsevier Inc.)

We review the evidence and identify limitations of the current literature on the effectiveness of brief interventions (≤5 intervention sessions) on illicit drug use, treatment enrollment/retention, and pregnancy outcomes among pregnant and postpartum women; and consider this evidence in the context of the broader brief intervention literature. Among 4 published studies identified via systematic review and meeting a priori quality criteria, we found limited, yet promising evidence of the benefit of brief interventions to reduce illicit drug use among postpartum women. Two of the 4 randomized controlled trials tested similar computer-delivered single-session interventions; both demonstrate effects on postpartum drug use. Neither of the 2 randomized controlled trials that assessed treatment use found differences between intervention and control groups. Studies examining brief interventions for smoking and alcohol use among pregnant women, and for illicit drug use in the general adult population, have shown small but statistically significant results of the effectiveness of such interventions. Larger studies, those that examine the effect of assessment alone on illicit drug use, and those that use technology-delivered brief interventions are needed to assess the effectiveness of brief interventions for drug use in the peripartum period., (Published by Elsevier Inc.)

Background: This study examines whether a woman's mental health is associated with use of contraception., Study Design: We used national data from 2004 and 2006 to calculate the prevalence of contraceptive use among women with frequent mental distress. We examined associations among mental distress and permanent contraception and any highly or moderately effective, reversible contraceptive method., Results: Women with (86%) and without (87%) frequent mental distress reported using contraception, but contraceptive type varied by mental distress and income. Among women who use contraception, those with frequent mental distress had 1.4 times higher odds (95% CI: 1.2-1.6) of using permanent contraception. Among lower income women who use reversible contraception, those with frequent mental distress had lower odds of using highly [adjusted odds ratio (aOR)=0.5, 95% CI: 0.4-0.8] and moderately (aOR=0.6, 95% CI: 0.4-0.9) effective methods than less effective methods., Conclusion: Contraceptive providers should consider mental health when providing counseling about contraception., (Published by Elsevier Inc.)

Objective: The objective of the study was to estimate prevalence of depression and serious psychological distress (SPD) and mental health service receipt among reproductive-age women., Study Design: We used 2006-2007 nationally representative data to estimate the prevalence of depression and SPD among nonpregnant women aged 18 to 44 years. Using logistic regression, we individually examined predictors of depression and SPD and characteristics associated with clinical diagnosis and current treatment., Results: More than 14% of women had current depression and 2.7% had current SPD. Risk factors for major depression and SPD included older age, less education, being unmarried, inability to work/unemployed, and low income. Among depressed women, 18-24 year-olds, nonwhite women, those with children, the employed, and urban women had lower odds of clinical diagnosis. Among women with SPD, Hispanic, employed, and those without health insurance had lower odds of receiving treatment., Conclusion: Mental health conditions are prevalent among women of reproductive age and a substantial proportion goes untreated., (Published by Mosby, Inc.)

Background: Women with rheumatoid arthritis (RA) and their clinicians may have unique concerns about certain methods of contraception., Study Design: We conducted a systematic review of the literature in the MEDLINE database through February 2009 for peer-reviewed journal articles on use of any method of contraception, or progestins or estrogens, and progression of RA., Results: We identified eight articles that met the inclusion criteria: six examined oral contraceptives (OCs), one progesterone, and one estrogen. We found no studies on other methods of contraception. For OCs, no consistent pattern of improvement or worsening of disease emerged and most patients showed little change in RA symptoms. We saw little improvement in the studies examining progesterone and estrogen., Conclusion: Although sparse and based primarily on older studies of poor quality, this information suggests that OC use is unlikely to affect RA disease progression. Research is needed on other forms of contraception, such as DMPA and IUD., (Published by Elsevier Inc.)

Objective: The purpose of this study was to estimate the national prevalence and predictors of sexually transmitted disease/human immunodeficiency virus (STD/HIV) service receipt in the preceding year among young women who received contraceptive services., Study Design: Weighted self-reported data from the 2002 National Survey of Family Growth was used to estimate the prevalence and multivariable odds ratios for the receipt of STD/HIV services among 1009 unmarried, sexually active 15- to 24-year-old women who received contraceptive services., Results: Of the women who received contraceptive services, 35% (2.7 million) did not receive STD/HIV services. Predictors of the receipt of STD/HIV services included younger age at first sexual intercourse (< or = 14 years; adjusted odds ratio [aOR], 2.0; 15-17 years; aOR, 1.7), having ever been pregnant (aOR, 2.2); having had > or = 2 partners in the past year (aOR, 2.6), receipt of a pregnancy test or abortion in the past year (aOR, 2.3), and having visited a Title X clinic in the last 12 months (aOR, 3.3)., Conclusion: Interventions are needed to help integrate contraceptive and STD/HIV services.

Objective: To evaluate the acceptability and feasibility of rapid human immunodeficiency virus testing in obstetric outpatient settings., Study Design: The Mother-Infant Rapid Intervention at Delivery (MIRIAD) study was a prospective, multicenter study. Women were offered rapid and conventional human immunodeficiency virus testing if they presented to outpatient settings late in pregnancy with undocumented human immunodeficiency virus status. We compared median times between conventional and rapid testing and between rapid point-of-care and rapid laboratory-based testing., Results: Among eligible women who were offered participation, 90% accepted testing. The median time from blood draw to result available was faster for rapid testing (25 minutes) than conventional testing (23 hours; P < .0001). For rapid tests, point-of-care testing was faster than laboratory-based testing (24 minutes vs 35 minutes; P < .0001). Almost 96% of rapid test results were available within 1 hour., Conclusion: Rapid human immunodeficiency virus testing is acceptable, feasible, and provides results far sooner than conventional testing in obstetric outpatient settings.