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The co-existence of chronic pain conditions with anxiety and/or depression is common in the general population but poorly described during pregnancy. In this study, we sought to describe trends in chronic pain among a sample of delivering people and describe the co-existence of chronic pain with anxiety and/or depression among delivering people. This cross-sectional study used data from Optum's de-identified Clinformatics® Data Mart Database between 2008 and 2021, for delivering persons with coverage by single employer-based health plan. We computed predicted margins from generalized estimating equations to determine the marginal predicted probability of chronic pain among all delivering and non-delivering persons who identify as women with and without diagnosed anxiety and/or depression. Musculoskeletal and pelvic pain occurred most often regardless of delivering status. Delivering persons with anxiety and/or depression had higher marginal predicted probabilities of chronic pain compared to all delivering persons. Between 2008 and 2021, the predicted probabilities ranged from 0.400 to 0.527 and 0.221–0.261, respectively. Chronic pain conditions are common in pregnancy and nearly two times higher among individuals with anxiety and/or depression. The frequency of comorbid depression and/or anxiety with pain disorders among delivering persons highlights the importance of proper detection, coordination of care, and safe treatment options for this population. [ABSTRACT FROM AUTHOR]

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Background:Despite the opioid epidemic in the U.S., little data exist to guide postoperative opioid prescribing in Obstetrics & Gynecology (Ob/Gyn).Objective:To describe Ob/Gyn resident opioid prescription patterns in the U.S. and assess influential factors.Methods:An anonymous survey was emailed to Ob/Gyn residents in the U.S. between January–February 2015. Respondents reported the typical number of discharge narcotic tablets prescribed following six common procedures. Responses to questions addressed potential factors influencing prescription practices and knowledge about opioid abuse in the U.S. Residents who prescribed a number of discharge narcotic tablets in the top quartile were compared to those who never did. Logistic regression was used to identify factors associated with top quartile prescribers.Results:267 residents responded. Median number of discharge narcotics prescribed following cesarean section was 30 (IQR 28, 40) and after laparoscopic hysterectomy was 29 (IQR 20, 30). Factors associated with increased odds of prescribing in the top quartile included training in the West (aOR 3.15, 95% CI 1.05–9.45,p= 0.04) and agreeing with: “I prescribe postoperative narcotics to avoid getting reprimanded by attendings” (aOR 2.72, 95% CI 1.20–6.15,p= 0.02). Factors associated with decreased odds of prescribing in the top quartile included training in a community-based program (aOR 0.33, 95% CI 0.15–0.71,p= 0.005) and agreeing with: “I am conservative with the number of narcotics I prescribe after surgery” (aOR 0.34, 95% CI 0.17–0.71,p= 0.004). Conclusions/Importance:Opioid prescribing practices of Ob/Gyn residents are influenced by region of country, program-type, and factors related to hospital culture and personal insight. [ABSTRACT FROM PUBLISHER]

Background: Research has not adequately examined the potential negative effects of perceiving routine discrimination on general healthcare utilization or health status, especially among reproductive-aged women. We sought to evaluate the association between everyday discrimination, health service use, and perceived health among a national sample of women in the United States. Materials and Methods: Data were drawn from the Women's Healthcare Experiences and Preferences survey, a randomly selected, national probability sample of 1078 U.S. women aged 18-55 years. We examined associations between everyday discrimination ( via a standardized scale) on frequency of health service utilization and perceived general health status using chi-square and multivariable logistic regression modeling. Results: Compared with women who reported healthcare visits every 3 years or less (reference group), each one-point increase in discrimination score was associated with higher odds of having healthcare visits annually or more often (odds ratio [OR] = 1.36, confidence interval [95% CI] = 1.01-1.83). Additionally, each one-point increase in discrimination score was significantly associated with lower odds of having excellent/very good perceived health (OR = 0.65; 95% CI = 0.54-0.80). Conclusion: Perceived discrimination was associated with increased exposure to the healthcare setting among this national sample of women. Perceived discrimination was also inversely associated with excellent/very good perceived health status. [ABSTRACT FROM AUTHOR]

Introduction: The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. Methods: Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18-45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. Results: The response rate was 61% ( n = 2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<$25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. Conclusions: While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women. [ABSTRACT FROM AUTHOR]

This study aimed to characterize the association between Mental Health Parity and the Affordable Care Act and rates of severe maternal morbidity among a population of commercially insured individuals, including individuals with and without perinatal mood and anxiety disorders. We conducted a serial, cross-sectional analysis of individuals with an inpatient delivery in Optum's Clinformatics® Data Mart Database from 2008 to 2021. We applied an interrupted time series model with autoregressive integrated moving average to evaluate changes in quarterly severe maternal morbidity rates. Adjusted severe maternal morbidity rates declined from 167.2 (95%CI: [152.6, 181.9]) per 10,000 deliveries in the first quarter of 2008 to 98.2 (95%CI: [83.5, 112.8]) per 10,000 deliveries in the last quarter of 2021. Severe maternal morbidity rates remained higher, but declined to a greater degree, among those with perinatal mood and anxiety disorders (435.6, 95%CI: [379.9, 491.3], to 165.0, 95%CI: [109.3, 220.8] per 10,000 deliveries) compared to those without (153.0, 95%CI: [140.7, 165.3] to 81.8, 95%CI: [69.6, 94.1] per 10,000 deliveries). The observed association suggests implementation of Mental Health Parity and Affordable Care Act may have played a role in lowering rates of severe maternal morbidity, particularly among individuals with perinatal mood and anxiety disorders. • Severe maternal morbidity declined following federal mental health policy changes. • Severe maternal morbidity was higher among those with mood and anxiety disorders. • Severe maternal morbidity declined most among those with mood and anxiety disorders. • The Mental Health Parity and Affordable Care Acts may have contributed to improved birth outcomes. [ABSTRACT FROM AUTHOR]

Background: Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA. Methods: Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18-55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression. Results: Among women who had heard of the ACA ( n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03-0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17-0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10-0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35-0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12-32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement. Conclusions: Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services. [ABSTRACT FROM AUTHOR]

Background: Lichen sclerosus (LS) is a chronic inflammatory condition that is known to arise on the vulva. Many women with LS report vulvar pain, often affecting a patient's quality of life. In this study, the sexual function of LS patients, with and without pain, was compared to control populations. Materials and Methods: A case-control study to examine the relationship between LS and sexual dysfunction was conducted. A total of 335 women presenting to the gynecology clinic were included in the study: 197 women with biopsy confirmed LS were compared to two control groups (95 asymptomatic women were 'healthy' controls and 43 women had vulvovaginal candidiasis) on self-reported current health complaints, medical and surgical history and current symptoms such as pain and itching, type and frequency of sexual activity, and satisfaction with sexual activity. Results: Women with LS reported less frequent sexual activity than healthy controls ( p=0.007) and Candida controls ( p=0.04). Currently sexually active women with LS were significantly less likely to report vaginal intercourse (71.6%) than healthy controls (89.0%, p=0.003) or Candida controls (100%, p=0.0003), even though similar proportions of all three groups reported that vaginal intercourse was important. Satisfaction towards the quality of current sexual activity was significantly lower among women with LS compared with both the healthy and Candida control groups. 23.7% of women with LS reported that sexual activity was rarely or never satisfactory as compared with 0% of healthy controls ( p<0.0001) and 6.5% of Candida controls ( p=0.03). Conclusion: Women with LS have less frequent sexual activity and less satisfying sexual activity when compared with controls. [ABSTRACT FROM AUTHOR]

Our population-based survey of 1078 randomly sampled US women, aged 18 to 55 years, sought to characterize their understanding of and attitudes toward the Affordable Care Act (ACA). Most women, especially socially disadvantaged groups, had negative or uncertain attitudes toward the ACA and limited understanding of its health benefits, including its relevance for their own health service coverage and utilization. Our findings are important for continued research, policy, and practice, with implications for whether, when, and how improved coverage will translate to improved access and outcomes for US women. [ABSTRACT FROM AUTHOR]

Insurance chum, or moving between different insurance plans or between insurance and uninsurance, is common during the perinatal period. We used survey data from the 2012-17 Pregnancy Risk Assessment Monitoring System to estimate the impact of Affordable Care Act-related state Medicaid expansions on continuity of insurance coverage for lowincome women across three time points: preconception, delivery, and postpartum. We found that Medicaid expansion resulted in a 10.1-percentage-point decrease in churning between insurance and uninsurance, representing a 28 percent decrease from the prepolicy baseline in expansion states. This decrease was driven by a 5.8- percentage-point increase in the proportion of women who were continuously insured and a 4.2-percentage-point increase in churning between Medicaid and private insurance. Medicaid expansion improved insurance continuity in the perinatal period for low-income women, which may improve the quality of perinatal health care, but it also increased churning between public and private health insurance. [ABSTRACT FROM AUTHOR]

Purpose To describe women's preferences for reproductive health providers as sources of primary and mental health care. Methods This is secondary data analysis of the Women's Health Care Experiences and Preferences Study, an Internet survey conducted in September 2013 of 1,078 women aged 18 to 55 randomly sampled from a U.S. national probability panel. We estimated women's preferred and usual sources of care (reproductive health providers, generalists, other) for various primary care and mental health care services using weighted statistics and multiple logistic regression. Main Findings Among women using health care in the past 5 years ( n = 981), 88% received primary and/or mental health care, including a routine medical checkup (78%), urgent/acute (48%), chronic disease (27%), depression/anxiety (21%), stress (16%), and intimate partner violence (2%) visits. Of those, reproductive health providers were the source of checkup (14%), urgent/acute (3%), chronic disease (6%), depression/anxiety (6%), stress (11%), and intimate partner violence (3%) services. Preference for specific reproductive health-provided primary/mental health care services ranged from 7% to 20%. Among women having used primary/mental health care services ( N = 894), more women (1%–17%) preferred than had received primary/mental health care from reproductive health providers. Nearly one-quarter (22%) identified reproductive health providers as their single most preferred source of care. Contraceptive use was the strongest predictor of preference for reproductive health-provided primary/mental health care (odds ratios range, 2.11–3.30). Conclusions Reproductive health providers are the sole source of health care for a substantial proportion of reproductive-aged women—the same groups at risk for unmet primary and mental health care needs. Findings have implications for reproductive health providers' role in comprehensive women's health care provision and potentially for informing patient-centered, integrated models of care in current health systems. [ABSTRACT FROM AUTHOR]

We aimed to examine the role of perceived and direct stigma on access to reproductive health services among women in treatment for substance use disorders in Michigan. We draw on self-interview data from a cross-sectional study of female patients aged 18–50 years who accessed substance use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. We conducted logistic regressions to examine associations between perceived stigma and access to three types of reproductive health services (screening exams, birth control, and prenatal care), as well as direct stigma and access to birth control. The final sample included 260 women. A notable percentage of women reported inability to access reproductive health services (24% for screening exams, 14% for birth control, and 12% for prenatal care). Women with higher levels of perceived stigma because of substance use were significantly more likely to report inability to access screening exams (odds ratio [OR]: 2.14; confidence interval [CI]: 1.43–3.20) and birth control (OR: 2.17; CI: 1.36–3.77). Women reporting higher levels of direct stigma were also significantly more likely to report inability to access birth control (OR: 3.87; CI: 2.29–6.53), even after accounting for perceived stigma. Perceived and direct stigma because of substance use may be significant barriers to seeking and accessing reproductive health services for women. Health professionals should reduce stigma in health care in order to increase access to necessary services for this population. [ABSTRACT FROM AUTHOR]

Reducing the rate of cesarean sections among women considered at low risk for delivery by that method is a goal of Healthy People 2030. Prior research suggests that perinatal mood and anxiety disorders increase the risk for cesarean section, but data are limited. This cross-sectional study of commercially insured women examined the relationship between perinatal depression and anxiety disorders and primary (first-time) cesarean section rates, using administrative claims data for US in-hospital deliveries from the period 2008-17. Of the 360,225 delivery hospitalizations among 317,802 unique women, 24.0 percent included a delivery by primary cesarean section, and 3.1 percent carried a diagnosis of depression, anxiety, or both made during the index pregnancy. Using an adjusted generalized estimating equation, we found that the predicted probability of primary cesarean section was 3.5 percentage points higher, on average, among women with these disorders compared with those without them. Our findings confirm the importance of pursuing research to identify mechanisms by which perinatal depression and anxiety disorders increase the risk for primary caesarean section among women otherwise considered at low risk for delivery by that method, as well as effective interventions. [ABSTRACT FROM AUTHOR]

The Affordable Care Act (ACA) requires employer-based insurance plans to cover maternity services, but plans are allowed to impose cost sharing such as copayments and deductibles for these services. This study aimed to evaluate trends in cost sharing for maternity care among working women in employer-based plans, before and after the ACA. Our data indicate that between 2008 and 2015, average out-of- pocket spending for maternity care rose among women with employer- based insurance. This increase was largely driven by increased spending among women with deductibles. When we controlled for potential confounders, we found that out-of-pocket spending was higher for lower- income working women in 2008-13, but disparities disappeared in 2014-15 because of a continued rise in spending among higher-income working women. Policies that aim to lower out-of-pocket spending for maternity care could reduce a significant financial burden on families. [ABSTRACT FROM AUTHOR]