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Author(s): Ashley V. Hill [sup.1] [sup.2] , Eileen Nehme [sup.3] , Nagla Elerian [sup.3] , Ella D. Puga [sup.1] [sup.3] , Brandie D. Taylor [sup.2] [sup.4] , David Lakey [sup.3] [...], Objectives Provision of long-acting reversible contraception (LARC) after delivery and prior to discharge is safe and advantageous, yet few Texas hospitals offer this service. Our study describes experiences of Texas hospitals that implemented immediate postpartum LARC (IPLARC) programs, in order to inform the development of other IPLARC programs and guide future research on system-level barriers to broader adoption. Methods Eight Texas hospitals that had implemented an IPLARC program were identified, and six agreed to participate in the study. Interviews with 19 key hospital staff covered (1) factors that led the development of an IPLARC program; (2) billing, pharmacy, and administrative operations related to implementation; (3) patient demand and readiness; (4) the consent process; (5) staff training; and (6) hospital plans for monitoring and evaluation of IPLARC services. Results Most hospitals in this study primarily served Medicaid and un- or under-insured populations. Participants from all six hospitals perceived high levels of patient demand for IPLARC and provider interest in providing this service. The major challenges were related to financing IPLARC programs. Participants from half of the hospitals reported that leadership had concerns about financial viability of providing IPLARC. The hospitals with the longest-running IPLARC programs were safety net hospitals with family planning training programs. Conclusions for Practice We found that hospitals with IPLARC programs all had strong support from both providers and hospital leadership and had funding sources to offset costs that were not reimbursed. Strategies to reduce the financial risks related to IPLARC provision could provide the impetus for new programs to launch and support their sustainability.

We evaluated relationships between preconception adiposity and human offspring sex and sex ratio. Using data from a prospective preconception cohort nested within a randomized controlled trial based at 4 US clinical sites (2006–2012), we used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for male:female sex ratio, and log-identity regression to estimate risk differences (RDs) and 95% CIs for male and female livebirth according to preconception adiposity measures. Inverse-probability weights accounted for potential selection bias. Among 603 women attempting pregnancy, there were meaningful reductions in sex ratio for the highest category of each adiposity measure. The lowest sex ratios were observed for obesity (body mass index of ≥30, calculated as weight (kg)/height (m)2, OR = 0.48, 95% CI: 0.26, 0.88) relative to normal body mass index, and the top tertiles (tertile 3) of serum leptin (OR = 0.50, 95% CI: 0.32, 0.80) and skinfold measurements (OR = 0.50, 95% CI: 0.32, 0.79) relative to the lowest tertiles. Reductions were driven by 11–15 fewer male livebirths per 100 women (for obesity, RD = −15, 95% CI: −23, −6.7; for leptin tertile 3, RD = −11, 95% CI: −20, −3.2; and for skinfolds tertile 3, RD = −11, 95% CI: −19, −3.3). We found that relationships between preconception adiposity measures and reduced sex ratio were driven by a reduction in male births. [ABSTRACT FROM AUTHOR]

Background: During gestation, the decidua is an essential layer of the maternal‐fetal interface, providing immune support and maintaining inflammatory homeostasis. Although Chlamydia (C.) trachomatis is associated with adverse pregnancy outcomes the pathogenic effects on maternal decidua contributing to adverse events are not understood. This study examined how C. trachomatis antigen affects cell signaling, cell death, and inflammation in the decidua. Methods: Primary decidua cells (pDECs) from term, not‐in‐labor, fetal membrane‐decidua were cultured using the following conditions: (1) control – standard cell culture conditions, (2) 100 ng/ml or (3) 200 ng/ml of C. trachomatis antigen to model decidual cell infection in vitro. Differential expression of Toll‐like receptor (TLR) 4 (receptor for C. trachomatis antigen), signaling pathway markers phosphorylated TGF‐Beta Activated Kinase 1 (PTAB1), TAB1, phosphorylated p38 mitogen‐activated protein kinases (Pp38 MAPK), and p38 MAPK (western blot), decidual cell apoptosis and necrosis (flow cytometry), and inflammation (ELISA for cytokines) were determined in cells exposed to C. trachomatis antigen. T‐test was used to assess statistical significance (p < 0.05). Results: C. trachomatis antigen significantly induced expression of TLR4 (p = 0.03) and activation of TAB1 (p = 0.02) compared to controls. However, it did not induce p38 MAPK activation. In addition, pDECs maintained their stromal cell morphology when exposed to C. trachomatis antigen showing no signs of apoptosis and/or necrosis but did induce pro‐inflammatory cytokine interleukin (IL)‐6 (100 ng/ml: p = 0.02 and 200 ng/ml: p = 0.03), in pDECs compared to controls. Conclusion: Prenatal C. trachomatis infection can produce antigens that induce TLR4‐TAB1 signaling and IL‐6 inflammation independent of Pp38 MAPK and apoptosis and necrosis. This suggests that C. trachomatis can imbalance decidual inflammatory homeostasis, potentially contributing to adverse events during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Prenatal chlamydia has been linked to preeclampsia (PE), a morbid and deadly hypertensive disorder of pregnancy. However, this association is primarily with term PE a milder phenotype of the syndrome. Less is known about the impact of Neisseria gonorrhoeae on PE phenotypes. We determined if gonorrhea was associated with term or preterm PE and if effect modification by maternal characteristics was evident. Methods: This retrospective analysis included 43,727 singleton and first recorded deliveries from an administrative database. Individuals were enrolled between 2011-2021 at one of three hospitals in Houston, TX. Data on maternal characteristics, sexually transmitted infections, medical history, and preeclampsia defined by gestational age of delivery were obtained. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals adjusting for insurance, race/ethnicity, coinfection with chlamydia, syphilis, or HIV, maternal age, and smoking. Relative excess risk due to interaction (RERI) for ORs was used to identify if maternal pregnancy characteristics (maternal age, obesity, foreign-born, race/ethnicity, chronic health conditions, gravidity, and fetal sex) interacted with gonorrhea. Analyses were stratified by these variables if RERI indicated a possible interaction. Results: Over 95% were screened for N. gonorrhoeae and a total of 188 cases were identified. Prenatal gonorrhea was not significantly associated with preterm PE (OR 2.00, 95% CI 0.85-4.75) or term PE (OR 0.82, 95% CI 0.45-1.51). However, RERI suggested interaction between prenatal gonorrhea and maternal age >24, foreign-born status, and male fetal sex. We found trends towards increase in odds of preterm PE among individuals >24 years of age (OR 3.37, 95% CI 1.23-9.20), foreign-born (OR 4.7, 95% CI 1.49-14.80), and those with a male fetus (OR 3.89, 95% CI 1.5-9.8). This was not observed for term PE. Conclusions: Given the rising rates of N. gonorrhoeae, there is a need to optimize screening and prevention strategies in pregnant individuals. We found that in a population with high screening rates and presumed treatment, certain maternal and pregnancy characteristics may enhance odds for preterm PE. Further research is needed to determine the burden of STIs on hypertensive disorders of pregnancy, including investigations into biological effects during pregnancy. [ABSTRACT FROM AUTHOR]