Disparities in women's health have been identified in clinical outcomes, research, and medical education. However, women's health education remains inconsistent in internal medicine training. Longitudinal women's health training tracks have proven positive impacts on trainees' confidence with women's health clinical practice, and graduates of these tracks go on to become leaders who further expand these efforts. Our objective was to update the 2023 Directory of Internal Medicine Residency and Fellowship Programs in Women's Health to provide trainees and clinician educators with a centralized list of U.S. internal medicine residency and fellowship women's health training programs. We contacted women's health education program leaders from the 2023 directory to update their program information. We sent a recruitment email to the Sex-and Gender-Based Women's Health Education Interest Group listserv of the Society of General Internal Medicine and used snowball sampling to identify new programs. New program leaders were sent an electronic Qualtrics survey to confirm current program status, contact information, website, capacity, educational offerings, and program highlights. This directory describes 29 graduate medical education training programs in women's health for internists, with 12 residency programs and 17 fellowship programs identified. This is an overall increase from the 25 programs in the 2023 directory. This directory is a practical resource for trainees seeking educational experiences and for medical educators seeking opportunities for collaboration and leadership in women's health. The increase in training opportunities is a step toward comprehensive medical education and equitable, high-quality care and research in women's health.
Despite significant medical and scientific advances, gaps remain in women's health research across the lifespan. We explore the use of the All of Us Research Program Data set to help close the research gaps for women. This paper describes the utility of the All of Us Research Program-a large, longitudinal U.S. cohort of over 800,000 individuals (63% women) representing all 50 states-to advance research in women's health. Three use cases explore conditions that affect women: (1) disproportionality (hyperthyroidism and osteoporosis), (2) differently (health care access), and (3) uniquely (postpartum hemorrhage). Each use case utilized electronic health records, survey responses, and clinical measurements, and was analyzed with R on the secure cloud-based workbench. Hyperthyroidism was strongly associated with the development of osteoporosis, suggesting opportunities for additional screening and treatment. Examining access to care, women described barriers including cost, transportation, and caregiving responsibilities. In postpartum hemorrhage of the over 10,000 pregnancies we analyzed, the multivariable linear regression showed that anemia, preeclampsia, obesity, placental abruption, and placenta previa were all significant risk factors. These use cases demonstrate the size and depth of the data and the usefulness for testing hypotheses and identifying areas for screening and prevention for women's health. All of Us enables comprehensive, inclusive research into sex-specific health issues. Our analyses show how this dataset fills long-standing gaps by supporting stratified analyses enabling research into women's health across the lifespan. Researchers can readily access these tools to accelerate science and medical advances for women.
With the onset of COVID-19 disruptions in the United States, Planned Parenthood rapidly expanded telehealth services to meet patient needs. This study examines patient and visit characteristics associated with telehealth use and compares the quality of contraceptive care delivered to telehealth and in-person patients. This cross-sectional study consisted of an electronic postvisit survey (N = 506, 2022) and a secondary analysis of electronic health record data from telehealth and in-person contraceptive patients (N = 59,691, 2020-2021) at five Planned Parenthood affiliates. We collected data on patient demographic characteristics, visit characteristics, and six dimensions of high-quality care from the Institute of Medicine's framework. We conducted bivariate (for the relationships between patient/visit characteristics and telehealth use) and multivariable modified Poisson regression (for the relationships between modality and multiple quality of care measures), adjusting for patient and visit characteristics (where appropriate). Patients who preferred Spanish or another language were less likely to have a telehealth visit compared with patients who preferred English (prevalence ratio [PR] = 0.45, 95% confidence interval [CI]: 0.29-0.67; PR = 0.26, 95% CI: 0.13-0.56, respectively). Patients who had a birth control-only visit were more likely to have a telehealth visit compared with patients who had a visit for birth control and other services (PR = 0.12, 95% CI: 0.05-0.25). A higher percentage of telehealth patients choose birth control pills than in-person patients (81% versus 54%; PR = 2.91, 95% CI: 1.81-4.70). We found no statistically significant differences in effectiveness, person-centeredness, safety, and equity. Telehealth patients were less likely to have a cycle time (time from appointment check-in to check-out) of ≥60 minutes (adjusted prevalence ration [aPR] = 0.07, 95% CI: 0.04-0.14) and a wait time of ≥10 minutes (aPR = 0.18, 95% CI: 0.09-0.34) than in-person patients. Our findings suggest that contraceptive care delivered through telehealth provides comparably high quality as in-person care. Telehealth care may offer benefits in the ease and speed of scheduling and attending appointments.
Unwanted or mistimed pregnancies are pregnancies that occur in women who do not intend to become pregnant or did not desire another child at the time of conception. Ensuring access to contraception is important for both preventing unwanted pregnancy among active duty service women (ADSW) and preserving their right to reproductive autonomy. Women's Health Clinics (WHCs), available on some installations, bases, or duty stations owned and operated by the United States military, are intended to improve contraceptive access. This study aims to determine the association between availability of WHCs and unwanted pregnancy among ADSW. Using data from the 2020 Women's Reproductive Health Survey of ADSW we examined unwanted pregnancy in 2,939 ADSW who reported pregnancy in the last 12 months. Bivariate analyses and weighted binary and multivariable logistic regressions were used to assess the relationship between women reporting an unwanted pregnancy and having a WHC at their installation. We identified 354 unwanted pregnancies. Having a WHC at their current installation was significantly associated with a 39% decreased odds of unwanted pregnancy (aOR = 0.61; 95% CI: 0.42-0.88). Having a WHC at an ADSW's installation is associated with significantly decreased odds of unwanted pregnancy. This suggests that access to specialty women's health care at duty stations may promote reproductive autonomy among ADSW, contributing to the prevention of unwanted or mistimed pregnancies, ultimately enhancing mission readiness.
To examine the immediate and long-term effect of the pandemic on clinical encounters in predominantly low-income, racially and ethnically diverse mothers. This is a longitudinal study of 3,073 predominantly low-income, racially, and ethnically diverse mothers in the Boston Birth Cohort. We conducted descriptive and random-effects negative binomial regression to examine the impact of the COVID-19 pandemic on medical and mental health care encounters of the study mothers, using comprehensive electronic health record data before and during the pandemic (January 2019-December 2021). We also conducted a qualitative survey in a subsample (N ∼200) to assess pandemic-related stressors. Compared with 2019 (prepandemic), mental health encounter incidence increased by 56% in 2020 (incidence rate ratio [IRR]: 1.56, 95% confidence interval [CI]: 1.29-1.88) and 37% in 2021 (IRR: 1.37, CI: 1.14-1.64). In contrast, primary care and non-mental health subspecialty care decreased in 2020 (IRRs: 0.91 and 0.73, CIs: 0.85-0.97 and 0.67-0.8) and recovered in 2021 (IRRs: 1.24 and 1.48, CIs: 1.17-1.32 and 1.37-1.61), whereas emergency department encounters decreased in both 2020 (IRR: 0.64, CI: 0.57-0.71) and 2021 (IRR: 0.74, CI: 0.67-0.82). Telemedicine was utilized the most for mental health. Consistently, 38.4% of the mothers reported higher levels of stress during the pandemic. COVID-19 imposed significant mental distress on this sample of racially and ethnically diverse mothers, with an increase in mental health encounters. Telemedicine was a major modality for mental health services. The study findings draw attention to the profound adverse impact of the pandemic on mental health in racially and ethnically diverse mothers and highlights the need to develop current and long-term strategies for addressing mental distress in this population and for future preparedness.
This study aimed to better estimate the risk of progression of vaginal intraepithelial neoplasia (VaIN) into vaginal cancer. A systematic review was conducted to identify eligible studies that (1) reported at least one event of progression from VaIN to vaginal cancer, (2) provided the VaIN grade, (3) had a follow-up period of at least 6 months, and (4) specified the proportion of treated and untreated patients. The effect size was the risk of progression from VaIN to invasive cancer, calculated as the number of events of progression out of all the observed cases at enrolment. Five thousand seven hundred and sixty-eight references were screened; 30 case series were deemed eligible for qualitative analysis. Twenty case series of treated women, and four case series of untreated women were quantitatively analyzed. Both subgroups included cases of high-grade VaINs (no progressions to vaginal cancer found in low-risk VaINs). A sensitivity analysis on the subgroup of untreated women resulted in the exclusion of a study with excessive influence, with the final data synthesis based on three poor-quality case series. The risk of progression of high-grade VaIN to vaginal cancer in treated women was 7.09% (95% confidence interval [CI]: 6.83-7.36%). The risk of progression of high-grade VaIN to vaginal cancer in untreated women was 29.88% (95% CI: 11.22-58.96%). Progression events primarily occurred within 5 years of follow-up. The risk of progression of high-grade VaIN to vaginal cancer is higher than previously reported and more serious for untreated women (CRD42024618227).
Recognition awards from medical societies are a key marker of professional achievement and play a crucial role in physician career advancement. At many academic institutions, national honors-such as society-based recognition awards-are integral to the criteria for promotion to the rank of full professor. To systematically review and conduct a meta-analysis of studies assessing the gender distribution of recognition awards conferred by United States (U.S.)-based medical societies. A systematic search of Ovid MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov was conducted in November 2023. Studies evaluating the gender composition of recipients of recognition awards from U.S. physician-focused medical societies were included. Studies without explicit methodology for selecting recognition awards were excluded. Data were independently extracted by two reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to estimate the pooled proportion of women award recipients. The primary outcome was the proportion of women among recognition award recipients from U.S. medical societies. A total of 35 studies comprising 16,994 award recipients were included. Across 25 medical specialties, the pooled proportion of women award recipients was 19% (95% CI: 15-23%). A similar pattern was observed among women physician recipients at 17% (95% CI: 13-23%). Substantial heterogeneity was observed (I2 = 95.5%), reflecting variations across specialties and award categories. Funnel plot analysis suggested minimal publication bias. Notably, representation of women overall varied widely across disciplines, with pediatric emergency medicine and pathology showing the highest proportion of women recipients, whereas neurosurgery and orthopedics were among the lowest. Overall, women are underrepresented among recipients of recognition awards from U.S. medical societies. Addressing this gap will require intentional, systemic efforts by both medical societies and academic institutions to promote equitable recognition and advancement for all physicians.
One in four persons with a uterus is unable to afford menstrual products, with even higher prevalence among low-income populations, an unmet need that contributes to preventable infections, missed school and work, and persistent health inequities. Despite the essential role of menstrual products in basic health and hygiene, many public health coverage programs across the United States, including Medicaid and other assistance programs, continue to exclude items such as pads and tampons. This gap disproportionately harms individuals who already face significant economic and health disparities. Although Flexible Spending Accounts and Health Savings Accounts now permit the use of funds for menstrual products, these mechanisms primarily benefit individuals with stable employment and disposable income, leaving the most vulnerable populations unprotected. Continued exclusion by insurance and assistance programs imposes an unnecessary financial and health burden and undermines dignity and well-being. Federal and state policymakers, including Congress, the Centers for Medicare & Medicaid Services, and state Medicaid agencies, have clear authority to address this inequity by expanding definitions of "durable medical equipment" and "hygiene supplies" to explicitly include menstrual products and by removing administrative barriers to coverage. The American Medical Women's Association calls for federal action to classify menstrual products as essential health services under Medicaid and other public assistance programs.
Women who are currently or formerly incarcerated experience disproportionately high rates of certain infections and diseases, including HIV, viral hepatitis, sexually transmitted infections (STIs), and tuberculosis (TB). These disparities are shaped by overlapping social and structural conditions such as substance use, trauma, poverty, and limited access to health care. Incarceration can be a critical point of intervention to provide health care access for women who otherwise might not be able to prioritize their own health. However, the effectiveness of these efforts is often limited by variable lengths of incarceration, stigma, limited resources, and fragmented systems of care. This report outlines opportunities to strengthen prevention, treatment, and linkage to care for HIV, viral hepatitis, STIs, and TB among women who are justice system-involved. Specifically, by summarizing recommendations from the U.S. Centers for Disease Control and Prevention (CDC), including those found in the Summary of CDC Recommendations for Correctional Settings, this report seeks to support care around screening, vaccination, and treatment for women at three key stages: intake, during incarceration, and at release. Guidance is also provided for incarcerated women during and after pregnancy, including recommendations for infection screening and unique aspects of chronic care management. Additional strategies are reviewed, including point-of-care testing, to support health engagement and health care continuity, peer mentorship, and coordinated reentry planning. CDC resources are highlighted throughout the report to assist correctional health staff, clinicians, and public health departments in improving outcomes for this population.
To examine the association between telehealth utilization and mammogram receipt by rurality, and to characterize geographic patterns of concurrent increases in telehealth and mammography use in urban and rural communities. The sample included women, aged 50 years or older, receiving services in primary care or gynecology/women's health practices at MultiCare Health System from 2018 to 2023. For the difference-in-difference (DiD) analyses, women who had only in-person visits during the prepandemic period but had at least one telehealth visit in each year of the postpandemic period were defined as the treatment group. Women who had only in-person visits during both pre- and postpandemic periods were defined as the control group. For the spatial analyses, we analyzed ZIP Codes in which both telehealth and mammography utilization increased from 2018-2019 to 2020-2022. DiD analyses suggested that telehealth use was significantly associated with a greater probability of mammogram receipt among rural women; however, this association was not found in urban women. Spatial analyses indicated that concurrent increases in telehealth and mammogram use occurred in both rural and urban settings but exhibited greater spatial concentration in urban areas and comparatively more dispersed patterns across rural ZIP Code Tabulation Areas. The findings suggest that telehealth may be particularly beneficial for improving mammography screening among rural individuals, who typically experience greater structural barriers to accessing health care. While urban areas may exhibit clustered patterns driven by interconnected care systems, rural areas may experience more diffuse but meaningful gains as telehealth expands access across large geographic distances.
There is increasing evidence that women who have experienced infertility are at greater risk for several chronic conditions. However, the mechanisms underlying these associations are not clear. Pathophysiology may be illuminated through observation of aberrant systemic biomarkers. However, there are limited data on infertility history and midlife biomarkers of inflammation, lipids, and adipokines. Among participants with biomarker measurements in the Nurses' Health Study II, we used generalized linear models to assess history of infertility and plasma C-reactive protein (CRP, n = 3,518), interleukin-6 (IL-6, n = 3,145), soluble tumor necrosis factor-alpha receptor 2 (sTNFR2, n = 2,648), high-density lipoprotein-cholesterol (HDL-C, n = 1,387), low-density lipoprotein-cholesterol (LDL-C, n = 1,193), total cholesterol (n = 4,427), leptin (n = 2,228), and adiponectin (n = 3,810). We investigated specific infertility diagnoses separately, as well as heterogeneity by body mass index (<25 kg/m2 versus ≥25 kg/m2), age at first infertility report, and primary versus secondary infertility. On average, participants were 44 years at blood draw (range: 32-54 years). We observed no difference by infertility history in levels of CRP (% difference: 6.9, 95% confidence interval [-1.4,16.0]), sTNFR2 (-0.6% [-2.4,1.2]), HDL-C (0.2% [-3.1,3.6]), total cholesterol (0.6% [-0.5,1.8]), or adiponectin (-1.7% [-5.0,1.8]). Women who had experienced infertility had higher IL-6 (5.0% [0.1,10.1]) and leptin (6.5% [1.7,11.6]) and lower LDL-C (-3.7% [-7.0, -0.3]). There was little evidence that women with a history of overall infertility have altered levels of inflammatory markers, total and HDL-C, or adiponectin compared with gravid women without infertility. In fully adjusted models, history of infertility was associated with higher IL-6 and leptin, as well as lower LDL-C levels.
Use of chemical hair straighteners ("relaxers") is associated with higher risks of hormonally mediated conditions. We hypothesized users of relaxers would have a higher prevalence of abnormal uterine bleeding (AUB) and dysmenorrhea. We analyzed baseline data from Pregnancy Study Online, an internet-based preconception cohort study of North American pregnancy planners. We included 14,366 participants aged 21-39 years who enrolled during 2014-2024 and reported on their typical menstrual cycle characteristics when not using hormones. We collected data on history of use, age at first use, frequency per year, duration of use, and number of burns. We defined AUB as cycle length <24 or >38 days, flow ≥ 7 days, irregular cycles, and/or heavy flow (>30 pads/tampons per menses). We defined dysmenorrhea as severe cramps requiring medication and bed rest. We used modified Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations of relaxer use with AUB and dysmenorrhea, adjusted for potential confounders. Overall, 2% of participants were current users and 10% were former users of relaxers. The frequencies of AUB and dysmenorrhea were 31% and 8%, respectively. PRs for current (versus never) relaxer use were 1.16 (95% CI: 1.00-1.33) for AUB and 1.30 (95% CI: 0.94-1.80) for dysmenorrhea. Participants who reported ever experiencing burns (versus never use) had a higher prevalence of dysmenorrhea (1-4 burns: PR = 1.42, 95% CI: 1.04-1.93; ≥5 burns: PR = 1.46, 95% CI: 1.00-2.13). Relaxer use was associated with a higher prevalence of menstrual disturbances.
Obtaining a National Institutes of Health (NIH) career development (K) award is a pivotal milestone for early-career faculty, contributing not only to individual career progression but also to the diversity of the biomedical sciences workforce. Despite the critical importance of these awards, disparities in access may perpetuate inequities within academic biomedical disciplines. In this large, retrospective cohort study, we investigated how sex, race, and ethnicity were associated with submission and success rates for NIH K-award applications among 2455 early-career faculty affiliated with a large medical school and life sciences departments at a leading public research university over 20 years (2001-2021). This cohort had 59% men, 58% White, and 35% Asian faculty. Faculty members from underrepresented groups (Black and Hispanic) represented 7% of the sample. Our findings indicated that women were more likely than men to submit a K award application (adjusted odds ratio [aOR]: 1.45; 95% confidence intervals [CIs]: 1.16, 1.82), whereas Asian faculty were less likely than their White counterparts to apply (aOR: 0.55; 95% CI: 0.43, 0.72). Submission rates did not differ between underrepresented groups and White faculty (aOR: 0.95; 95% CI: 0.61, 1.47). Importantly, we observed no differences in award receipt by sex (aOR: 1.11, 95% CI: 0.60, 2.03) or by race/ethnicity, with aORs of 0.55 (95% CI: 0.21, 1.46) for underrepresented groups versus White faculty and 0.79 (95% CI: 0.39, 1.57) for Asian versus White faculty. While sex, race, and ethnicity influence the likelihood of applying for NIH K awards, these factors did not affect the likelihood of receiving career awards once submitted. The observed disparities in application rates underscore a critical need for targeted outreach, mentorship, and support to enhance awareness and encourage applications among all early-career faculty, ultimately promoting greater equity in access to these vital career development opportunities.
Across the lifespan, more women than men report abdominal bloating. However, little is known about bloating during the menopause transition (MT). The purpose of this study was to assess patterns of bloating severity during the MT in relation to age, reproductive aging stage, reproductive- and stress-related biomarkers, and stress-related perceptions in a longitudinal cohort study. This analysis included 291 women from the Seattle Midlife Women's Health Study who provided health diary data and could be classified into reproductive aging stages. A subset of 131 women also provided urine samples, which were assayed for estrone glucuronide, follicle-stimulating hormone, testosterone, cortisol, norepinephrine, and epinephrine levels. Mixed-effects multilevel modeling was used to examine the relationship between bloating severity and age, reproductive aging stages, reproductive- and stress-related biomarkers, and stress-related perceptions. In the univariate model, the early MT stage, tension, and anxiety were associated with increased bloating severity, whereas the early postmenopausal stage and testosterone levels were associated with decreased bloating severity. In the multivariate model, both the early and late MT stages were related to an increase in bloating severity. Age and testosterone levels were associated with decreased bloating severity. Tension was related to increased bloating severity. Tension and anxiety may play a role in increased bloating severity, whereas testosterone levels and age are associated with decreased bloating severity. The MT stage may contribute to bloating through several mechanisms. More research is needed to fully elucidate these relationships.
Functional hypothalamic amenorrhea (FHA) is a common form of secondary amenorrhea caused partly by undernutrition relative to demand. To compare the dietary nutritional intake between women with FHA and eumenorrheic controls and evaluate micronutrient profiles. This cross-sectional study included 30 women with FHA and 29 eumenorrheic controls not on hormones. FHA was defined as ≥3 consecutive months of amenorrhea, estradiol of <50 pg/mL, and FSH and LH of <10 mIU/L, excluding other etiologies. A 3-day food diary was collected for dietary analysis, excluding dietary supplements using ESHA Research Food Processor. The mean age of women with FHA and controls was 26.4 years ± 6.2 versus 30.3 years ± 3.7 (p = 0.002), with no differences in BMI (p = 0.16) or the waist-to-hip ratio (p = 0.71). Women with FHA and controls consumed comparable median calorie intake (1784 kcal [1465, 2011] vs. 1732 kcal [1578, 1982], p = 0.62), with no differences in self-reported exercise patterns. Women with FHA consumed more dietary protein (84.2g [74, 112] vs. 74 g [59, 92], p = 0.001) and dietary fiber (30.1 g [22, 43] vs. 17.3 g [15, 23], p = 0.02) versus controls, respectively. When expressed as a percentage of estimated average requirements (% estimated average requirement), women with FHA had higher intakes of vitamin A (105% [45, 219] vs. 43% [21, 86], p = 0.005), vitamin C (201% [139, 351] vs. 107% [75, 190], p = 0.004), and iron (169% [146, 220] vs. 120% [99, 192], p = 0.027) compared with controls. Women with FHA had similar caloric intake to eumenorrheic controls but consumed more dietary protein, fiber, vitamin A, vitamin C, and iron. Future studies should examine the nutritional profiles of women with FHA in relation to long-term health consequences such as bone and vascular health.
In the United States, cardiovascular disease (CVD) is a leading cause of death among American Indian women. We examined the associations of parity and pregnancy complications (history of preeclampsia, protein in urine, eclampsia or seizures, gestational diabetes, hypertension) with incident CVD (myocardial infarction, coronary heart disease, congestive heart failure, ischemic stroke) among American Indian women in the Strong Heart Family Study. Baseline information was collected between January 2006 and December 2009, and CVD events were evaluated through December 2022. We used clustered logistic regression analyses to assess associations of each parity or pregnancy complications with risk of CVD among women free of CVD at baseline (N = 1,203). We found no statistically significant association of parity with risk of CVD when comparing grand multiparous (≥5) women (OR = 0.76, 95% CI: 0.39, 1.46; p = 0.41) and moderate parous (2-4) women (OR = 1.33; 95% CI: 0.65, 2.71; p = 0.44) to low parous (0/1) women. We found no statistically significant association of pregnancy complications with risk of CVD (OR = 1.08, 95% CI: 0.62, 1.88; p = 0.78) comparing participants with no pregnancy complications to those with pregnancy complications. Although not statistically significant, findings support potential positive associations of grand multiparity and pregnancy complications with CVD among American Indian women. Given the limited sample size, more research is needed to assess the impact of multiparity and/or pregnancy complications on CVD risk among American Indians women.
To assess the reliability and validity of the Japanese version of the Menopause Rating Scale (MRS). The English-language version of the MRS was translated into Japanese using recommended methodology. A cross-sectional, web-based survey was conducted among 1,600 Japanese women aged 45-60 years. Participants completed the Japanese MRS, 36-Item Short Form Health Survey (SF-36), Hospital Anxiety and Depression Scale, and modified Kupperman Index. Psychometric properties included internal consistency, test-retest reliability, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), criterion-related validity, and receiver operating characteristic (ROC) analysis. The Japanese MRS exhibited high internal consistency (Cronbach's α = 0.884) and excellent test-retest reliability (intraclass correlation coefficient = 0.834). According to the EFA, three factors, similar to those of the original MRS, were identified for the Japanese version, accounting for 66.8% of the total variance. CFA supported the original three-factor structure of the MRS, demonstrating acceptable model fit (comparative fit index = 0.930, root mean square error of approximation = 0.081). Regarding criterion-related validity, the MRS Psychological subscale showed a strong negative correlation with the SF-36 Mental Component Summary (r = -0.604) and a weak negative correlation with the Physical Component Summary (r = -0.256), indicating robust convergent and discriminant validity. Furthermore, the ROC analysis revealed high diagnostic accuracy of MRS for detecting severe menopausal symptoms (area under the ROC curve [AUC] = 0.894). The Japanese version of the MRS is highly reliable, valid, and can be used to evaluate menopausal symptoms and quality of life in women in menopause.
Prescription opioid analgesic use among reproductive-aged women is prevalent in North America. Women with disabilities experience high rates of pain and structural barriers to accessing resources, potentially increasing their likelihood of opioid use and harm. Yet, few studies have examined opioid analgesic use in this population. This study compared the use of opioid pain relievers and nonmedical opioid use in reproductive-aged women with and without disabilities across Canada. We analyzed data from the 2018 Canadian Community Health Survey for 11,062 women aged 15-49 years. Disability status (30.6%) was determined using the Washington Group Short Set on Functioning. Modified Poisson regression was used to calculate prevalence ratios (PRs) for use of opioid pain relievers within the past 12 months, comparing women with and without disabilities, and by disability severity (mild, moderate/severe) and number of impacted functional domains (1, ≥2). Multivariable models adjusted for sociodemographic factors and health behaviors. Women with disabilities were more likely than those without disabilities to use opioid pain relievers (19.6% versus 10.3%, adjusted prevalence ratio (aPR): 1.71, 95% confidence intervals [CI]: 1.47-1.99) and nonmedical opioids (6.2% versus 3.0%, aPR: 1.77, 95% CI: 1.28-2.43). A dose-response relationship was observed, with greater differences among women with moderate/severe disabilities and disabilities in ≥2 functional domains, compared with women without disabilities. These findings suggest a need for comprehensive education for health care providers on disability and pain management. In their early reproductive years, women with disabilities may benefit from accessible education and counseling on the risks and benefits of opioid pain relievers, with a focus on addressing social determinants of health.
Choosing antibiotics for prenatal urinary tract infections (UTIs) is challenging because fetal safety data are inconclusive and must be weighed against resistance. Recent information on prescribing patterns and antimicrobial susceptibility is sparse; we aimed to address this gap. We used electronic health record data from two US health systems (Kaiser Permanente Washington [KPWA] and Vanderbilt University Medical Center [VUMC]) to ascertain pregnancies from January 1, 2006, to August 31, 2023, to individuals aged 15-49. We included outpatient-treated prenatal UTIs with an oral UTI antibiotic plus a diagnosis or positive urine culture. We described patterns of antibiotic utilization and susceptibility overall (2006-2023) and by year (2010-2022). We identified 10,734 eligible UTIs. The most common antibiotics were nitrofurantoin (KPWA: 42%; VUMC: 65%) and first generation cephalosporins (KPWA: 23%; VUMC: 15%). Nitrofurantoin decreased substantially from 2010 to 2022 (KPWA: from 50% to 27%; VUMC: 65-49%), while first generation cephalosporins increased (KPWA: 12 to 45%; VUMC: 14 to 21%). Escherichia coli was susceptible to nitrofurantoin in 98-99% of UTIs. Susceptibility to other antibiotics was higher at KPWA than VUMC (first generation cephalosporins: KPWA: 97%, VUMC: 89%; amoxicillin-clavulanate: KPWA: 93%, VUMC: 85%). 93-95% were treated with an appropriate antibiotic based on susceptibility results. In two health systems in different regions, nitrofurantoin decreased substantially while first generation cephalosporins increased, despite better nitrofurantoin susceptibility. Other concerns, like malformation risk, may have influenced prescribing. Further research and guideline development are needed to weigh risks versus benefits of different antibiotics for prenatal UTIs.
Hypertensive disorders of pregnancy (HDPs) are associated with an increased risk of long-term maternal cardiovascular disease. Lactation is associated with favorable cardiometabolic profiles, but its impact on blood pressure (BP) recovery following an HDP is less clear. We sought to assess the relationship of lactation initiation and duration with BP among individuals with prior HDP. We used prospectively collected data from individuals with prepregnancy overweight or obesity with HDP and no prepregnancy hypertension who participated in a postpartum pilot lifestyle intervention trial. The parent trial assessed BP in triplicate and self-reported lactation status at enrollment and follow-up (8-12 months postpartum) study visits. Daily BPs were obtained by home BP monitoring for the first 6 weeks postpartum, then 1 week per month for the remainder of the first year postpartum. Hypertension was defined as BP ≥ 130/80 mmHg or the use of antihypertensive medications. We compared demographic and cardiometabolic outcomes by lactation initiation and created multivariable logistic regression models adjusted for age, race, education, and prepregnancy body mass index (BMI) to assess the relationship of lactation with hypertension. Data from 129 individuals included 14,177 home BPs. Overall, 81% of participants initiated lactation, and median lactation duration was 6 months [Interquartile range (IQR) 2,9]. At follow-up (10.9 ± 2.1 months postpartum), both systolic (SBP; p = 0.004) and diastolic (DBP; p = 0.008) BP were lower in individuals who initiated lactation compared with those who did not. Each month of lactation was associated with a 12% [adjusted odds ratio 0.88; 95% confidence interval (CI) 0.78-0.98] decreased odds of hypertension at 1 year postpartum with adjustment for age, race, education, and BMI. In overweight and obese individuals with an HDP, lactation is associated with a significant reduction in SBP and DBP at 1 year postpartum and throughout the first year postpartum. https://clinicaltrials.gov/ct2/show/NCT03749746.