Pregnancy Intendedness by Maternal Disability Status and Type in the United States

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154611/1/psrh12130.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154611/2/psrh12130_am.pd

Mating-Induced Changes in Behavior and Gene Expression of Female

57 pages. A thesis presented to the Departments of chemistry and Biochemistry, and the Clark Honors College of the University of Oregon in partial fulfillment of the requirements for degree of Bachelor of Science, Spring 2014.Sexual reproduction plays a significant role in how many organisms pass on their genetic information by introducing diversity into the genomes of offspring. With sexual reproduction also comes the opportunity for conflict, however, as females and males counter-adapt to each other to fulfill their own fitness needs. This study uses the nematode Caenorhabditis remanei as a model organism to investigate female responses to mating at both the behavioral and genetic levels. Using behavioral assays and RNAseq, we found that mating causes females to eat more and move less than their virgin counterparts. These adaptations are likely the result of a pathway in response to mating that confers a fitness benefit to these females

The Curse of the Perinatal Epidemiologist: Inferring Causation Amidst Selection

Purpose of Review Human reproduction is a common process and one that unfolds over a relatively short time, but pregnancy and birth processes are challenging to study. Selection occurs at every step of this process (e.g., infertility, early pregnancy loss, and stillbirth), adding substantial bias to estimated exposure-outcome associations. Here, we focus on selection in perinatal epidemiology, specifically, how it affects research question formulation, feasible study designs, and interpretation of results. Recent Findings Approaches have recently been proposed to address selection issues in perinatal epidemiology. One such approach is the ongoing pregnancies denominator for gestation-stratified analyses of infant outcomes. Similarly, bias resulting from left truncation has recently been termed “live birth bias,” and a proposed solution is to control for common causes of selection variables (e.g., fecundity, fetal loss) and birth outcomes. However, these approaches have theoretical shortcomings, conflicting with the foundational epidemiologic concept of populations at risk for a given outcome. Summary We engage with epidemiologic theory and employ thought experiments to demonstrate the problems of using denominators that include units not “at risk” of the outcome. Fundamental (and commonsense) concerns of outcome definition and analysis (e.g., ensuring that all study participants are at risk for the outcome) should take precedence in formulating questions and analysis approaches, as should choosing questions that stakeholders care about. Selection and resulting biases in human reproductive processes complicate estimation of unbiased causal exposure-outcome associations, but we should not focus solely (or even mostly) on minimizing such biases

Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States

Background: Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. Materials and Methods: We used 2011–2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Results: Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21–2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20–2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (e.g., 65.007% of women with independent living disability vs. 33.98% of women without disability, p = 0.018). Conclusions: In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations

Utility of the 5-minute Apgar Score as a Research Endpoint

Although Apgar scores are commonly used as proxy outcomes, little evidence exists in support of the most common cutpoints (n= 52,877; 2012–2016), and the other contained hospital births from California (n = 428,877; 2010). We treated 5-minute Apgars as clinical “tests,” compared against 18 known outcomes; we calculated sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve for each. We used 3 different criteria to determine optimal cutpoints. Results were very consistent across data sets, outcomes, and all subgroups: The cutpoint that maximizes the trade-off between sensitivity and specificity is universall

The association between longer durations of the active phase of labor and subsequent perinatal processes and outcomes among midwifery patients

Background/Objective To evaluate the association between the duration of the latent phase of labor and subsequent processes and outcomes. Methods Secondary analysis of prospectively collected data among 1,189 women with low-risk pregnancies and spontaneous labor. Results Longer latent phase duration was associated with labor dystocia (eg, nulliparous ≥ mean [compared with 80th% [compared with < 80th%] aOR 6.39 [4.04-10.12]; multiparous ≥ 80th% [compared with < 80th%] aOR 6.35 [3.79-10.64]). Longer latent phase duration was also associated with longer active phase and second stage. There were no associations between latent phase duration and risk for cesarean delivery or postpartum hemorrhage in a practice setting with relatively low rates of primary cesarean. Newborns born to multiparous women with latent phase of labor durations at and beyond the 80th% were more frequently admitted to the NICU (≥80th% [compared with < 80th%] aOR 2.7 [1.22-5.84]); however, two-thirds of these NICU admissions were likely for observation only. Conclusions Longer duration of the spontaneous latent phase of labor among women with low-risk pregnancies may signal longer total labor processes, leading to an increase in diagnosis of dystocia, interventions to manage dystocia, and epidural use. Apart from multiparous neonatal NICU admission, no other maternal or child morbidity outcomes were elevated with longer duration of the latent phase of labor

Incidence of new outpatient long-acting reversible contraceptive insertions among a commercially insured, US population from 2010 to 2020

Objectives: Characterize new use of long-acting reversible contraceptives (LARCs), highly effective contraceptive methods, in a broad population over time. Study Design: We constructed a retrospective cohort of commercially insured individuals aged 15 to 54 years from 2010 to 2020 and estimated monthly incidence of new LARC insertions. Results: The monthly standardized incidence increased from 6.0 insertions per 10,000 individuals in January 2010 to 14.1 in December 2020, with a dip in insertions after March 2020. Hormonal intrauterine devices were consistently the most inserted LARC; implants were increasingly favored over time. Conclusions: LARCs are increasingly popular forms of contraception among commercially insured individuals. Implications: Given the increasing popularity, ensuring access to LARCs is critical

Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor

Background Recent research suggests that latent phase of labor may terminate at 6 rather than 4 centimeters of cervical dilation. The objectives of this study were to: (a) characterize duration of the latent phase of labor among term, low‐risk, United States women in spontaneous labor using the women's self‐identified onset; and (b) quantify associations between demographic and maternal/newborn health characteristics and the duration of the latent phase. Methods This prospective study (n = 1281) described the duration of the latent phase of labor in hours, stratified by parity at the mean, median, and 80th, 90th, and 95th percentiles. The duration of the latent phase was compared for each characteristic using t tests or Wilcoxon rank‐sum tests and regression models that controlled for confounders. Results In this sample of predominantly white, healthy women, duration of the latent phase of labor was longer than described in previous studies: The median duration was 9.0 hours and mean duration was 11.8 hours in nulliparous women. The median duration was 6.8 hours and mean duration was 9.3 hours in multiparous women. Among nulliparous women, longer duration was seen in women whose fetus was in a malposition. Among multiparous women, longer durations were noted in women with chorioamnionitis and those who gave birth between 41 and 41 + 6 weeks’ gestation (vs between 40 and 40 + 6 weeks’ gestation). Conclusions The latent phase of labor may be longer than previously estimated. Contemporary estimates of latent phase of labor duration will help women and providers accurately anticipate, prepare, and cope during spontaneous labor