26 research outputs found
Recommended from our members
Medicaid Policy on Sterilization — Anachronistic or Still Relevant?
Female sterilization, typically accomplished by means of tubal ligation, is a widely used method of contraception that is highly effective at preventing unintended pregnancy. Yet there appears to be unmet demand for the procedure in certain segments of the U.S. population. Specifically, low-income women and women from minority racial and ethnic groups may face substantial system-level barriers to obtaining a desired sterilization procedure. One such barrier is the federal policy regarding Medicaid-funded sterilizations. Although this policy was designed to protect vulnerable populations, we believe that it does not effectively fulfill that intention — in fact, it restricts the reproductive autonomy of the women it intends to serve. With the upcoming Medicaid expansions, the number of women affected by these barriers could increase substantially.Population Research Cente
Elevated Lipid Oxidation Is Associated with Exceeding Gestational Weight Gain Recommendations and Increased Neonatal Anthropometrics: A Cross-Sectional Analysis
BACKGROUND: Deviations from gestational weight gain (GWG) recommendations are associated with unfavorable maternal and neonatal outcomes. There is a need to understand how maternal substrate metabolism, independent of weight status, may contribute to GWG and neonatal outcomes. The purpose of this study was to explore the potential link between maternal lipid oxidation rate, GWG, and neonatal anthropometric outcomes.
METHODS: Women (N = 32) with a lean pre-pregnancy BMI were recruited during late pregnancy and substrate metabolism was assessed using indirect calorimetry, before and after consumption of a high-fat meal. GWG was categorized as follows: inadequate, adequate, or excess. Shortly after delivery (within 48 h), neonatal anthropometrics were obtained.
RESULTS: Using ANOVA, we found that fasting maternal lipid oxidation rate (grams/minute) was higher (p = 0.003) among women with excess GWG (0.1019 ± 0.0416) compared to women without excess GWG (inadequate = 0.0586 ± 0.0273, adequate = 0.0569 ± 0.0238). Findings were similar when lipid oxidation was assessed post-meal and also when expressed relative to kilograms of fat free mass. Absolute GWG was positively correlated to absolute lipid oxidation expressed in grams/minute at baseline (r = 0.507, p = 0.003), 2 h post-meal (r = 0.531, p = 0.002), and 4 h post-meal (r = 0.546, p = 0.001). Fasting and post-meal lipid oxidation (grams/minute) were positively correlated to neonatal birthweight (fasting r = 0.426, p = 0.015; 2-hour r = 0.393, p = 0.026; 4-hour r = 0.540, p = 0.001) and also to neonatal absolute fat mass (fasting r = 0.493, p = 0.004; 2-hour r = 0.450, p = 0.010; 4-hour r = 0.552, p = 0.001).
CONCLUSIONS: A better understanding of the metabolic profile of women during pregnancy may be critical in truly understanding a woman\u27s risk of GWG outside the recommendations. GWG counseling during prenatal care may need to be tailored to women based not just on their weight status, but other metabolic characteristics
Recommended from our members
Female tubal sterilization: the time has come to routinely consider removal.
Female sterilization, one of the most effective forms of pregnancy prevention, can be performed remote from pregnancy (interval sterilization) or around the time of delivery. Modern methods for sterilization include tubal interruption, salpingectomy, and transcervical sterilization. Tubal interruption has been the primary method for interval sterilization for decades, developing as a means of rapid intra-abdominal laparoscopic surgery at a time when instrumentation and operating systems were less sophisticated than today. New evidence that the most common ovarian cancer, serous adenocarcinoma, frequently may start in the Fallopian tube, has increased research and clinical use of salpingectomy as a preferred method for sterilization. With studies showing that the surgical risks with tubal interruption and salpingectomy are likely equivalent, even when performed at cesarean delivery, the rationale seems to be in place to change our clinical practice. However, we should ask why this revelation has not occurred sooner, even though surgical techniques have advanced and salpingectomy, unlike tubal occlusion or hysteroscopic sterilization, does not leave patients at risk for future intrauterine or ectopic pregnancy. We should not have started thinking about salpingectomy for female sterilization only once a decrease in ovarian cancer risk became part of the equation. Providers' failure to offer this option means that women and their true desires were not part of the conversation. If we had included the patient in the discussion, perhaps the higher efficacy of salpingectomy would have been what women desired all along
Recommended from our members
Female tubal sterilization: the time has come to routinely consider removal.
Female sterilization, one of the most effective forms of pregnancy prevention, can be performed remote from pregnancy (interval sterilization) or around the time of delivery. Modern methods for sterilization include tubal interruption, salpingectomy, and transcervical sterilization. Tubal interruption has been the primary method for interval sterilization for decades, developing as a means of rapid intra-abdominal laparoscopic surgery at a time when instrumentation and operating systems were less sophisticated than today. New evidence that the most common ovarian cancer, serous adenocarcinoma, frequently may start in the Fallopian tube, has increased research and clinical use of salpingectomy as a preferred method for sterilization. With studies showing that the surgical risks with tubal interruption and salpingectomy are likely equivalent, even when performed at cesarean delivery, the rationale seems to be in place to change our clinical practice. However, we should ask why this revelation has not occurred sooner, even though surgical techniques have advanced and salpingectomy, unlike tubal occlusion or hysteroscopic sterilization, does not leave patients at risk for future intrauterine or ectopic pregnancy. We should not have started thinking about salpingectomy for female sterilization only once a decrease in ovarian cancer risk became part of the equation. Providers' failure to offer this option means that women and their true desires were not part of the conversation. If we had included the patient in the discussion, perhaps the higher efficacy of salpingectomy would have been what women desired all along
Recommended from our members
Federally funded sterilization: time to rethink policy?
In the 1970s, concern about coercive sterilization of low-income and minority women in the United States led the US Department of Health, Education, and Welfare to create strict regulations for federally funded sterilization procedures. Although these policies were instituted to secure informed consent and protect women from involuntary sterilization, there are significant data indicating that these policies may not, in fact, ensure that consent is truly informed and, further, may prevent many low-income women from getting a desired sterilization procedure. Given the alarmingly high rates of unintended pregnancy in the United States, especially among low-income populations, we feel that restrictive federal sterilization policies should be reexamined and modified to simultaneously ensure informed decision-making and honor women's reproductive choices
Federally funded sterilization: time to rethink policy?
In the 1970s, concern about coercive sterilization of low-income and minority women in the United States led the US Department of Health, Education, and Welfare to create strict regulations for federally funded sterilization procedures. Although these policies were instituted to secure informed consent and protect women from involuntary sterilization, there are significant data indicating that these policies may not, in fact, ensure that consent is truly informed and, further, may prevent many low-income women from getting a desired sterilization procedure. Given the alarmingly high rates of unintended pregnancy in the United States, especially among low-income populations, we feel that restrictive federal sterilization policies should be reexamined and modified to simultaneously ensure informed decision-making and honor women's reproductive choices
Recommended from our members
Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy
OBJECTIVE: Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly-funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers. STUDY DESIGN: We constructed a cost effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a post-partum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively. RESULTS: With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and 215 million each year