Evaluating the unevaluated: a secondary analysis of the National Survey for Family Growth (NSFG) examining infertile women who did not access care

PurposeTo characterize the demographic differences between infertile/sub-fertile women who utilized infertility services vs. those that do not.MethodsA retrospective analysis of cross-sectional data obtained during the 2011–2013, 2013–2015, and 2015–2017 cycles of National Survey for Family Growth from interviews administered in home for randomly selected participants by a National Center of Health Statistics (NCHS) surveyor was used to analyze married, divorced, or women with long-term partners who reported difficulty having biological children (sub-fertile/infertile women). Demographic differences such as formal marital status, education, race, and religion were compared between women who presented for infertility care vs. those that did not. The primary outcome measure was presenting for infertility evaluation and subsequently utilizing infertility services. Healthcare utilization trends such as having a usual place of care and insurance status were also included as exposures of interest in the analysis.ResultsOf the 12,456 women included in the analysis 1770 (15.3%) had used infertility services and 1011 (8.3%) said it would be difficult for them to have a child but had not accessed infertility services. On univariate analysis, compared to women who used infertility services, untreated women had lower average household incomes (295.3 vs. 229.8% of the federal poverty line respectively). Untreated women also had lower levels of education and were more likely to be divorced or never have married. In terms of health status, unevaluated women were less likely to have a usual place for healthcare (87.3%) as compared to women presenting for fertility care (91.9%) (p = 0.004). When examining insurance status, 23.3% of unevaluated women were uninsured as compared to 8.3% of evaluated women. On multivariate analysis, infertile women without insurance were at 0.37 odds of utilizing infertility care compared to women with insurance.ConclusionsDemographic factors are associated with the utilization of infertility care. Insurance status is a significant predictor of whether or not infertile women will access treatment. Data from the three most recent NSFG surveys along with prior analyses demonstrate the need for expanded insurance coverage in order to address the socioeconomic disparities between infertile women who are accessing services vs. those that are not.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-021-02149-6.     

子痫前期和正常妊娠代谢综合征变量的对比

目的:研究妊娠期高血压疾病中代谢综合征变量的发生情况。方法:前瞻性对比年龄、孕周、产次相匹配的65例妊娠期高血压,60例子痫前期,30例子痫及33例正常妊娠孕妇的各项指标。主要测量指标包括血压、血脂、血糖及尿酸水平。结果:患者年龄19～40岁,平均28.5±4.6岁;妊娠期高血压,子痫前期和子痫患者的血压较对照组明显增加(收缩压P0.01;舒张压P0.01);子痫前期组和子痫组的血浆总胆固醇、甘油三酯、血糖和尿酸均明显高于妊娠期高血压组及对照组(P0.05);妊娠期高血压组、子痫前期组及子痫组代谢综合征的发生率分别为13.8%、23.3%及26.7%。结论:妊娠期高血压疾病患者有代谢综合征的标志,推断两种情况相互关联。     

Family history of hypertension, heart disease, and stroke among women who develop hypertension in pregnancy

OBJECTIVE: To assess familial cardiovascular risk factors in women developing hypertension in pregnancy. METHOD: Of 2211 women delivering live births after enrollment in a pregnancy cohort study, 85 (3.8%) developed preeclampsia (antepartum systolic blood pressure greater than 140 or diastolic blood pressure greater than 90 plus proteinuria) and 142 (6.4%) developed transient hypertension of pregnancy (antepartum blood pressure elevation without proteinuria). At a mean of 10.2 weeks' gestation, women were asked about first-degree family members with heart disease or stroke, hypertension, diabetes, renal disease, or any of these, which defined familial cardiovascular risk. RESULTS: After adjustment for age and body size, having two or more family members, versus no family members, with cardiovascular risk imparted a 1.9-fold (95% confidence interval [CI] 1.1, 3.2) elevated risk for developing preeclampsia and a 1.7-fold (95% CI 1.1, 2.6) risk for developing transient hypertension of pregnancy. Having two or more family members with hypertension also imparted a significant, two-fold elevation in risk of preeclampsia and transient hypertension of pregnancy, and having two or more family members with heart disease or stroke imparted a 3.2-fold (95% CI 1.4, 7.7) elevation in the risk for preeclampsia. CONCLUSION: A strong family history of aggregate cardiovascular risk increased the likelihood for developing preeclampsia and transient hypertension of pregnancy. These findings support the theory that a preexisting tendency to cardiovascular risk, and particularly hypertension, increases a women's susceptibility to developing hypertension in pregnancy.     

Survey and analysis for impact factors of psychological distress in HIV-infected pregnant women who continue pregnancy

Objective: The objective of this study is to explore the psychological distress of HIV-infected pregnant women who continue pregnancy, and analyze the possible influencing factors.

Methods: A total of 194 HIV-infected pregnant women who continue pregnancy were enrolled for this study by a convenient sampling method during June 2012–August 2016. Participants completed questionnaires including Hospital Anxiety and Depression Scale (HADS), Berger HIV Stigma Scale (BHSS), Distress Thermometer (DT) and Problem List (PL), and to determine the cut-off value of DT in the group.

Results: The positive detection rate of psychological distress in the HIV-infected pregnant women who continue pregnancy was 69.1%, and the highest frequency of PL was the emotional problems. The positive detection rate of anxiety was 60.8%, the positive detection rate of depression was 54.1%, and the discrimination score was 113.16?±?19.21. Spearman relevant analysis showed that psychological distress score was positively correlated with anxiety, depression and discrimination score (p?4⁺T cell count, infection and confidentiality could affect the psychological distress (p?Conclusion: HIV-infected pregnant women who continue pregnancy have higher incidence of psychological distress, and the psychological distress is not inferior to cancer patients. The influencing factors are mainly related to the infection and pregnancy characteristics, and have nothing to do with the general social demographic characteristics. The DT can be used as a screening tool to quickly identify psychological distress of the group.     

Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru

Objective

To examine the associations between lifetime physical and/or sexual intimate partner violence (IPV) with pregnancy intent among pregnant women in Lima, Peru.

Methods

A total of 2167 women who delivered at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during the postpartum recovery period. Logistic regression was used to estimate multivariable adjusted odds ratios and 95% confidence intervals.

Results

Lifetime physical or sexual violence (40.0%) and unintended pregnancies (65.3%) were common in the study population. Compared with non-abused women, abused women had a 1.63-fold increased risk for unintended pregnancy. Unintended pregnancy risk was 3.31-fold higher among women who experienced both physical and sexual abuse compared with non-abused women. The prevalence and severity of physical violence during pregnancy was greater among women with unintended pregnancies compared with women with planned pregnancies.

Conclusion

The findings indicate the need to include IPV screening and treatment in prenatal care and reproductive health settings.     

Outcome and effect of medical intervention in women experiencing infertility following removal of an ectopic pregnancy

The outcome of pregnancy and the effect of medical intervention were reviewed in patients who had had a previous ectopic pregnancy and a subsequent history of infertility. The case records of 3.650 patients were reviewed. Seventy met the study criteria. Twenty patients either voluntarily withdrew or were discouraged on medical grounds; one conceived. Five of the remainder of the patients conceived prior to laparoscopy. In the other 45 patients, the remaining tube was normal in 13, irreparable in 16, and suitable for surgical repair in 16. To date, among the original patients, there have been 13 live births (18.5%) and two ectopic pregnancies (2.8%). One patient was delivered of a live-born infant subsequent to surgical intervention. The pregnancy outcome in this group of patients is poor. Medical intervention was useful primarily in ruling out other causes of infertility and to provide advice to the couple on future fertility. Medical intervention altered outcome in a very few cases.     

An investigation of social inequalities in help-seeking and use of health services for fertility problems in a population-based sample of UK women

Although infertility is an important public health problem, treatment can be expensive and resources are increasingly scarce. This study investigates possible inequalities in the use of medical services for fertility problems. We analysed data from a population-based survey for associations between socio-economic characteristics and help-seeking or use of services, to establish whether inequalities existed. More women of higher social status and education reported fertility problems, but there was no clear trend in help-seeking, investigations or treatments for infertility by social status and education level. New work is planned to investigate these issues more fully, particularly the role of family income.     

The importance of identifying and treating depression in HIV infected,pregnant women: a review

Women make up approximately half of all HIV infections worldwide. A substantial number of women living with HIV in the United States are of childbearing age and many of these women will become pregnant each year. These women must navigate the complexities of two health concerns (HIV infection and pregnancy) and the complexities of two health care provision systems (obstetrics and infectious disease). The goal of HIV treatment during pregnancy is to optimize health of the mother and minimize risk of vertical transmission. To realize these goals, high levels of adherence to antiretroviral therapy (ART) and periodic contact with medical professionals are required. Depression is not uncommon in pregnant women and has been identified as a robust predictor of non-adherence to ART and implicated in difficulty utilizing prenatal care. The purpose of the current article is to review evidence in support of diagnosis and treatment, when appropriate, of unipolar depression in HIV positive, pregnant women in developed nations. The article begins by defining the scope of the problem. Assessment and treatment options are discussed, followed by suggestions for future research.     

Maternal appraisals of risk,coping and prenatal attachment among women hospitalised with pregnancy complications

One goal of pregnancy is the development of maternal emotional attachment to the unborn baby, and this attachment has been shown to be related to later relationships and development. There are many factors which may hinder the development of prenatal attachment, including the presence of complications, hospitalisation, and anxiety. However, women's appraisals of risk may not be congruent with medical assessments of risk. The current study sought to model the relationships between risk (maternal perceptions and medical ratings), coping, psychological well‐being, and maternal–foetal attachment among 87 women hospitalised for pregnancy‐related complications. Analysis indicated that positive appraisal as a coping strategy mediates the relationship between maternal appraisals of risk and maternal–foetal attachment, and that medical ratings of risk were not predictive of maternal–foetal attachment. Awareness of the potential incongruence between patients' and health professionals' perceptions of risk is important within the clinical environment. The potential benefits of promoting positive appraisal in high‐risk pregnancy merit further research.     

A review of instruments to measure health-related quality of life and well-being among pregnant women

Objective: To describe a rapid review of major health-related, electronic bibliographic databases, to identify pregnancy-specific measures of health-related quality of life and well-being. This paper details the range of available instruments, rather than aiming to critique their psychometric properties or indicate problem prevalence. Background: While many instruments are used to measure health and well-being in pregnant women, most are primarily designed for use with a generic population to quantify the presence and magnitude of problems. Few instruments are designed to measure well-being specifically with pregnant women. Methods: A comprehensive search was undertaken to retrieve studies reporting the use of pregnancy-specific instruments to measure health-related quality of life or well-being. The search was conducted on Medline, Cochrane Library and Social Sciences Citation Indexes. Results: 1938 papers were identified and checked for inclusion at title and abstract stage. Eighty-four full papers were obtained for review against inclusion criteria. Thirty-nine papers were selected for inclusion, covering 30 instruments available for use solely with pregnant women. Most of the studies were conducted in Scandinavia or the USA, involved low-risk women, were of cross-sectional design or longitudinal design with data collected across more than one trimester. Conclusion: Most instruments identified in this review were developed for use in non-pregnancy contexts. Those specifically designed for use during pregnancy were infrequently used, apart from the Wijma Delivery Expectancy Questionnaire and the Cambridge Worry Scale. We found limited activity in assessing and measuring the health and well-being of pregnant women to capture positive psychological pregnancy outcomes.     

Pregnancy outcomes and antiretroviral treatment in a national cohort of pregnant women with HIV: overall rates and differences according to nationality

We used data from the main surveillance study of HIV and pregnancy in Italy to evaluate possible differences in pregnancy care and outcomes according to nationality. Among 960 women followed in 2001–06, 33.5% were of foreign nationality, mostly from African countries. Foreign women had lower rates of preconception counselling and planning of pregnancy. They had more frequently HIV diagnosed during pregnancy, with a later start of antiretroviral treatment and lower treatment rates at all trimesters but not when the entire pregnancy, including delivery, was considered. No differences were observed between the two groups in ultrasonography assessments, hospitalisations, AIDS events, intrauterine or neonatal deaths, and mode and complications of delivery. Foreign women had a slightly lower occurrence of preterm delivery and infants with low birthweight. The results indicate good standards of care and low rates of adverse outcomes in pregnant women with HIV in Italy, irrespective of nationality. Specific interventions, however, are needed to increase the rates of counselling and HIV testing before pregnancy in foreign women.     

Nutritional status of pregnant and lactating women in Japan: a comparison with non-pregnant/non-lactating controls in the National Nutrition Survey

AIM: To describe the nutritional status in Japanese pregnant and lactating women at a national level, through a comparison with their non-pregnant/non-lactating controls. MATERIAL AND METHODS: Pooled data from five years (1995-1999) of the National Nutrition Survey, Japan. Data on 330 pregnant and 388 lactating women, and their one-by-one matched non-pregnant/non-lactating controls, were used for analysis. RESULTS: There were fewer smokers, drinkers, and exercisers in pregnant women compared to their controls (P < 0.01). Both pregnant and lactating women showed significantly higher intakes of carbohydrates, calcium and vitamin B2. Mean iron intakes ranged 10.3-11.5 mg in the four groups, all being lower than the recommended intake level for non-pregnant/non-lactating women (12mg/day). Pregnant women consumed more fruits, milk and milk products, and less alcohol beverages and fish/shellfish compared to controls. Lactating women consumed more grain, vegetables, milk and milk products, and less alcohol beverages. There were 22.9% anemic subjects (Hb < 11 g/dL) in pregnant women, and 11.1% anemic subjects (Hb < 12g/dL) in lactating women and 15.7% in non-pregnant/non-lactating women. None of the pregnant subjects was severely anemic (Hb < 8 g/dL). No significant differences were observed in iron intakes between anemic and non-anemic women in each group. CONCLUSION: Pregnant and lactating women in Japan were aware of adopting healthy behaviors, such as smoking less, drinking less, and taking more milk or milk products compared to controls. Prevalence of mild anemia in pregnant women may have been partly due to plasma volume expansion in pregnancy.