Journal of women's health
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Journal of women's health · Jun 2022
Interconception Preventive Care and Recurrence of Pregnancy Complications for Medicaid-Insured Women.
Background: Pregnancy complications may recur and are associated with potentially modifiable risks. The role of interconception preventive care in reducing repeat pregnancy complications is understudied. Materials and Methods: This retrospective cohort used 2007-2012 Medicaid claims from 12 states. ⋯ Preventive visits were associated with reduced hypertension in the subsequent pregnancy (OR 0.88, 95% CI 0.82-0.97) but not reduced preterm birth or diabetes. Conclusions: Preventive visits after an index birth complicated by prematurity, hypertension, or diabetes were associated with 10% lower odds of hypertension in a subsequent pregnancy, but not with reductions in diabetes or prematurity. Some complications may be more amenable to interconception preventive services than others.
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Journal of women's health · Jun 2022
Differences in Breast Cancer Screening Practices by Diabetes Status and Race/Ethnicity in the United States.
Background: Socioeconomic and health-related factors, including comorbid illness, may affect mammography screening rates and subsequently contribute to breast cancer outcomes. We explored the association between diabetes and mammography screening, and whether this association varied between racial, ethnic, and geographic groups. Methods: Cross-sectional data from the 2012, 2014, 2016, and 2018 Behavioral Risk Factor Surveillance System were used to fit logistic regression models assessing the association between diabetes and up-to-date mammography screening in 497,600 women, aged 50-74 years. ⋯ Patterns were similar across geographic regions. Conclusions: Women of ages 50-74 years with diabetes were more likely to be up to date on screening than women without diabetes. Chronic disease management may represent an opportunity to address cancer screening.
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Journal of women's health · Jun 2022
A County Hospital Experience with Reproductive Travelers to the United States for Obstetric Care: Maternal and Neonatal Outcomes.
Objective: To describe the maternal and neonatal outcomes, health care utilization, and cost to reproductive travelers for obstetric care (RTOC) at a single institution. Materials and Methods: A retrospective chart review was conducted of women identified as reproductive travelers who delivered at Stroger Hospital in Chicago, IL when a self-pay package of obstetrical services was offered. Data included maternal characteristics and obstetric and neonatal outcomes. ⋯ Extra charges beyond those covered by the financial package were incurred by 230 (55.7%) of the women. Conclusion: Reproductive travelers have better obstetric outcomes and fewer NICU admissions than non-travelers who delivered at the same institution. However, the care of RTOC in this manner is fraught with challenges, including late presentation for care, lack of medical records, providers at times managing unfamiliar conditions, and unforeseen financial obligations assumed by patients.
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Journal of women's health · Jun 2022
Excessive Gestational Weight Gain and Long-Term Maternal Cardiovascular Risk Profile: The Study of Women's Health Across the Nation.
Background: Excessive gestational weight gain (GWG) is consistently linked with maternal risk of obesity. However, the literature on its long-term cardiovascular risk is minimal and conflicting. We evaluated whether excessive GWG is associated with a high-risk cardiovascular profile among parous women in midlife. ⋯ Longitudinal models estimated that at a mean age of 67, women with a history of excessive GWG had a 9.8% (9.2, 10.5) 10-year ASCVD risk, compared to 9.5% (8.9, 10.1) for those without, and mean CRP of 2.20 mg/L (1.89, 2.57) versus 1.85 mg/L (1.61, 2.14), respectively, adjusted for participant characteristics. Conclusions: In this multiethnic cohort of parous women, a history of excessive GWG was associated with a small, but statistically significant difference in ASCVD risk, and a moderate, statistically significant difference in CRP across midlife. More research is necessary to understand the mechanistic pathway between excessive GWG and long-term maternal cardiovascular health.
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The goal in selecting these recent articles was to help identify literature that may change the clinical practice of women's health for practitioners in the primary care setting. Articles were identified by reviewing high-impact medical and women's health journals, national guidelines, ACP JournalWise, and NEJM Journal Watch. ⋯ The decision to initiate menopausal hormone therapy is influenced by estimation of underlying vascular risk, and new data suggest that CVD risk scores are more accurate in predicting CVD risk than the traditionally used age and years since menopause and should be incorporated into counseling. Finally, new data support the growing belief that breast arterial calcification on mammography is a promising noninvasive marker that can enhance CVD risk prediction in women.