Journal of women's health
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Journal of women's health · Oct 2024
Racial and Ethnic Disparities in Postpartum Depressive Symptoms Before and During the COVID-19 Pandemic.
Background: Existing evidence regarding the impact of the COVID-19 pandemic on postpartum mental health is mixed, with disparate studies showing increased, stable, or even reduced risk of postpartum depression (PPD) amid the pandemic. Furthermore, although it is plausible that the pandemic impacted the mental health of mothers from vulnerable and underserved communities differentially, few studies have characterized racial and ethnic differences in the impact of the COVID-19 pandemic on PPD. Materials and Methods: Pregnancy Risk Assessment Monitoring System data for 2018-2019 (pre-pandemic period) and 2020 (peri-pandemic period) from 40 sites (n = 110,779, representing 5,485,137 postpartum women) were used to determine whether rates of PPD changed during the first year of the pandemic. ⋯ Results: Adjusting for sociodemographic and clinical characteristics, we found that the overall risk for PPD remained stable (0.0 percentage points [pp]; 95% confidence interval [CI]: -0.7, 0.6 pp) in the first year of the pandemic. We detected no statistically significant changes in risk for PPD across seven of eight racial/ethnic groups considered; however, the risk of PPD among non-Hispanic Black women fell by 2.0 pp (95% CI: -3.5, -0.4 pp) relative to the pre-pandemic period. Conclusion: We identified important subgroup differences in pandemic-related changes in risk for PPD.
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Journal of women's health · Oct 2024
Managing the Lactating Patient Receiving Anesthesia: An Innovative Educational Initiative.
Background: Breastfeeding has numerous health benefits for patients and their infants. There are inconsistencies in how anesthesia providers care for lactating patients undergoing anesthesia. Providers may be cautious and have patients "pump and dump" instead of following current evidence-based recommendations. ⋯ After education, 92% would recommend preoperative feeding or pumping prior to transport to the operating room, compared with the 50% in the pre-education group. Conclusions: Video-based, just-in-time education is an effective way to deliver updated information to anesthesia providers. This format is conducive to just-in-time delivery, and there may be implications for other patient populations that present infrequently but require population-specific care.
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Journal of women's health · Oct 2024
Pre-COVID Trends in Substance Use Disorders and Treatment Utilization during Pregnancy in West Virginia 2016-2019.
Introduction: Access to prenatal care offers the opportunity for providers to assess for substance use disorders (SUDs) and to offer important treatment options, but utilization of treatment during pregnancy has been difficult to measure. This study presents pre-COVID trends of a subset of SUD diagnosis at the time of delivery and related trends in treatment utilization during pregnancy. Materials and Methods: A retrospective cohort design was used for the analysis of West Virginia Medicaid claims data from 2016 to 2019. ⋯ Conclusions: Interventions enacted within West Virginia have improved access and utilization of treatment for OUD in pregnancy. However, consistent with national trends in the general population, non-opioid SUD diagnoses, especially for stimulants, have rapidly increased, while treatment for this group decreased. Early identification and referral to treatment by OB-GYN providers are paramount to reducing pregnancy and postpartum complications for the mother and neonate.
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Journal of women's health · Oct 2024
Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions.
Objective: To assess the appropriateness of hysterectomies performed at a large tertiary health system using the 1997 RAND appropriateness classification system and an updated algorithm. Design: We abstracted structured and unstructured data from electronic medical records on patient demographics, primary indication(s) for hysterectomy, diagnosis codes associated with the hysterectomy, previous treatments, and laboratory results. Subjects: Patients aged 18-44 years. ⋯ RAND also has an outdated requirement for diagnostic surgeries such as laparoscopies, which have decreased in practice as diagnostic imaging has improved. Sensitivity analyses suggest that inappropriate surgeries cannot all be attributed to bias from missing electronic medical record data. Accurately documenting care delivery for benign gynecological conditions is key to ensuring quality and equity in gynecological care.
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Journal of women's health · Oct 2024
Associations between Historical Redlining and the Risk of Pregnancy Complications and Adverse Birth Outcomes in Massachusetts, 1995-2015.
Objective: To assess the impact of historical redlining on the risk of pregnancy complications and adverse birth outcomes in Massachusetts (MA) from 1995 to 2015. Methods: In total, 288,787 pregnant people from the MA Birth Registry had information on parental characteristics, pregnancy factors, and redlining data at parental residences at the time of delivery. Historic redlining data were based on MA Home Owners' Loan Corporation (HOLC) security maps, with grades assigned (A "best," B "still desirable," C "definitely declining," and D "hazardous"). ⋯ Results: Living in HOLC grades B through D compared with A was associated with an increased risk of entering pregnancy with chronic conditions and adverse pregnancy/birth outcomes. The strongest associations were seen with pregestational diabetes (adjusted risk ratio [RR] Grade D: 1.7, 95% confidence interval [CI]: 1.3, 2.4) and chronic hypertension (adjusted RR Grade D: 1.5, 95% CI: 1.1, 1.9). Conclusions: Historical redlining policies from the 1930s were associated with adverse pregnancy outcomes and chronic conditions; associations were strongest for chronic conditions in pregnancy.