Primary Cesarean Delivery Rates, by State: Results From the Revised Birth Certificate, 2006–2012 (PDF)
Source: National Center for Health Statistics
This report describes state-specific trends in pri mary cesarean delivery rates from 2006 through 2012 for reporting areas that implemented the 2003 U.S. Standard Certificate of Live Birth by January 1, 2006, and from 2009 through 2012 for reporting areas that implemented the 2003 revision by January 1, 2009. State-specific changes by gestational age are also explored.
Data for 2006–2012 are based on 100% of singleton births to residents of the reporting areas that implemented the 2003 birth certificate revision by January 1 of each year. Results are not generalizable to the entire United States—the reporting areas do not represent a random sample of U.S. births.
The primary cesarean delivery rate for the 2006 reporting area (19 states) increased from 21.9% in 2006 to 22.4% in 2009, and then declined to 21.9% in 2012. For the 2009 reporting area (28 states and New York City), the primary cesarean rate declined from 22.1% to 21.5% during 2009–2012. Rates for 16 of 29 areas declined during 2009–2012; the remaining states were unchanged. By gesta tional age, state-specific primary cesarean delivery rates at 38 weeks declined for 18 of 29 areas from 2009 to 2012; few state-specific changes were observed at other gestational ages. The primary cesarean delivery rate for the 38 states, District of Columbia, and New York City that were using the revised certificate by January 1, 2012, was 21.5%. State-specific rates ranged from 12.5% (Utah) to 26.9% (Florida and Louisiana).
Factors Associated with Successful Discontinuation of Hormone Therapy
Source: Journal of Women’s Health
Careful management of symptoms, particularly sleep and mood disturbances, may assist women in discontinuing hormone therapy (HT). We sought to describe characteristics associated with successful HT cessation in women who attempted to discontinue estrogen pills/patches with or without progestin.
We invited 2,328 women, aged 45–70, enrolled January 1, 2005, to May 31, 2006, at Group Health in Washington State and Harvard Vanguard Medical Associates in Massachusetts, to participate in a telephone survey about HT practices. For the sample, we selected 2,090 women with estrogen dispensings (pharmacy data) during the study period, 200 women without HT dispensing after January 2005, and 240 women with no estrogen dispensings; 1,358 (58.3%) completed the survey. These analyses are based on survey responses.
Among 802 women who attempted HT discontinuation, the mean age was 50 years, 93% were postmenopausal, 90% were white, 30% had had a hysterectomy, and 75% experienced hot flashes after discontinuation. Those who did not succeed had greater trouble sleeping (74% vs. 57%) and mood disturbances (51% vs. 34%) than those who succeeded. In multivariable analyses, factors associated with successful discontinuation included doctor advice (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.68–4.08), lack of symptom improvement (OR 4.21, CI 1.50–12.17), vaginal bleeding (OR 5.96, CI 1.44–24.6), and learning to cope with symptoms (OR 3.36, CI 2.21–5.11). Factors associated with unsuccessful HT discontinuation included trouble sleeping (OR 0.40, CI 0.26–0.61) and mood swings or depression (OR 0.63, CI 0.42–0.92).
Doctor advice is strongly associated with successful HT discontinuation. Symptom management, particularly sleep and mood disturbances, may help women discontinue HT.
Pregnancy- and Child-Related Legal and Policy Issues Concerning Justice-Involved Women (PDF)
Source: National Institute of Corrections
This document provides an overview of pregnancy- and child-related legal questions concerning justice-involved women that can be raised in correctional settings. It updates and expands the Legal Appendix, written by Southwestern Law School Professor Myrna Raeder, that is included in Gender-Responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders, by Barbara Bloom and colleagues, published by the National Institute of Corrections (NIC) in 2003. The information presented here is expected to be pertinent to a wide audience, only some of whom have legal training. Commissioners of correctional departments and their legal staff, wardens, sheriffs, and other prison and jail administrators; community correctional officials; service providers; and stakeholders, including advocates for inmates, should all be able to reference this document as a starting point for analyzing family issues that affect a large percentage of female inmates. A variety of resources, legal and otherwise, are cited to help further research about these issues. Administrators and policymakers may find it useful to review their policies in light of these pregnancy- and child-related legal questions and answers, with the caveat that their responses must be dictated in part by the specific laws and policies that exist in the particular jurisdiction where their facility is located, and by the specific circumstances of each issue that arises.
Birth Outcomes and Maternal Residential Proximity to Natural Gas Development in Rural Colorado
Source: Environmental Health Perspectives
Birth defects are a leading cause of neonatal mortality. Natural gas development (NGD) emits several potential teratogens and US production is expanding.
We examined associations between maternal residential proximity to NGD and birth outcomes in a retrospective cohort study of 124,842 births between 1996 and 2009 in rural Colorado.
We calculated inverse distance weighted natural gas well counts within a 10-mile radius of maternal residence to estimate maternal exposure to NGD. Logistic regression, adjusted for maternal and infant covariates, was used to estimate associations with exposure tertiles for congenital heart defects (CHDs), neural tube defects (NTDs), oral clefts, preterm birth, and term low birth weight. The Association with term birth weight was investigated using multiple linear regression.
Prevalence of CHDs increased with exposure tertile, with an odds ratio (OR) of 1.3 for the highest tertile (95% CI: 1.2, 1.5) and NTD prevalence was associated with the highest tertile of exposure (OR = 2.0, 95% CI: 1.0, 3.9, based on 59 cases), compared to no gas wells within a 10-mile radius. Exposure was negatively associated with preterm birth and positively associated with fetal growth, though the magnitude of association was small. No association was found between exposure and oral clefts.
In this large cohort, we observed an association between density and proximity of natural gas wells within a 10-mile radius of maternal residence and prevalence of CHDs and possibly NTDs. Greater specificity in exposure estimates are needed to further explore these associations.
Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men
An association between testosterone therapy (TT) and cardiovascular disease has been reported and TT use is increasing rapidly.
We conducted a cohort study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre). We also compared post/pre rates in a cohort of men prescribed phosphodiesterase type 5 inhibitors (PDE5I; sildenafil or tadalafil, N = 167,279), and compared TT prescription post/pre rates with the PDE5I post/pre rates, adjusting for potential confounders using doubly robust estimation.
In all subjects, the post/pre-prescription rate ratio (RR) for TT prescription was 1.36 (1.03, 1.81). In men aged 65 years and older, the RR was 2.19 (1.27, 3.77) for TT prescription and 1.15 (0.83, 1.59) for PDE5I, and the ratio of the rate ratios (RRR) for TT prescription relative to PDE5I was 1.90 (1.04, 3.49). The RR for TT prescription increased with age from 0.95 (0.54, 1.67) for men under age 55 years to 3.43 (1.54, 7.56) for those aged ≥75 years (ptrend = 0.03), while no trend was seen for PDE5I (ptrend = 0.18). In men under age 65 years, excess risk was confined to those with a prior history of heart disease, with RRs of 2.90 (1.49, 5.62) for TT prescription and 1.40 (0.91, 2.14) for PDE5I, and a RRR of 2.07 (1.05, 4.11).
In older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.
Views of internists towards uses of PGD
Source: Reproductive BioMedicine Online
Preimplantation genetic diagnosis (PGD) is increasingly available, but how physicians view it is unclear. Internists are gatekeepers and sources of information, often treating disorders for which PGD is possible. This quantitative study surveyed 220 US internists, who were found to be divided. Many would recommend PGD for cystic fibrosis (CF; 33.7%), breast cancer (BRCA; 23.4%), familial adenomatous polyposis (FAP; 20.6%) and familial hypertrophic cardiomyopathy (19.9%), but few for social sex selection (5.2%); however, in each case, >50% were unsure. Of those surveyed, 4.9% have suggested PGD to patients. Only 7.1% felt qualified to answer patient questions about it. Internists who would refer for PGD had completed medical training less recently and, for CF, were more likely to have privately insured patients (P < 0.033) and patients who reported genetic discrimination (P < 0.013). Physicians more likely to refer for BRCA and FAP were less likely to have patients ask about genetic testing. This study suggests that internists often feel they have insufficient knowledge about it and may refer for it based on limited understanding. They view possible uses of PGD differently, partly reflecting varying ages of onset and disease treatability. These data have critical implications for training, research and practice.
Climate Change Increases Reproductive Failure in Magellanic Penguins
Source: PLoS ONE
Climate change is causing more frequent and intense storms, and climate models predict this trend will continue, potentially affecting wildlife populations. Since 1960 the number of days with >20 mm of rain increased near Punta Tombo, Argentina. Between 1983 and 2010 we followed 3496 known-age Magellanic penguin (Spheniscus magellanicus) chicks at Punta Tombo to determine how weather impacted their survival. In two years, rain was the most common cause of death killing 50% and 43% of chicks. In 26 years starvation killed the most chicks. Starvation and predation were present in all years. Chicks died in storms in 13 of 28 years and in 16 of 233 storms. Storm mortality was additive; there was no relationship between the number of chicks killed in storms and the numbers that starved (P = 0.75) or that were eaten (P = 0.39). However, when more chicks died in storms, fewer chicks fledged (P = 0.05, R2 = 0.14). More chicks died when rainfall was higher and air temperature lower. Most chicks died from storms when they were 9–23 days old; the oldest chick killed in a storm was 41 days old. Storms with heavier rainfall killed older chicks as well as more chicks. Chicks up to 70 days old were killed by heat. Burrow nests mitigated storm mortality (N = 1063). The age span of chicks in the colony at any given time increased because the synchrony of egg laying decreased since 1983, lengthening the time when chicks are vulnerable to storms. Climate change that increases the frequency and intensity of storms results in more reproductive failure of Magellanic penguins, a pattern likely to apply to many species breeding in the region. Climate variability has already lowered reproductive success of Magellanic penguins and is likely undermining the resilience of many other species.
U.S. abortion rates hit lowest level since 1973
Source: Guttmacher Institute
The U.S. abortion rate declined to 16.9 abortions per 1,000 women aged 15–44 in 2011, well below the 1981 peak of 29.3 per 1,000 and the lowest since 1973 (16.3 per 1,000), according to “Abortion Incidence and Service Availability in the United States, 2011,” by Rachel Jones and Jenna Jerman. Between 2008 and 2011, the abortion rate fell 13%, resuming the long-term downward trend that had stalled between 2005 and 2008. The number of abortions (1.1 million in 2011) also declined by 13% in this time period.
While the study did not specifically investigate reasons for the decline, the authors note that the study period (2008–2011) predates the major surge in state-level abortion restrictions that started during the 2011 legislative session, and that many provisions did not go into effect until late 2011 or even later. The study also found that the total number of abortion providers declined by only 4% between 2008 and 2011, and the number of clinics (which provide the large majority of abortion services) declined by just 1%.
Abortion: Judicial History and Legislative Response (PDF)
Source: Congressional Research Service (via Federation of American Scientists)
n 1973, the U.S. Supreme Court concluded in Roe v. Wade that the U.S. Constitution protects a woman’s decision to terminate her pregnancy. In Doe v. Bolton , a companion decision, the Court found that a state may not unduly burden the exercise of that fundamental right with regulations that prohibit or substantially limit access to the means of effectuating the decision to have an abortion. Rather than settle the issue, the Court’s rulings since Roe and Doe have continued to generate debate and have precipitated a variety of governmental actions at the national, state, and local levels designed either to nullify the ru lings or limit their effect. These governmental regulations have, in turn, spawned further litigatio n in which resulting judicial refinements in the law have been no more successful in dampening the controversy.
Source of Payment for the Delivery: Births in a 33-state and District of Columbia Reporting Area, 2010
Source of Payment for the Delivery: Births in a 33-state and District of Columbia Reporting Area, 2010 (PDF)
Source: National Center for Health Statistics
Private insurance was the most frequent payment source for deliveries in the birth certificate-revised reporting area in 2010 (45.8% of births), followed closely by Medicaid (44.9%), ‘‘other’’ payment sources (5.0%), and self-pay (4.4%). Similarly, NHDS data show that private insurance was the most common payment source for deliveries nationally in 2010, followed by Medicaid. Privately insured deliveries declined over the last decade, while the use of Medicaid insurance increased. Medicaid insurance of deliveries was highest for births to teenagers and for non-Hispanic black and Hispanic mothers, according to the birth certificate data. Privately insured mothers were most likely of all payment groups to receive early prenatal care and to have cesarean deliveries.
Cervical Screening at Age 50–64 Years and the Risk of Cervical Cancer at Age 65 Years and Older: Population-Based Case Control Study
There is little consensus, and minimal evidence, regarding the age at which to stop cervical screening. We studied the association between screening at age 50–64 y and cervical cancer at age 65–83 y.
Methods and Findings
Cases were women (n = 1,341) diagnosed with cervical cancer at age 65–83 y between 1 April 2007 and 31 March 2012 in England and Wales; age-matched controls (n = 2,646) were randomly selected from population registers. Screening details from 1988 onwards were extracted from national databases. We calculated the odds ratios (OR) for different screening histories and subsequent cervical cancer. Women with adequate negative screening at age 65 y (288 cases, 1,395 controls) were at lowest risk of cervical cancer (20-y risk: 8 cancers per 10,000 women) compared with those (532 cases, 429 controls) not screened at age 50–64 y (20-y risk: 49 cancers per 10,000 women, with OR = 0.16, 95% CI 0.13–0.19). ORs depended on the age mix of women because of the weakening association with time since last screen: OR = 0.11, 95% CI 0.08–0.14 at 2.5 to 7.5 y since last screen; OR = 0.27, 95% CI 0.20–0.36 at 12.5 to 17.5 y since last screen. Screening at least every 5.5 y between the ages 50 and 64 y was associated with a 75% lower risk of cervical cancer between the ages 65 and 79 y (OR = 0.25, 95% CI 0.21–0.30), and the attributable risk was such that in the absence of screening, cervical cancer rates in women aged 65+ would have been 2.4 (95% CI 2.1–2.7) times higher. In women aged 80–83 y the association was weaker (OR = 0.49, 95% CI 0.28–0.83) than in those aged 65–69 y (OR = 0.12, 95% CI 0.09–0.17). This study was limited by an absence of data on confounding factors; additionally, findings based on cytology may not generalise to human papillomavirus testing.
Women with adequate negative screening at age 50–64 y had one-sixth of the risk of cervical cancer at age 65–83 y compared with women who were not screened. Stopping screening between ages 60 and 69 y in women with adequate negative screening seems sensible, but further screening may be justifiable as life expectancy increases.
Medicare Payments for Vacuum Erection Systems Are More Than Twice as Much as the Amounts Paid for the Same or Similar Devices by Non-Medicare Payers
Medicare Payments for Vacuum Erection Systems Are More Than Twice as Much as the Amounts Paid for the Same or Similar Devices by Non-Medicare Payers
Source: U.S. Department of Health and Human Services, Office of Inspector General
Medicare payment amounts for vacuum erection systems (VES) remain grossly excessive compared with the amounts that non-Medicare payers pay. Medicare currently pays suppliers more than twice as much for VES as the Department of Veterans Affairs and consumers over the Internet pay for these types of devices.
Processes exist to remedy this imbalance by adjusting Medicare payment rates for VES. Use of the inherent reasonableness process would achieve cost savings. If the Medicare fee schedule amount for VES had been adjusted to approximate the amount paid for the same or similar devices by non-Medicare payers, the Federal Government would have saved an average of approximately $14.4 million for each of the 6 years reviewed, and Medicare beneficiaries would have saved approximately $3.6 million annually. We are unable to calculate precise cost savings that would be achieved through application of the Competitive Bidding Program to VES. However, the Centers for Medicare & Medicaid Services (CMS) recently announced that the latest round of competitive bidding will reduce prices by 45 percent for certain types of durable medical equipment, prosthetics, orthotics, and supplies and by 72 percent for mail-order diabetic testing supplies nationwide.
Further, we estimate that if claim levels remain the same in future years as they were on average for calendar years 2009 through 2011, the potential annual savings to the Federal Government and Medicare beneficiaries through adjusted VES payment rates would be approximately $18 million and $4.5 million, respectively.
We recommended that CMS either (1) use its authority under the inherent reasonableness regulations to determine whether the payments for VES are grossly excessive and, if so, establish a special payment limit or (2) seek legislative authority to include VES in the Competitive Bidding Program and then implement a National Mail-Order Competitive Bidding Program for VES. CMS concurred with both of our recommendations.
Associations between Intimate Partner Violence and Termination of Pregnancy: A Systematic Review and Meta-Analysis
Intimate partner violence (IPV) and termination of pregnancy (TOP) are global health concerns, but their interaction is undetermined. The aim of this study was to determine whether there is an association between IPV and TOP.
Methods and Findings
A systematic review based on a search of Medline, Embase, PsycINFO, and Ovid Maternity and Infant Care from each database’s inception to 21 September 2013 for peer-reviewed articles of any design and language found 74 studies regarding women who had undergone TOP and had experienced at least one domain (physical, sexual, or emotional) of IPV. Prevalence of IPV and association between IPV and TOP were meta-analysed. Sample sizes ranged from eight to 33,385 participants. Worldwide, rates of IPV in the preceding year in women undergoing TOP ranged from 2.5% to 30%. Lifetime prevalence by meta-analysis was shown to be 24.9% (95% CI 19.9% to 30.6%); heterogeneity was high (I2>90%), and variation was not explained by study design, quality, or size, or country gross national income per capita. IPV, including history of rape, sexual assault, contraceptive sabotage, and coerced decision-making, was associated with TOP, and with repeat TOPs. By meta-analysis, partner not knowing about the TOP was shown to be significantly associated with IPV (pooled odds ratio 2.97, 95% CI 2.39 to 3.69). Women in violent relationships were more likely to have concealed the TOP from their partner than those who were not. Demographic factors including age, ethnicity, education, marital status, income, employment, and drug and alcohol use showed no strong or consistent mediating effect. Few long-term outcomes were studied. Women welcomed the opportunity to disclose IPV and be offered help. Limitations include study heterogeneity, potential underreporting of both IPV and TOP in primary data sources, and inherent difficulties in validation.
IPV is associated with TOP. Novel public health approaches are required to prevent IPV. TOP services provide an opportune health-based setting to design and test interventions.
Assisted Reproductive Technology Surveillance — United States, 2010
Source: Morbidity and Mortality Weekly Report (CDC)
Since the first U.S. infant conceived with Assisted Reproductive Technology (ART) was born in 1981, both the use of advanced technologies to overcome infertility and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Women who undergo ART procedures are more likely to deliver multiple-birth infants than those who conceive naturally because more than one embryo might be transferred during a procedure. Multiple births pose substantial risks to both mothers and infants, including pregnancy complications, preterm delivery, and low birthweight infants. This report provides state-specific information on U.S. ART procedures performed in 2010 and compares infant outcomes that occurred in 2010 (resulting from procedures performed in 2009 and 2010) with outcomes for all infants born in the United States in 2010.
Prospective Study of Peripregnancy Consumption of Peanuts or Tree Nuts by Mothers and the Risk of Peanut or Tree Nut Allergy in Their Offspring
The etiology of the increasing childhood prevalence of peanut or tree nut (P/TN) allergy is unknown.
To examine the association between peripregnancy consumption of P/TN by mothers and the risk of P/TN allergy in their offspring.
Design, Setting, and Participants
Prospective cohort study. The 10 907 participants in the Growing Up Today Study 2, born between January 1, 1990, and December 31, 1994, are the offspring of women who previously reported their diet during, or shortly before or after, their pregnancy with this child as part of the ongoing Nurses’ Health Study II. In 2006, the offspring reported physician-diagnosed food allergy. Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results. Two board-certified pediatricians, including a board-certified allergist/immunologist, independently reviewed each potential case and assigned a confirmation code (eg, likely food allergy) to each case. Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring.
Peripregnancy consumption of P/TN.
Main Outcomes and Measures
Physician-diagnosed P/TN allergy in offspring.
Among 8205 children, we identified 308 cases of food allergy (any food), including 140 cases of P/TN allergy. The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more P/TN in their peripregnancy diet (≥5 times vs <1 time per month: odds ratio = 0.31; 95% CI, 0.13-0.75; Ptrend = .004). By contrast, a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers (Ptrend = .12). The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant (Pinteraction = .004).
Conclusions and Relevance
Among mothers without P/TN allergy, higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring. Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy.
Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study
Source: BMC Women’s Health
Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.
This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student’s t-test were used to compare data between groups.
The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.
Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.