has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version. If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting).

Background Reducing pregnancy risk requires a multidimensional approach to sexual and reproductive health product development. The purpose of this analysis is to identify, compare, and contrast women’s pre-use beliefs and attitudes about three different forms of contraceptives: intravaginal rings; spermicide in conjunction with condoms; and oral contraceptive pills – and explore how those attitudes and beliefs, along with actual method-use experience, may affect potential choices in contraceptive method moving forward. The relationship of beliefs and attitudes to their risk–benefit calculations when using these methods was also considered.? Methods: Women used one or more contraceptive methods, each for 3–6 months. Qualitative data from individual in-depth interviews completed after each 3-month use period were analysed using a summary matrix framework. Data were extracted and summarised into themes. Each woman’s experiences were compared among the methods she used; comparisons were also made across participants. Results: The data consist of 33 90–120 min in-depth qualitative interviews from 16 women aged 20–34 years, in which they discussed various elements of their method use experience. One prominent theme was identified: the influence of attitudes and beliefs on the risk–benefit calculus. There were six key elements within the theme: pregnancy prevention; dosing and the potential for user error; side-effects; familiarity; disclosure; and sexual partnerships. Conclusions: Women weighed perceived risks and benefits in their decision-making and, ultimately, their contraception choices. Understanding women’s beliefs and attitudes that contribute to a calculation of risk–benefit can inform the development of sexual and reproductive health products.

Background Adenovirus infection is usually mild in presentation. However during pregnancy, the course can be more severe. Case A 21-year-old woman in her second pregnancy presented with abdominal pain, vomiting, and fevers at 34 weeks and 4 days of gestation. Her respiratory pathogen panel on nasopharyngeal secretions was positive for adenovirus. Electrolytes were notable for hypomagnesaemia and persistent hypokalemia (nadir of 2.6 mmol/L) despite repletion but otherwise unremarkable. During her course, she developed rhabdomyolysis. During routine fetal monitoring at 35 weeks and 6 days of gestation, prolonged fetal bradycardia was identified, and an emergency caesarean delivery was performed. The infant had no clinical or laboratory evidence of adenovirus infection. The patient had a protracted clinical course but recovered with supportive care. Conclusion Adenovirus can present with severe complications in a pregnant woman including hypokalemia and rhabdomyolysis. The mainstay of treatment is supportive care and monitoring of electrolyte abnormalities and renal function.

(Abstracted from Obstet Gynecol 2022;139:821–831)The aim of this study was to characterize gynecology clinical trials over time, compare trials in various subspecialties, and analyze factors associated with early discontinuation, failure, or inadequacy to report results, as well as to publish and disseminate findings of gynecology clinical trials. The authors performed cross-sectional analysis of all gynecology trials registered on ClinicalTrials.gov between 2007 and 2020 and their resulting publications.

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OBJECTIVE:To assess maternal and neonatal outcomes between women with GDM who receive WIC benefits compared to those who don't. STUDY DESIGN: e performed a retrospective cohort study using National Vital Statistics Birth Data of births to women between 2014-2018. Inclusion criteria were women who were diagnosed with gestational diabetes (GDM) during their pregnancy. We analyzed maternal and neonatal outcomes for these women who received WIC benefits compared to those who did not receive WIC benefits. Bivariate tests and multivariable logistic regression were used for comparison. Maternal race/ethnicity, body mass index, age, parity, chronic hypertension, educational attainment, insurance type, and cigarette use were included as confounders. All analyses were conducted using STATA version 17. RESULTS: There were 1,088,949 deliveries to women with GDM included in the analysis; 41% receiving WIC and 59% who did not receive WIC. Women with GDM receiving WIC compared to control were less likely to be obese (46.82% vs 53.2%); however, more likely to be enrolled in Medicaid (72.7% vs 27.3%), and to be an active smoker (61.7% vs 38.3%). Receipt of WIC benefits in women with GDM was associated with higher odds of cesarean delivery (aOR 1.017, 95% CI 1.005-1.029 and higher odds of neonatal LGA (aOR 1.100, 95% CI 1.082-1.112). There was no difference in maternal gestational hypertension/preeclampsia, eclampsia, maternal ICU admission, neonatal ICU admission, small for gestational age, or neonatal ventilation requirements. CONCLUSION: Receipt of WIC resulted in varied outcomes among women with GDM suggesting that the role of WIC and nutrition in perinatal health outcomes is complicated. Therefore, further studies are needed to determine the role of nutrition and nutritional access and pregnancy outcomes. Although nutrition is imperative for management of GDM, the importance of exercise and medication therapy in addition to nutritional health cannot be assessed with this study and should be further researched.

INTRODUCTION: Current contraceptive literature includes limited studies focusing on the impact of contraceptive methods (exclusive of condom-only contraception) on women's sexual experiences. Many of these focus on hormonal effects of oral contraceptive pills (OCPs). Though important, women's experiences with contraception extend far beyond hormonal impacts. This study aims to add depth to the knowledge base by exploring the meaningful effects of intravaginal rings (IVR) on women's sexual experiences, highlighting the IVR as a device physically experienced by both the user and her sexual partner(s). METHODS: Twelve women, aged 18-45 years, used the IVR for 3-6 months, and completed daily phone surveys, monthly web surveys, and in-depth interviews regarding IVR use. This thematic content analysis of qualitative data explores how the IVR affects participants' sexual experiences. RESULTS: Sexual experiences with the IVR elicited a range of user reactions. Women reported impacts on their sexual experiences related to physical (e.g., feeling the IVR during sex), administrative (e.g., navigating IVR removal before sex), and relationship factors (e.g., partner's sexual comfort and pleasure). Women derived both positive and negative meaning from these experiences, which then altered and individualized their use and subsequent opinions of the IVR. CONCLUSION: The range of IVR impacts on women's sexual experiences shape their use and opinions of the product, leading to either increased motivation or poor adherence and discontinuation. Awareness of these individualized experiences can help providers better understand and guide their patients through effective IVR use. Research on user experiences across contraceptive methods is necessary to support women's sexual and reproductive health.

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