ImportanceClinical trials guide evidence-based obstetrics and gynecology (OB-GYN) but often enroll nonrepresentative participants.ObjectiveTo characterize race and ethnicity reporting and representation in US OB-GYN clinical trials and their subsequent publications and to analyze the association of subspecialty and funding with diverse representation.Design and SettingCross-sectional analysis of all OB-GYN studies registered on ClinicalTrials.gov (2007-2020) and publications from PubMed and Google Scholar (2007-2021). Analyses included logistic regression controlling for year, subspecialty, phase, funding, and site number. Data from 332 417 studies were downloaded. Studies with a noninterventional design, with a registration date before October 1, 2007, without relevance to OB-GYN, with no reported results, and with no US-based study site were excluded.ExposuresOB-GYN subspecialty and funder.Main Outcomes and MeasuresReporting of race and ethnicity data and racial and ethnic representation (the proportion of enrollees of American Indian or Alaskan Native, Asian, Black, Latinx, or White identity and odds of representation above US Census estimates by race and ethnicity).ResultsAmong trials with ClinicalTrials.gov results (1287 trials with 591 196 participants) and publications (1147 trials with 821 111 participants), 662 (50.9%) and 856 (74.6%) reported race and ethnicity data, respectively. Among publications, gynecology studies were significantly less likely to report race and ethnicity than obstetrics (adjusted odds ratio [aOR], 0.54; 95% CI, 0.38-0.75). Reproductive endocrinology and infertility trials had the lowest odds of reporting race and ethnicity (aOR, 0.14; 95% CI, 0.07-0.27; reference category, obstetrics). Obstetrics and family planning demonstrated the most diverse clinical trial cohorts. Compared with obstetric trials, gynecologic oncology had the lowest odds of Black representation (ClinicalTrials.gov: aOR, 0.04; 95% CI, 0.02-0.09; publications: aOR, 0.06; 95% CI, 0.03-0.11) and Latinx representation (ClinicalTrials.gov: aOR, 0.05; 95% CI, 0.02-0.14; publications: aOR, 0.23; 95% CI, 0.10-0.48), followed by urogynecology and reproductive endocrinology and infertility. Urogynecology (ClinicalTrials.gov: aOR, 0.15; 95% CI, 0.05-0.39; publications: aOR, 0.24; 95% CI, 0.09-0.58) had the lowest odds of Asian representation.Conclusions and RelevanceRace and ethnicity reporting and representation in OB-GYN trials are suboptimal. Obstetrics and family planning trials demonstrate improved representation is achievable. Nonetheless, all subspecialties should strive for more equitably representative research.
Patient portal utilization has become common in healthcare. A patient portal is a secure Web-based interface paired to an electronic medical record (EMR). Portals provide individuals with an accessible avenue to communicate with providers, access their medical record, and schedule appointments. 1 Secure messaging is a component of patient portals that may promote self-management, shared decision-making, and patient satisfaction by providing opportunities to correspond with providers. 2 In studies exploring the role of patient portals in diabetes self-management, portal use and secure messaging have been associated with positive clinical outcomes, including lower hemoglobin A1c (HbA1c) values. 1,3 However, these relationships have not been studied in obstetrics. Pregnancy is a period of increased intensity and frequency of healthcare interactions, and for individuals with diabetes, optimal glycemic control requires significant participation. 4,5 Thus, it was of interest to determine if portal use, in particular secure messaging, was associated with glycemic outcomes during pregnancy. The objective of this study was to determine if enrollment in and use of an EMRlinked electronic patient portal were associated with glycemic control during pregnancy.This was a retrospective cohort study of patients who received prenatal care at a large academic medical center (2014)(2015)(2016). All patients who had at least one HbA1c value or a postpartum 2-hour oral glucose tolerance test (OGTT) value in the EMR were eligible for inclusion. At the time of study, routine practice at this institution was to conduct HbA1c surveillance only among patients with diabetes or diabetes risk factors. Patients were considered enrolled in the portal if they had an account at the time of delivery. Glycemic control outcomes for enrollees were compared to non-enrollees. Enrollees were further categorized by the number of secure messages sent during pregnancy as active (≥1) vs inactive (0) users. Multivariable Poisson regression was used to assess the associations of (1) portal enrollment and (2) secure messaging activity with initial HbA1c value during pregnancy, postpartum HbA1c value, and postpartum 2-hour OGTT value.Of the 3450 patients eligible for inclusion, 728 (21%) had either initial HbA1c (N=670), postpartum HbA1c (N=120), or 2-hour postpartum OGTT (N=89) values available. The majority of patients (59.1%, N=430) were enrolled in the portal. Of portal enrollees, 303 (70.5%) met criteria for active use. Glycemic control did not differ significantly by portal enrollment. However, patients who utilized secure messaging had lower odds of having initial HbA1c value ≤7% or postpartum 2-hour OGTT value ≤140 mg/dL (Table 1).In contrast to studies in primary care, our study showed that patient portal use was not associated with significant differences in glycemic control during pregnancy. Rather, patients who were active users were less likely to have within-goal glycemic control. This finding suggests that pregnant patients with suboptimal glyce...
Introduction As deaths related to opioids continue to rise, reducing opioid use for postpartum pain management is an important priority. Thus, we conducted a systematic review of postpartum interventions aimed at reducing opioid use following birth. Methods From database inception through September 1, 2021, we conducted a systematic search in Embase, MEDLINE, Cochrane Library, and Scopus including the following Medical Subject Heading (MeSH) terms: postpartum, pain management, opioid prescribing. Studies published in English, restricted to the United States, and evaluating interventions initiated following birth with outcomes including an assessment of change in opioid prescribing or use during the postpartum period (<8 weeks postpartum) were included. Authors independently screened abstracts and full articles for inclusion, extracted data, and assessed study quality using the Grading of Recommendations, Assessment, Development, and Evaluation tool and risk of bias using the Institutes of Health Quality Assessment Tools. Results A total of 24 studies met inclusion criteria. Sixteen studies evaluated interventions aimed at reducing postpartum opioid use during the inpatient hospitalization, and 10 studies evaluated interventions aimed at reducing opioid prescribing at postpartum discharge. Inpatient interventions included changes to standard order sets and protocols for the management of pain after cesarean birth. Such interventions resulted in significant decreases in inpatient postpartum opioid use in all but one study. Additional inpatient interventions, including use of lidocaine patches, postoperative abdominal binder, valdecoxib, and acupuncture were not found to be effective in reducing postpartum opioid use during inpatient hospitalization. Interventions targeting the postpartum period included individualized prescribing and state legislative changes limiting the duration of opioid prescribing for acute pain both resulted in decreased opioid prescribing or opioid use. Discussion A variety of interventions aimed at reducing opioid use following birth have shown efficacy. Although it is not known if any single intervention is most effective, these data suggest that implementation of any number of interventions may be advantageous in reducing postpartum opioid use.
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