Cervical cancer screening has reduced the incidence of cervical cancer over the past 75 years. The primary aim of this study was to determine if women receiving Gardasil™ (HPV4 vaccine) participated in future cervical cancer screening at the same rate as that observed for unvaccinated women matched on birth year and health care campus. This is a retrospective cohort study of subjects selected from 27,786 females born from 1980 to 1992 who received health care in the Truman Medical Center safety net health system in Kansas City Missouri, USA. 1154 women 14–26 years old who received at least one dose of HPV4 vaccine between 2006 and 2009 were chosen at random from the vaccine records. 1154 randomly chosen unvaccinated women were age and health campus matched to the vaccinated women and all were followed until July 1, 2013. Women who were screened after 21 years and received three vaccine doses before 21 years, had the lowest screening rate of 24%. Their only predictive factor for screening, compared to the unvaccinated, was being closer to 21 years than 14 years at vaccination (aOR = 1.71 95% CI: 1.45, 2.00). Women vaccinated with three doses and screened at or after 21 years had the highest screening rate of 84% predicting a six-fold increase in screening participation over no vaccine received (aOR = 5.94 95% CI: 3.77, 9.35). Our results suggest that women who receive HPV4 vaccination closer to 21 years, not 14, are more likely to participate in cervical cancer screening in an underserved US population.

In this cohort of women with preeclampsia and severe features before delivery, NSAIDs were not associated with increased rates of persistent postpartum hypertension.

OBJECTIVE: Treatment of gestational diabetes (GDM) is associated with improved pregnancy outcomes. Obstacles to taking prescribed medications can lead to non-compliance. The objective was to determine the challenges that lead to low medication adherence and whether this increases the rate of adverse pregnancy outcomes in women with GDM. STUDY DESIGN: A prospective, observational study was performed of women with GDM treated with metformin, glyburide or insulin at a tertiary care center. Women greater than 16 weeks gestation and treated for a minimum of 2 weeks were included. Women with pre-DM were excluded. Women completed a validated survey, MMAS-8 (low: score <6 and high: score 7-8), to identify women with low and high medication adherence. Information resulting in medication compliance was collected. The primary outcome was neonatal birth weight >4,000g. Secondary outcomes included factors with medication adherence, adherence rates for each medication and neonatal outcomes. RESULTS: Of 79 women who met study criteria, 42 reported high and 37 reported low adherence. Birth weight >4,000g were similar in each group, (low: 16.2% vs. high: 7.1%, p ¼ 0.292). Women prescribed metformin had the highest rate of high adherence (38.1%) and women on glyburide had the highest rate of low adherence (46%). The rate of neonatal hypoglycemia was significantly higher in women with low adherence compared to high adherence, (low: 70.3% vs high 42.9%, p ¼ 0.023). There were similar rates of induction of labor, cesarean section, NICU admissions, and neonatal respiratory complications. There were no cases of shoulder dystocia, Erb's palsy, or major neonatal morbidities. Obstacles to medication adherence were documented in 14% of women including prescription error, insurance difficulties and delay in dispensing the medications. Adverse effects to medication were reported in 10-20% of women. CONCLUSION: Although there were no differences in neonatal birthweight between groups, low medication adherence was associated with neonatal hypoglycemia. Challenges to compliance with prescribed medications occurred in 14% of GDM women and up to 1 in 5 women reported a medication side effects. Further studies are needed to investigate patient-specific and system-level strategies to improve medication adherence in women with GDM.