The original study was funded by the UNDP/UNPFA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. The donors and sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, writing of the report or the decision to submit the paper for publication.
Utah's extended waiting period showed a small reduction in the proportion of counseled women who returned for their abortion procedure statewide. Women who had abortions after the law was enacted reported several burdensome aspects of the law.
Intrauterine contraceptive devices and the progestin implant are the most effective long-acting reversible contraception (LARC) methods available for preventing unintended pregnancy. LARC devices are safe, non-user-dependent methods that have the highest rates of continuation and satisfaction of all reversible contraceptives. Use of these contraceptives remains low in the United States due to several barriers including: misperceptions among both providers and patients; cost barriers; and patient access to the devices. Increasing the opportunities for women to access LARC methods in the primary care, postabortion, and postpartum setting can be achieved by addressing the system, provider, and patient barriers that exist.
OBJECTIVES
Preterm birth (PTB) is a public health crisis in need of effective preventative strategies. Multi-disciplinary Neonatal Follow-up Programs (NFPs) provide health services to preterm infants at high risk for developmental problems after discharge from U.S. newborn intensive care units (NICUs). We aimed to determine whether NFPs are a potential effective venue for specialized maternal counseling and intervention aimed at reducing the high rate of recurrent PTB in this population.
METHODS
This prospective case series enrolled women with preterm children evaluated in the Utah Department of Health NFP, 2010-2012. Women were interviewed, received Maternal Fetal Medicine (MFM) counseling services, and maternal and neonatal records were abstracted. We assessed maternal demographics, medical history, and characteristics of the index pregnancy. We calculated the proportion of women with knowledge of PTB recurrence risk and available prevention strategies, and assessed current contraceptive use and reproductive plans.
RESULTS
Ninety-six women with a history of early PTB (≤26 weeks and/or birth weight <1250 gms) were evaluated. Nearly 1 in 5 women (19.8%) evaluated reported sexual activity, desire to avoid pregnancy, and no current contraceptive use, and were therefore at imminent risk of unintended pregnancy. Of women without permanent contraception, only 24.3% were aware of their individual PTB recurrence risk. Of women with a history of spontaneous PTB, only 4% were aware of effective pharmacologic preventative strategies.
CONCLUSIONS
Introduction of MFM consultation as part NFP multi-disciplinary services is a novel approach with the potential to reduce recurrent PTB in an exceptionally high-risk population.
Prenatal care providers are frequently asked to provide employment notes for their patients requesting medical leave or changes to work duties. Writing employment notes correctly can help patients negotiate for and obtain medically indicated workplace accommodations, allowing them to continue to work and earn an income. However, a poorly written or poorly timed note can jeopardize a patient's employment and salary. This commentary provides an overview of pregnancy-related employment laws and guidance in writing work accommodations letters that allow pregnant women to keep their jobs while maintaining a healthy pregnancy.
Objectives
This study assesses the ability to maintain contact with participants enrolled in an emergency contraception (EC) trial with 12 months of follow-up based on the modes of contact they provided at enrollment.
Study Design
Data came from a clinical trial offering women the copper intrauterine device (IUD) or oral levonorgestrel (LNG) for EC. A modified Poisson regression was used to assess predictors associated with the ability to contact study participants 12 months after enrollment.
Results
Data were available for 542 participants; 443 (82%) could be contacted at 12 months. Contact at 12 months was greatest for those whose preferred method of contact was text messaging, email, or any (62/68 91% contacted) and worst for the 18 who had a landline phone (only 7 contacted, 39%). After controlling for age, having an email address, text messaging, language preference, type of EC chosen, and insurance, preferred contact other than phone increased the likelihood of follow-up by 10% (RR 1.1 95% CI 1.0-1.2), while having a landline reduced a woman's likelihood of being contacted at 12 months by 50% compared to women with a contract cell (RR 0.5; 95% CI 0.3-1.0).
Conclusion
The few women with a landline for contact had poor follow-up at one year while women who preferred email or text had the highest rate of follow-up.
Implications
Understanding how best to reduce loss to follow-up is an essential component of conducting a contraceptive clinical trial. Improved participant retention maximizes internal validity and allows for important clinical outcomes, such as pregnancy, to be assessed.
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