Objectives: The primary objective was to determine the rate of breastfeeding by gestational age reported by new mothers 1 month postpartum, with particular focus on early term newborns (37-38 6 / 7 weeks). Materials and Methods: Three thousand six primiparous women aged 18-36 years were interviewed during their third trimester and again 1 month postpartum. Logistic regression analysis was used to model the association between gestational age and breastfeeding 1 month postpartum among those who reported that they planned to breastfeed, controlling for potentially confounding variables. Results: Two thousand seven hundred seventy-two women planned to breastfeed (92.2%), among whom 116 (4.2%) delivered late preterm (34-36 6 / 7 weeks), 519 (18.7%) early term (37-38 6 / 7 weeks), and 2,137 (77.1%) term or postterm (39+ weeks). Among those who delivered late preterm, 63.8% were breastfeeding 1 month postpartum, early term 72.6%, and term or postterm 76.5%. This relationship was verified by a multivariate logistic regression analysis; late preterm newborns were significantly less likely to be breastfeeding 1 month postpartum than the term or postterm newborns (odds ratio [OR] 0.44; 95% confidence interval [CI] 0.28-0.69; p £ 0.0001), as were early term newborns (OR 0.77; 95% CI 0.60-0.99; p = 0.038).
Conclusions:In this large prospective study of first-time mothers and newborns, gestational age was significantly associated with breastfeeding 1 month postpartum; highlighting late preterm and early term infants as populations at risk for shortened breastfeeding duration and the need to create specific breastfeeding support and education.
Objective
To investigate risk factors for dyspareunia among primiparous women.
Methods
This was a planned secondary analysis, using data from the 1 and 6 month postpartum interviews of a prospective study of women who delivered their first baby in Pennsylvania, 2009 to 2011. Participants who had resumed sexual intercourse by the 6 month interview (n = 2,748) constituted the analytic sample. Women reporting a big or medium problem with painful intercourse at 6 months were categorized as having dyspareunia. Multivariable logistic regression was used to evaluate the effect of patient characteristics, obstetric and psychosocial factors, and breastfeeding on dyspareunia.
Results
There were 583 women (21.2%) who reported dyspareunia at 6 months postpartum. Nearly a third of those breastfeeding at 6 months reported dyspareunia (31.5%), versus 12.7% of those not breastfeeding (adjusted odds ratio (adjusted OR) 2.89, 95% confidence interval (CI) 2.33–3.59, P < .001); 32.5% of those reporting a big or medium problem with perineal pain at 1-month reported dyspareunia at 6 months versus 15.9% of those who did not (adjusted OR 2.45, 95% CI 1.93–3.10, P < .001); 28.3% of women who reported fatigue all or most of the time at 1 month reported dyspareunia at 6 months versus 18.0% of those who reported fatigue less often (adjusted OR 1.60, 95% CI 1.30–1.98, P < .001); and 24.1% of those who scored in the upper third on the stress scale at 1 month reported dyspareunia at 6 months postpartum, compared to 15.6% of those who scored in the lowest third (adjusted OR 1.55, 95% CI 1.18–2.02, P = .001).
Conclusion
In this prospective cohort study we identified specific risk factors for dyspareunia in primiparous women that can be discussed at the first postpartum visit, including breastfeeding, perineal pain, fatigue and stress.
HighlightsThis is the 20th documented case of metastatic breast carcinoma to the vulva.Greater than 21 years have passed from initial diagnosis to vulvar metastasis.Existing literature supports long term surveillance in women with invasive lobular carcinoma of the breast.
The greatest modifiable risk factor for the development of cervical carcinoma is non-compliance with recommended preventative care, yet the reasons why women fail to receive this care are varied. A multi-faceted approach to risk reduction is needed, including improved health care access, population-targeted outreach, language-appropriate services, and culturally competent care.
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