Barriers to insurance coverage for transgender patients.

Transgender people report discrimination in access to health care that is associated with numerous poor health outcomes, including higher prevalence of HIV infection, substance use disorders, and suicide attempts. The field of obstetrics and gynecology is uniquely positioned to meet a wide range of health care needs for transgender people, and obstetrician-gynecologists can and ought to provide gender-affirming care for these patients. Despite growing evidence that gender-affirming care is both necessary and cost-effective, transgender patients continue to face barriers to securing insurance coverage, which prevents clinicians from practicing standards of care. The purpose of this article is to delineate the major barriers transgender patients face when seeking insurance reimbursement for services routinely available to cisgender (nontransgender) women.

Use of intrapartum antibiotics and the incidence of postnatal maternal and neonatal yeast infections.

OBJECTIVES: To estimate 1) the risk of candidiasis (neonatal thrush or breast infections or both) in nursing mother-infant pairs and 2) whether receipt of intrapartum antibiotics increases this risk. METHODS: Demographic and obstetric data were obtained at delivery, and telephone follow-up was obtained at 1 week and 1 and 3 months and recorded in the Lactation Services database, which was reviewed retrospectively. The diagnoses of thrush and breast candidiasis were based on symptoms and patient reports, as per standard clinical practice. For statistical analysis, chi(2) analysis and Student t test were used. A value of P < .05 was considered significant. RESULTS: A total of 811 nursing mother-infant pairs were seen between February 1, 2001, and August 31, 2002. Mother-infant pairs with follow-up who nursed for 1 month or longer were included (n = 435). Of these, 173 (39.8%) received intrapartum antibiotics, most (78.6%) for group B streptococci prophylaxis. Overall, 46 mother-infant pairs (10.6%) had either thrush or breast candidiasis (32 with both) within 1 month of delivery. Mothers who were exposed to intrapartum antibiotics were significantly more likely to develop breast candidiasis (odds ratio 2.1, 95% confidence interval 1.08-4.08). Antibiotic-exposed neonates were more likely to develop thrush, although this was not statistically significant. (odds ratio 1.87, 95% confidence interval 0.97-3.63). Antibiotic-exposed infants were younger (mean +/- standard deviation, 38.5 +/- 1.9 weeks compared with 39.0 +/- 1.3 weeks; P = .002), but there were no differences in maternal age, gravity or parity, or route of delivery. CONCLUSIONS: Neonatal thrush and maternal breast candidiasis are common early postnatal complications. The higher rates of thrush and breast candidiasis in antibiotic-exposed mother-infant pairs merits further study. LEVEL OF EVIDENCE: II-2.