Gabapentin as an adjunct to paracervical block for perioperative pain management for first-trimester uterine aspiration: a randomized controlled trial.

BACKGROUND: Pain management approaches during uterine aspiration vary, which include local anesthetic, oral analgesics, moderate sedation, deep sedation, or a combination of approaches. For local anesthetic approaches specifically, we continue to have suboptimal pain control. Gabapentin as an adjunct to pain management has proven to be beneficial in gynecologic surgery. We sought to evaluate the impact of gabapentin on perioperative pain during surgical management of first-trimester abortion or early pregnancy loss with uterine aspiration under local anesthesia. OBJECTIVE: We hypothesized that adding gabapentin to local anesthesia will reduce perioperative and postoperative pain associated with uterine aspiration. Secondary outcomes included tolerability of gabapentin and postoperative pain, nausea, vomiting, and anxiety. STUDY DESIGN: We conducted a randomized double-blinded placebo-controlled trial of gabapentin 600 mg given 1 to 2 hours preoperatively among subjects receiving a first-trimester uterine aspiration under paracervical block in an outpatient ambulatory surgery center. There were 111 subjects randomized. The primary outcome was pain at time of uterine aspiration as measured on a 100-mm visual analog scale. Secondary outcomes included pain at other perioperative time points. To assess changes in pain measures, an intention to treat mixed effects model was fit with treatment groups (gabapentin vs control) as a between-subjects factor and time point as a within-subjects factor plus their interaction term. Because of a non-normal distribution of pain scores, the area under the curve was calculated for secondary outcomes with comparison of groups utilizing Mann-Whitney U tests. RESULTS: Among the 111 randomized, most subjects were Black or African American (69.4%), mean age was 26 years (±5.5), and mean gestational age was 61.3 days (standard deviation, 14.10). Mean pain scores at time of uterine aspiration were 66.77 (gabapentin) vs 71.06 (placebo), with a mean difference of -3.38 (P=.51). There were no significant changes in pain score preoperatively or intraoperatively. Subjects who received gabapentin had significantly lower levels of pain at 10 minutes after surgery (mean difference [standard error (SE)]=-13.0 [-5.0]; P=.01) and 30 minutes after surgery (mean difference [SE]=-10.8 [-5.1]; P=.03) compared with subjects who received placebo. Median nausea scores and incidence of emesis pre- and postoperatively did not differ between groups. Similarly, anxiety scores did not differ between groups, before or after the procedure. At 10 and 30 minutes after the procedure, most participants reported no side effects or mild side effects, and this did not differ between groups. CONCLUSION: Preoperative gabapentin did not reduce pain during uterine aspiration. However, it did reduce postoperative pain, which may prove to be a desired attribute of its use, particularly in cases where postoperative pain may be a greater challenge.

Understanding the Impacts of the Supreme Court Case FDA v Alliance for Hippocratic Medicine.

This Viewpoint outlines the potential effects of the Supreme Court case regarding mifepristone restrictions: a decision for the FDA would allow current dispensing, while ruling against the FDA would severely curtail access to reproductive health options.

My Health in My Hands: Improving Medication Abortion Knowledge and Closing Disparities with a Community-Led Media Intervention.

Purpose: Inaccurate beliefs about medication abortion (MA) are common. This study evaluated pilot data from a community-led media intervention designed to increase MA knowledge among Black and Latinx women in Georgia. Methods: Participants (N=855) viewed the intervention video and completed pre-post surveys. Data were analyzed using linear and logistic regression. Results: Knowledge scores significantly increased from 3.88/5.00 to 4.47/5.00. Participants who were Native American, Asian and Pacific Islander, multiracial, Black, <20 years old, and living in Georgia scored below the sample mean at baseline; however, nearly all disparities disappeared after intervention exposure. Conclusions: This intervention effectively increased MA knowledge and narrowed racial/ethnic, age-based, and geographic disparities.

Employment Status in the United States and Use of Long-Acting Reversible Contraception or Moderately Effective Contraception before and after the Affordable Care Act: National Survey of Family Growth 2006-2010 and 2015-2017.

Employment status has been previously associated with contraceptive use among women of reproductive age. We assessed the association between employment status and method of contraception among US women of reproductive age, before and after the implementation of the Affordable Care Act (ACA) passed in 2010. We conducted a cross-sectional study using data from the National Survey of Family Growth (NSFG): 2006-2010 survey for our pre-ACA analysis and 2015-2017 survey for post-ACA analysis. We combined the use of moderately-effective or long-acting reversible contraceptives (LARC) as the main study outcome. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI). Our study included 5,572 women pre-ACA and 2,340 women post-ACA. Pre-ACA, non-Hispanic white women who were employed were significantly more likely to use moderately-effective or LARC contraceptives (aPOR = 1.66; 95% CI = 1.28, 2.14), but post-ACA, this association was non-significant (aPOR = 0.94; 95% CI = 0.67, 1.33). Findings were not significant for other race/ethnic groups in either time frame. Our study shows that being employed was no longer associated with contraceptive method during a post-ACA time period among non-Hispanic white women. Modifications to the ACA should be scrutinized to further evaluate the impact it may have on women's access to moderately-effective or LARC contraception.

Community-led research for reproductive justice: Exploring the SisterLove Georgia Medication Abortion project.

Introduction: While reproductive injustice indicators are improving globally, they are worsening in the United States particularly for Black and other marginalized communities. Eugenics and obstetric violence against low-income and communities of color create well-founded distrust of sexual and reproductive health (SRH). Transformational, reparative ways of conducting SRH research are needed. Proposed principles of community-led research for reproductive justice: Drawing on our collective experience as reproductive justice leaders, SRH researchers, and clinicians, we propose the following principles of community-led research for reproductive justice: 1) Center the marginalized community members most affected by SRH inequities as leaders of research; 2) Facilitate equitable, collaborative partnership through all phases of SRH research; 3) Honor multiple ways of knowing (experiential, cultural, empirical) for knowledge justice and cross-directional learning across the team; 4) Build on strengths (not deficits) within the community; 5) Implement the tenets of reproductive justice including structural-level analysis and the human rights framework; 6) Prioritize disseminating useful findings to community members first then to other audiences; 7) Take action to address social and reproductive injustices. SisterLove's community-led georgia medication abortion project: We offer the community-led Georgia Medication Abortion (GAMA) Project by reproductive justice organization SisterLove from 2018-2022 as a case study to demonstrate these principles along with the strengths and challenges of reproductive justice research. Discussion: Community-led reproductive justice research offers innovative and transformational methods for truly advancing SRH in an era of increasing policy restrictions and decreasing access to care. Yet existing funding, research administrative, and publishing systems will require structural change.

"I don't regret it at all. It's just I wish the process had a bit more humanity to it a bit more holistic": a qualitative, community-led medication abortion study with Black and Latinx Women in Georgia, USA.

Traditional family planning research has excluded Black and Latinx leaders, and little is known about medication abortion (MA) among racial/ethnic minorities, although it is an increasingly vital reproductive health service, particularly after the fall of Roe v. Wade. Reproductive justice (RJ) community-based organisation (CBO) SisterLove led a study on Black and Latinx women's MA perceptions and experiences in Georgia. From April 2019 to December 2020, we conducted key informant interviews with 20 abortion providers and CBO leaders and 32 in-depth interviews and 6 focus groups (n = 30) with Black and Latinx women. We analysed data thematically using a team-based, iterative approach of coding, memo-ing, and discussion. Participants described multilevel barriers to and strategies for MA access, wishing that "the process had a bit more humanity … [it] should be more holistic." Barriers included (1) sociocultural factors (intersectional oppression, intersectional stigma, and medical experimentation); (2) national and state policies; (3) clinic- and provider-related factors (lack of diverse clinic staff, long waiting times); and (4) individual-level factors (lack of knowledge and social support). Suggested solutions included (1) social media campaigns and story-sharing; (2) RJ-based policy advocacy; (3) diversifying clinic staff, offering flexible scheduling and fees, community integration of abortion, and RJ abortion funds; and (4) social support (including abortion doulas) and comprehensive sex education. Findings suggest that equitable MA access for Black and Latinx communities in the post-Roe era will require multi-level intervention, informed by community-led evidence production; holistic, de-medicalised, and human rights-based care models; and intersectional RJ policy advocacy.