Prevalence and correlates of pregnancy self-testing among pregnant women attending antenatal care in western Kenya.

In sub-Saharan Africa little is known about how often women use pregnancy self-tests or characteristics of these women despite evidence that pregnancy self-testing is associated with early antenatal care (ANC) initiation. Understanding the characteristics of women who use pregnancy self-tests can facilitate more targeted efforts to improve pregnancy testing experiences and entry into the ANC pathway. We conducted a cross-sectional survey among pregnant women enrolling in a pre-exposure prophylaxis (PrEP) implementation study to determine the prevalence and factors associated with pregnancy self-testing among women in western Kenya. Overall, in our study population, 17% of women obtained a pregnancy self-test from a pharmacy. Pregnancy test use was higher among employed women, women with secondary and college-level educated partners, and women who spent 30 minutes or less traveling to the maternal and child health (MCH) clinic. The most reported reasons for non-use of pregnancy self-tests included not thinking it was necessary, lack of knowledge, and money to pay for the test. Future research should focus on understanding the knowledge and attitudes of women toward pregnancy self-testing as well as developing community-based models to improve access to pregnancy testing and ANC.

Perceived stress and sleep quality before oocyte pick-up, embryo transfer, and pregnancy test in women receiving in vitro fertilization treatment.

BACKGROUND: Infertility is a major health problem that affects both the family and the community. Women receiving infertility treatment may suffer from stress and even experience sleep disturbance. Sleep quality is an important factor of human health and well-being. Sleep disturbances tend to occur among infertile women during in vitro fertilization treatment. Many studies have focused on the stress and sleep quality associated with their treatment in infertile women. However, few studies have investigated factors linked to their sleep disturbances. OBJECTIVE: This study investigated the relationship between perceived stress and sleep quality before oocyte pick-up, in vitro fertilization-embryo transfer, and pregnancy test in women receiving in vitro fertilization treatment. MATERIAL AND METHODS: This prospective, longitudinal study was conducted between January and May 2020. One hundred fifty-seven women receiving infertility treatment were included in the study. A personal information form, the Perceived Stress Scale (PSS), and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. RESULTS: The relationship between the Perceived Stress Scale scores and the Pittsburgh Sleep Quality Index scores in all stages of infertility treatment was found to be positively significant at the p < .001 significance level. CONCLUSION: Perceived stress level was high in women throughout the infertility treatment. Our study suggested that sleep quality was impaired as stress increased. TRIAL REGISTRATION: 70904504/38.

What the pregnancy test is testing.

Is the test result positive or negative? Tests that occur in labs and doctors' offices pose specific questions to try to obtain specific information. But what happens in the social world when these tests never see the inside of a lab or doctor's office, and instead they are used in a house, in a Walmart bathroom, or in a dormitory bathroom stall? Putting the diagnosis aside, what does the presence of these tests do to social life? This paper examines one such test, the home pregnancy test, and specifically, its use in contemporary intimate life of people who do not want to be pregnant. Pregnancy tests test for pregnancy. But what else is the pregnancy test putting to the test? To investigate this, I spent 8 years studying American pregnancy tests using a qualitative mixed methods approach. This paper draws on some of my research materials, specifically, 85 life history interviews. Each participant was asked to recall, in full, all of their experiences with home pregnancy tests throughout their lives, resulting in well over 300 narratives of home pregnancy test usage which I qualitatively analyzed. I find that more than just a test for a pregnancy, the use of the home pregnancy test is a test of roles, relationships, and responsibilities in social life. These findings suggest implications for social life as more biomedical tests move out of the purview of the medical establishment.

Sexually Transmitted Disease, Human Immunodeficiency Virus, and Pregnancy Testing Behaviors Among Internet and Mobile Dating Application Users and Nonusers, 2016.

We examined 2016 United States market research to understand the demographics and sexual health testing behaviors of dating app users. Internet/app users were more likely to be young adults, male, nonwhite, of Hispanic ethnicity, and unmarried. Users also reported greater testing for sexually transmitted disease, human immunodeficiency virus, and pregnancy.

A prospective observational study on the stress levels at the time of embryo transfer and pregnancy testing following in vitro fertilisation treatment: a comparison between women with different treatment outcomes.

OBJECTIVE: To ascertain whether stress biomarkers and psychological indices of stress may predict both conception and miscarriage rates in women undergoing in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI). DESIGN: Prospective observational study. SETTING: A university-affiliated tertiary hospital. POPULATION: Infertile women who were undergoing fresh or frozen IVF/ICSI cycles. METHODS: Women were recruited to (1) complete validated psychological questionnaires (visual analogue scale of stress, state-trait anxiety inventory, perceived stress scale, fertility problem inventory, Beck depression inventory, and general health questionnaire), at the time of embryo transfer (ET) and pregnancy testing (PT), and (2) provide saliva samples for α-amylase (sAA) measurement before and after ET and at PT. MAIN OUTCOME MEASURES: Women were grouped according to subsequent reproductive outcome; scores/levels of all tests were then compared between groups at each time-point. RESULTS: In all, 197 women completed the study, of which 92 conceived and 28 miscarried. The level of psychological stress, as measured by questionnaires, was highest at the time of PT, whereas the level of biological stress as measured by sAA level (IU/l) post-ET (1.8 × 105  ± 1.5 × 105 ) was significantly (P < 0.001) higher than pre-ET (1.2 × 105  ± 1.0 × 105 ) and at PT (1.0 × 105  ± 1.1 × 105 ). However, there was no difference in psychological scoring and in sAA levels between women who did or did not conceive and who had miscarried or had an ongoing pregnancy. CONCLUSIONS: The level of sAA is highest following ET, whereas psychological stress is highest at PT. However, neither stress level appeared to be of prognostic value in predicting conception or miscarriage. TWEETABLE ABSTRACT: Stress level fluctuated at different time-points, but it did not predict conception or miscarriage.

A Formative Evaluation of Two FASD Prevention Communication Strategies.

AIMS: To evaluate the feasibility, acceptability and effectiveness of placing FASD prevention messages in the women's restrooms of establishments serving alcohol in Alaska and the Yukon, regions with high rates of FASD. METHODS: Our team placed an FASD educational poster, and posters affixed to a pregnancy test dispenser, in women's restrooms of bars and restaurants. We compared drinking behaviors and knowledge and beliefs about FASD among participants at baseline and at follow-up. RESULTS: Respondents consisted of 2132 women who completed a baseline survey and 1182 women who completed both a baseline and a follow-up survey. Women in both groups showed improvement in knowledge of FASD; the dispenser group scored higher than participants in the poster group on the FASD Health Belief questions at both baseline and follow-up. Forty-three women learned they were pregnant from our pregnancy tests and alcohol consumption among pregnant women was lower at follow-up than at baseline. CONCLUSIONS: FASD prevention messages, particularly paired with pregnancy test dispensers, in the women's restrooms of establishments that serve alcohol can effectively promote informed alcohol consumption decisions among women who are, or may become, pregnant. SHORT SUMMARY: In this FASD prevention feasibility study, we found that FASD prevention messages, particularly paired with pregnancy test dispensers, placed in the women's restrooms of establishments that serve alcohol can effectively promote informed alcohol consumption decisions among women who are, or may become, pregnant.

Social Representations of Gynecologic Cancer Screening Assessment a Qualitative research on Ecuadorian women.

The purpose of this work was to explore: knowledge, attitudes, and beliefs regarding gynecologic cancer screening on Ecuadorian women users of primary care facilities, to identify the social representations that users of health services make about these programs and their influence on the decision to undergo a screening. An exploratory and qualitative research design was held using focus groups and in-depth interviews for data collection. A narrative content analysis of the results was conducted. Women's knowledge on gynecological cancer screening was confusing. Most frequent misconceptions related to the pap smear were: the belief that it could be useful for detecting pregnancy, ovarian cysts or infections. Most of the participants stated that the pap smear procedure is a traumatic and painful experience. Regarding to mammography women said it was used for sick woman and this procedure by itself may cause cancer. El propósito de esta investigación fue explorar los conocimientos, actitudes y creencias respecto a los programas de detección del cáncer ginecológico entre usuarias de centros de atención primaria de salud para identificar las representaciones sociales que las usuarias de los servicios de salud elaboran acerca de estos programas y de los diferentes procedimientos que comprenden. El diseño de la investigación fue exploratorio y cualitativo, mediante grupos focales y entrevistas a profundidad, con el respectivo análisis narrativo e interpretativo del contenido. Se encontró conocimiento confuso acerca de los programas de tamizaje de cáncer ginecológico y dificultades asociadas a la realización de los procedimientos. Los significados más frecuentes acerca de los programas fueron: el uso de la citología cérvico-vaginal para detectar embarazo, quistes ováricos o infecciones. La mayoría de los participantes asociaba este procedimiento con una experiencia dolorosa y traumática. Respecto al autoexamen de mamas, lo calificaron como un masaje preventivo-terapéutico y a la mamografía como peligrosa porque podría desarrollar cáncer.

Comparison of volunteers' experience of using, and accuracy of reading, different types of home pregnancy test formats.

BACKGROUND: Women suspecting pregnancy need an accurate result when they conduct a home pregnancy test. A variety of tests are available from simple professional style strips to midstream tests with a digitally displayed result. However, it is not known whether all these formats can be used and read correctly by untrained women. OBJECTIVES: The aim of this study is to evaluate usability and reading accuracy of home pregnancy test formats. METHODS: Female volunteers, 18 - 45 years (Manchester, UK) completed questionnaires on their home-use experience of six pregnancy tests (strip, cassette, midstream visual and digital formats). These volunteers then evaluated device results using hCG-urine standards at a study centre, thereafter completing a questionnaire and ranking evaluation. RESULTS: Data were available from 111 volunteers. Women preferred midstream test formats; > 70% scored branded midstream digital and easy-use visual tests as 1or 2 (7-point Likert score), compared with ∼ 30% for store-brand and branded midstream visual tests, and < 10% for cassette or strip tests. Many cassette tests (23%) failed to provide a result (4, ≤ 2% for strips, midstream, respectively). Volunteers disagreed with study co-ordinator reading of test results in 30 and 40% of cases for the cassette and strip test results, respectively, compared with < 3% when using midstream digital or easy-use visual tests. Volunteers preferred the branded midstream digital, followed by branded midstream easy-use and visual tests. CONCLUSIONS: In this study, the branded midstream digital test was superior to other tests evaluated and fulfilled the criteria of being an easy-to-use and interpret test; strip and cassette tests showed poor performance in women's hands.

Acceptability of sexual health discussion and testing in the pediatric acute care setting.

OBJECTIVE: The objective of this study was to determine acceptability of sexual health discussion and testing among adolescents, parents, and health care providers (HCPs). METHODS: We conducted a cross-sectional study of acute care patients (aged 14-19 years), parents, nurses, and physicians/nurse practitioners. Subjects rated sexual health discussion, sexually transmitted disease and pregnancy testing as acceptable/unacceptable and verbally explained their reasoning. Reasons were transcribed verbatim, coded, and analyzed. Agreement with individual adolescent responses was determined. Controlling for visit type, logistic regression was used to evaluate association between location and acceptance with odds ratios (ORs). Visits were categorized as reproductive/nonreproductive. RESULTS: Subjects included 127 adolescents, 90 parents, and 190 HCP responses. Mean adolescent age was 15.5 years; 57% were female; 43% reported previous intercourse; 43% were black, and 39% were white. Most visits (76%) were nonreproductive. Adolescents and parents were highly accepting of discussion and testing and were more accepting than HCPs. Acceptance was more likely for reproductive versus nonreproductive visits (P ≤ 0.05). Emergency department HCPs were more likely to accept discussion (OR, 2.8) and sexually transmitted disease testing (OR, 3.1) than urgent care HCPs. Acceptance themes among adolescents were comfort with system/HCP, confidentiality concerns, and desire for good health; among parents, acceptance themes were identification as a safe place for disclosure and desire for adolescent good health and information; and among HCPs, these were relevance to chief complaint and perception of appropriate care. CONCLUSIONS: In contrast to HCPs, adolescents and parents expressed broad support for sexual health discussion and testing, which may inform HCP practice to improve access to care.

Caring for women with unintended pregnancies.

Unintended pregnancy is a common reproductive health event. Professional responsibilities for nurses providing care to women with unintended pregnancies include appropriate assessment, options counseling, provision of or referral for desired services, care coordination, and prevention efforts aimed at decreasing future unintended pregnancies. Nurses' awareness of available services and their involvement in referring or providing services is an essential component to reproductive health care.

Medical waiting periods: imminence, emotions and coping.

The diagnosis and treatment of various medical conditions requires patients to wait for results that are potentially threatening to their wellbeing (e.g., breast biopsy results, pregnancy test results after fertility treatment and genetic screening outcomes). Little research has been carried out to document the psychological processes that unfold during such waiting periods. The aim of the present study was to document the course of anxiety, depression, positive affect and coping during the waiting period before a pregnancy test result in fertility treatment. Using a daily record-keeping chart designed for fertility treatment, 61 women undergoing IVF were monitored daily for emotional reactions (e.g., anxiety, depression and positive affect) and coping during 7 days of active treatment (stimulation), 7 days of waiting to find out whether a pregnancy was achieved (waiting) and 4 days of reacting to the pregnancy test results (outcome). The stimulation stage of treatment was characterized by positive affect with a lesser degree of anxiety, whereas the predominant emotions in the waiting stage were a combination of positive affect and anxiety symptoms versus depression. From the pregnancy test day onwards, the predominant emotion was depression. There was a significant increase in coping activity between the stimulation and waiting stages, with variable effects across coping strategies. It was concluded that whilst medical waiting periods have a clearly defined emotional trajectory, the coping pattern is less differentiated. This may explain why waiting for medical test results is so demanding. Healthcare professionals can assist their patients by facilitating coping strategies that better fit the demands of the waiting period and by offering support once outcomes are known.

Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, National Birth Defects Prevention Study, 1997-2002.

OBJECTIVES: Given that approximately half of all pregnancies in the United States are unplanned, the authors sought to understand the relation between pregnancy intention and health behaviors. METHODS: Mothers of live-born infants without major birth defects were interviewed as part of the National Birth Defects Prevention Study. The interview assessed pregnancy intention as well as exposures to vitamins, alcohol, tobacco, illicit drugs, occupational hazards, exogenous heat (e.g., hot tubs and saunas) and caffeine. Crude odds ratios and 95% confidence intervals were calculated and stratified analyses were performed to assess interaction. Multiple logistic regression was used to calculate adjusted odds ratios. RESULTS: Both before and after the diagnosis of pregnancy, women with unintended pregnancies were more likely to use illicit drugs, smoke, be exposed to environmental smoke, and not take folic acid or multivitamins. The degree to which women altered behaviors after they realized they were pregnant was also associated with their pregnancy intention status. For certain behaviors, maternal age or parity altered the association between pregnancy intention and changing behaviors after awareness of pregnancy. CONCLUSION: Pregnancy intention status is a key determinant of pregnancy-related behavior. To improve reproductive outcomes, preconceptional and prenatal programs should consider a woman's desire for pregnancy.

Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment.

OBJECTIVE: To identify risk factors associated with depression and anxiety in infertile women and men undergoing in vitro fertilization (IVF). DESIGN: Prospective study. SETTING: A university hospital in Sweden during a 2-year period. PATIENT(S): 825 participants (413 women and 412 men). INTERVENTION(S): Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), as the diagnostic tool for evaluating mood and anxiety disorders, and fertility history and outcome of IVF treatment collected from the patients' medical records. MAIN OUTCOME MEASURE(S): Risk factors associated with depression and anxiety disorders. RESULT(S): A negative pregnancy test and obesity were the independent risk factors for any mood disorders in women. Among men, the only independent risk factor for depression was unexplained infertility. No IVF-related risk factors could be identified for any anxiety disorder. CONCLUSION(S): A negative pregnancy test is associated with an increased risk for depression in women undergoing IVF, but no risk of developing anxiety disorders is associated with the pregnancy test result after IVF. Pregnancy test results were not a risk factor for depression or anxiety among men.

Placental site trophoblastic tumor.

When the author received a positive pregnancy test at a time she knew she couldn't possibly be pregnant, it caused her to rethink the healthy skepticism her years of nursing had engendered. This case reminds nurses that positive pregnancy tests can result from medical conditions other than pregnancy, including various cancers, such as placental site trophoblastic tumor, the focus of this article. It also serves as a reminder that any positive pregnancy test that isn't accompanied by corresponding clinical evidence needs to be evaluated further.

Making sense of home pregnancy test instructions.

OBJECTIVE: To examine readability and related formatting characteristics of English language instructions accompanying home pregnancy tests (HPTs). METHODS: We identified 16 HPTs; however, because of duplicate instructions, our final sample included 13 unique sets of HPT instructions (brand names, n = 9; store brand, n = 4). Reading grade level of How to Use and Interpret Results and General Information sections were calculated using the Simple Measure of Gobbledygoop readability formula. Total number of graphics was tallied. Foldout dimension, text point size, and graphic dimensions were measured to the nearest millimeter with a standard ruler. We also assessed layout features, graphic characteristics, presence of a clear message, and presentation of manageable information using the User-Friendliness Tool (UFT). RESULTS: Reading level ranged from 7th to 10th grade (mean +/- SD 8.5 +/- 0.9) for the How to Use and Interpret Results sections, and the Question and Answer sections ranged from 11th to 14th grade (mean +/- SD 12.1 +/- 0.7). Mean page length was 29.7 +/- 6.6 cm, and average page width was 23.3 +/- 7.0 cm, similar in size to an 8.5 x 11 inch sheet of paper. Graphics were used throughout HPT instructions (range 2-9), and most were similar in size to a U.S. quarter. None of the instructions scored high in all criteria on the UFT. CONCLUSIONS: Readability and formatting characteristics of most HPT instructions do not meet recommended criteria for compliance with plain language guidelines. These findings underscore the need for improved instructions and ultimately improving patients' ability to use HPTs and interpret results with accuracy.

Female adolescents' perceptions of male partners' pregnancy desire.

Our objective was to examine the relationship between pregnancy desire among female adolescents and their perception of desire for pregnancy in their male partners. This is an observational cross-sectional study which examined 92 surveys administered to adolescent women between the ages of 14 to 19 years at two obstetrical care services serving a population from limited socioeconomic backgrounds. Participants were all pregnant or awaiting pregnancy test results. Participants were asked about their levels of pregnancy happiness and desire and their partners' levels of pregnancy happiness and desire. Spearman's correlation coefficient was calculated and discordant pairs were examined with McNemar's test. Logistic regression was utilized to examine the relationship between male and female pregnancy happiness and desire. We found that there was a significant correlation between the adolescents' feelings about pregnancy and their perceptions of their male partners' feelings about pregnancy (0.326; P = .004). McNemar's test indicated that male partners were significantly more likely to be reported to feel positively about the pregnancy than female partners (P = .017). Female adolescents who reported male partners who felt positively about the pregnancy were four times as likely to report having desired their pregnancy now or sooner (odds ratio [OR] = 4.35). We conclude that male partners may impact adolescent pregnancy desire. Further prospective studies are needed and male-focused adolescent pregnancy interventions should be developed.

A feasibility study of a brief coping intervention (PRCI) for the waiting period before a pregnancy test during fertility treatment.

BACKGROUND: Waiting for a pregnancy test during fertility treatment can be particularly stressful because distress and intrusive cognitions about the nature and implications of the result can reduce quality of life. The aim of this feasibility study was to establish whether a novel brief coping intervention (positive reappraisal coping intervention, PRCI) card that encouraged women waiting for an IVF pregnancy test to redefine the waiting period more positively would be acceptable and practical in this context. METHODS: Women (n = 55) were randomly assigned on the day of embryo transfer. Women read either 10 statements in a PRCI (n = 28) or 10 statements in a positive self-affirmative (positive mood) intervention (PMI; n = 27) twice daily for 14 days between embryo transfer (T1) and the pregnancy test (T2). At T2, we evaluated the practicality, acceptability, perceived benefits and endorsements of these cards. RESULTS: Compared with the PMI, the PRCI was rated as more helpful and suitable for the situation, helping women to feel more positive and better helping to sustain efforts to cope. There were no differences relating to the practicality of the intervention method. CONCLUSIONS: PRCI was feasible in the IVF context and was perceived as an acceptable intervention to help minimize the strain of waiting for pregnancy test results during fertility treatment. Future research needs to evaluate the full benefits of PRCI against routine care during the waiting period.

First IVF treatment--short-term impact on psychological well-being and the marital relationship.

BACKGROUND: The aim of this study was to assess infertile couples' short-term emotional responses to their first IVF treatment (the women's and men's emotional reactions and their experiences of the marital relationship at different stages of the first treatment) and to relate these responses to the outcome of the IVF treatment. METHODS: The study was part of a prospective, longitudinal study where 117 couples participated. The women and men answered questionnaires separately concerning psychological and social factors at three occasions: before, during and 1 month after treatment. RESULTS: Women's and men's emotional reactions related to first IVF treatment were dependent on whether they achieved a pregnancy or not. Those who failed to become pregnant rated their emotional well-being worse, whereas those who became pregnant rated their emotional well-being better than before treatment started. The women reported stronger emotional reactions about their infertility than their husbands. However, the men reacted in the same emotional pattern as their wives when pregnancy was not achieved. A majority reported that the marital relationship improved during treatment. CONCLUSION: Couples undergoing their first IVF treatment are as a group well adjusted and manage to handle the short-term emotional strain under treatment. The determining factor for short-term emotional response of treatment was whether pregnancy was achieved.

Adolescent girls with negative pregnancy tests.

UNLABELLED: STUDY OBJECTIVES AND DESIGN: This descriptive study assessed background characteristics and attitudes about pregnancy held by adolescent girls presenting for pregnancy tests and receiving negative results. An additional aim was to determine types of health care services that would be of perceived benefit to them to reduce their risk of subsequent pregnancy. SETTING: Two health care sites in an urban community included a hospital-based adolescent clinic and a hospital-based women's health care clinic. PARTICIPANTS: Sixty-five adolescent, low-income, single women with negative pregnancy test results in a consecutive sample were included in the study. Participants had a mean age of 16.9 (+/-1.3) years and described themselves as 64.1% African American, 26.6% Latina and 9.4% white, with 81.5% enrolled or recently graduated from high school. MAIN OUTCOME MEASURES: The following variables were included: demographic characteristics, reproductive health history, personal and perceived partner attitude about the negative pregnancy test result, perceived parental influences, and teens' suggestions for health care services to prevent unintended pregnancy. RESULTS: Health history data revealed high risk status for unintended pregnancy and sexually transmitted infections (STI); 28.5% of participants were ambivalent or disappointed with their negative result, 71.4% were pleased and the majority felt that their partners would be more disappointed with the negative result than they were. Health care services that teens felt would be most helpful were one-on-one contraceptive education and discussion sessions with their own health care provider. CONCLUSIONS: Sexually active teen women with negative pregnancy test results are at high risk of subsequent pregnancy and STIs, and present important opportunities for preventive reproductive health care during visits with health care providers.