Factors Associated with the Uptake of Long-acting Reversible Contraception and Contraceptive Use in Postpartum People with HIV at a Single Tertiary Care Center.

OBJECTIVE: This study aimed to elucidate factors contributing to uptake of highly effective contraception, including permanent contraception, and no contraceptive plan among postpartum people with HIV (PWHIV). STUDY DESIGN: A retrospective cohort analysis was conducted to correlate postpartum birth control (PPBC) with sociodemographic and biomedical variables among postpartum PWHIV who received care at The Ruth M. Rothstein CORE Center and delivered at John H. Stroger, Jr. Hospital of Cook County in Chicago, from 2012 to 2020. RESULTS: Earlier gestational age (GA) at initiation of prenatal care, having insurance, and increased parity are associated with uptake of highly effective contraception. Meanwhile, later GA at presentation increased odds of having no PPBC plan. CONCLUSION: Early prenatal care, adequate insurance coverage, and thorough PPBC counseling are important for pregnant PWHIV. KEY POINTS: · Contraceptive use among PWHIV is poorly understood.. · Having insurance and increased parity are associated with long-acting reversible contraception use.. · Earlier GA at first prenatal care visit is associated with increased PPBC uptake..

Association Between State Paid Family and Medical Leave and Breastfeeding, Depression, and Postpartum Visits.

OBJECTIVE: To evaluate the association of state paid family and medical leave policies with the likelihood of breastfeeding, postpartum depression symptoms, and attendance of the postpartum visit. METHODS: This was a cross-sectional study that used 2016-2019 data from PRAMS (Pregnancy Risk Assessment Monitoring System) for 43 states and Washington, DC. We describe the association of state paid family and medical leave generosity with rates of breastfeeding, postpartum depression symptoms, and attendance of the postpartum visit. Logistic and Poisson regression models tested the significance of state paid family and medical leave coverage generosity after controlling for individual respondent sociodemographic characteristics, with sensitivity analyses for respondents with deliveries covered by Medicaid insurance. RESULTS: Of the 143,131 respondents, representative of an estimated 7,426,725 population, 26.2% lived in eight states and DC with the most generous paid family and medical leave, 20.5% lived in nine states with some paid family and medical leave, and 53.3% lived in 26 states with little or no paid family and medical leave. Overall, 54.8% reported breastfeeding at 6 months or at time of the survey, ranging from 59.5% in the most generous paid family and medical leave states to 51.0% in states with the least paid family and medical leave coverage. Postpartum depression symptoms varied from 11.7% in the most generous states to 13.3% in the least generous states (both P <.001). State differences in postpartum visit attendance rates (90.9% overall) did not differ significantly. After adjusting for respondent characteristics, compared with states with the least paid family and medical leave, breastfeeding was 9% more likely (adjusted incidence rate ratio [aIRR] 1.09, 95% CI, 1.07-1.11) in states with the strongest paid family and medical leave coverage and 32% more likely (aIRR 1.32, 95% CI, 1.25-1.39) in analyses limited to respondents with deliveries covered by Medicaid insurance. A more generous state paid family and medical leave policy was significantly associated with a lower likelihood of postpartum depression symptoms compared with states with the least paid family and medical leave (adjusted odds ratio 0.85, 95% CI, 0.76-0.94) and a modest but significant increase in postpartum visit attendance (aIRR 1.03, 95% CI, 1.01-1.04) among respondents with deliveries covered by Medicaid insurance. CONCLUSION: Respondents from states with strong paid family and medical leave had a greater likelihood of breastfeeding and had lower odds of postpartum depression symptoms, with stronger associations among respondents with deliveries covered by Medicaid insurance. Despite major potential health benefits of paid family and medical leave, the United States remains one of the few countries without federally mandated paid parental leave.

Tup1 Paralog CgTUP11 Is a Stronger Repressor of Transcription than CgTUP1 in Candida glabrata.

TUP1 is a well-characterized repressor of transcription in Saccharomyces cerevisiae and Candida albicans and is observed as a single-copy gene. We observe that most species that experienced a whole-genome duplication outside of the Saccharomyces genus have two copies of TUP1 in the Saccharomycotina yeast clade. We focused on Candida glabrata and demonstrated that the uncharacterized TUP1 homolog, C. glabrata TUP11 (CgTUP11), is most like the S. cerevisiae TUP1 (ScTUP1) gene through phenotypic assays and transcriptome sequencing (RNA-seq). Whereas CgTUP1 plays a role in gene repression, it is much less repressive in standard growth media. Through RNA-seq and reverse transcription-quantitative PCR (RT-qPCR), we observed that genes associated with pathogenicity (YPS2, YPS4, and HBN1) are upregulated upon deletion of either paralog, and loss of both paralogs is synergistic. Loss of the corepressor CgCYC8 mimics the loss of both paralogs, but not to the same extent as the Cgtup1Δ Cgtup11Δ mutant for these pathogenesis-related genes. In contrast, genes involved in energy metabolism (CgHXT2, CgADY2, and CgFBP1) exhibit similar behavior (dependence on both paralogs), but deletion of CgCYC8 is very similar to the Cgtup1Δ Cgtup11Δ mutant. Finally, some genes (CgMFG1 and CgRIE1) appear to only be dependent on CgTUP11 and CgCYC8 and not CgTUP1. These data indicate separable and overlapping roles for the two TUP1 paralogs and that other genes may function as the CgCyc8 corepressor. Through a comparison by RNA-seq of Sctup1Δ, it was found that TUP1 homologs regulate similar genes in the two species. This work highlights that studies focused only on Saccharomyces may miss important biological processes because of paralog loss after genome duplication. IMPORTANCE Due to a whole-genome duplication, many yeast species related to C. glabrata have two copies of the well-characterized TUP1 gene, unlike most Saccharomyces species. This work identifies roles for the paralogs in C. glabrata, highlights the importance of the uncharacterized paralog, called TUP11, and suggests that the two paralogs have both overlapping and unique functions. The TUP1 paralogs likely influence pathogenicity based on tup mutants upregulating genes that are associated with pathogenicity.

A Novel cis Element Achieves the Same Solution as an Ancestral cis Element During Thiamine Starvation in Candida glabrata.

Regulatory networks often converge on very similar cis sequences to drive transcriptional programs due to constraints on what transcription factors are present. To determine the role of constraint loss on cis element evolution, we examined the recent appearance of a thiamine starvation regulated promoter in Candida glabrata This species lacks the ancestral transcription factor Thi2, but still has the transcription factor Pdc2, which regulates thiamine starvation genes, allowing us to determine the effect of constraint change on a new promoter. We identified two different cis elements in C. glabrata - one present in the evolutionarily recent gene called CgPMU3, and the other element present in the other thiamine (THI) regulated genes. Reciprocal swaps of the cis elements and incorporation of the S. cerevisiae Thi2 transcription factor-binding site into these promoters demonstrate that the two elements are functionally different from one another. Thus, this loss of an imposed constraint on promoter function has generated a novel cis sequence, suggesting that loss of trans constraints can generate a non-convergent pathway with the same output.