Use of levonorgestrel as emergency contraception in overweight women.

OBJECTIVE: Levonorgestrel (LNG) emergency contraception (EC) may have decreased efficacy for women with body mass indices (BMI)≥26kg/m2. This study aims to evaluate the prevalence of LNG EC use and EC counseling among overweight women. METHODS: The 2013-2015 dataset from the National Survey of Family Growth was analyzed to determine the proportion of women with BMI≥26kg/m2 who report recent use of LNG EC and EC counseling. RESULTS: Overall, 2.4% of respondents reported recent use of LNG EC. Among women using oral LNG for EC, 29.8% of survey participants reported BMI≥26kg/m2. Additionally, 40.2% of women with BMI≥26kg/m2 using oral LNG EC reported having a doctor or medical provider talk to them about emergency contraception within the last 12 months, compared to 18.3% of LNG EC users with BMI<26kg/m2 (p<0.001). CONCLUSIONS: Despite recent counseling from clinicians and concerns for decreased efficacy, a significant number of overweight women continue to use LNG for EC. Clinicians should counsel women with BMI≥26kg/m2 on the potential limitations of oral LNG for EC and offer more effective EC methods, including the copper intrauterine device and oral ulipristal acetate.

Prenatal Depression: Screening and Referral for Women Who Are Low Income during Antenatal Care.

This study uses prenatal clinical chart reviews of 245 women who were screened for depression while receiving antenatal care services at an urban hospital-based clinic in Syracuse, New York. The results indicate that more than one half of the mothers who screened positive are not being adequately referred and followed-up on to ensure they are receiving proper treatment. Among the mothers who are not being successfully referred are women who are non-English speaking, facing multiple life stressors, and inadequately insured. Recommendations for colocating services that may ease the ongoing burdens of new motherhood are addressed.

Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project.

BACKGROUND: Adolescent women have a high risk of unintended pregnancy. Currently, there are little data about their choice to initiate long-acting reversible contraception (LARC). STUDY DESIGN: We evaluated the association of age and preference for a LARC vs. a non-LARC method among adolescent participants in the Contraceptive CHOICE Project, comparing those aged 14-17 years to adolescents aged 18-20 years. We then analyzed the association between age and choice of the implant vs. the intrauterine device (IUD) among adolescents. RESULTS: Of the 5086 women enrolled, 70% (n=3557) of participants chose a LARC method. Among adolescents aged 14-20 years, 69% of 14-17-year-olds chose LARC, while 61% of 18-20-year-olds chose LARC (relative risk 1.16, 95% confidence interval 1.03-1.30). Among adolescents choosing a LARC method, 63% (n=93/148) of the 14-17-year-olds chose the implant, whereas 71% (n=364/510) of the 18-20-year-olds chose the IUD. CONCLUSION: Long-acting reversible contraception use is clearly acceptable and common among adolescents enrolled in the Contraceptive CHOICE Project, with the younger group being most interested in the implant.

Association between tampon use and choosing the contraceptive vaginal ring.

OBJECTIVE: To estimate whether tampon users are more likely to select the contraceptive vaginal ring than combined oral contraceptive pills (OCPs). METHODS: The Contraceptive Choice Project is a longitudinal study of 10,000 St. Louis area women promoting the use of long-acting, reversible methods of contraception and evaluating user continuation and satisfaction for all reversible methods. We performed univariable and multivariable analyses of the 311 women who were asked about tampon use at the time of enrollment and who chose the contraceptive vaginal ring or OCPs to assess the association of tampon use and choice of combined hormonal method. RESULTS: Among contraceptive vaginal ring and OCP users, 247 (79%) reported using tampons. Contraceptive vaginal ring users were not significantly different from OCP users in terms of age, race or ethnicity, marital status, insurance, body mass index, or parity. Adjusted analysis indicated that tampon users were more likely to choose the contraceptive vaginal ring instead of OCPs (adjusted relative risk 1.34, 95% confidence interval 1.01-1.78). Women with previous contraceptive vaginal ring experience were also more likely to choose the contraceptive vaginal ring (adjusted relative risk 1.96, 95% confidence interval 1.6-2.4). Recent OCP use did not influence method choice. CONCLUSION: In our baseline analysis of the Contraceptive Choice Project, tampon users were more likely to choose the contraceptive vaginal ring than OCPs. Use of tampons could be considered an indicator for the initial acceptability of the contraceptive vaginal ring, but all women should be offered the contraceptive vaginal ring regardless of experience with tampon use. LEVEL OF EVIDENCE: II.

Reversible contraception update: the importance of long-acting reversible contraception.

The past several years have seen an expansion in contraception options. Emerging data support the use of long-acting reversible contraception (LARC) such as the intrauterine device and subdermal implant as the most effective methods of contraception with the highest continuation rates and very high levels of patient satisfaction. In addition, the appropriate target population for the use of the intrauterine device now includes nulliparous women and adolescents. When a patient considers initiating a new contraceptive method, it is important to consider the characteristics of each method, including the side effects, effectiveness, and patient acceptability. Additionally, medical comorbidities must also be evaluated prior to choosing a method. In this article, we provide a brief overview of available reversible contraceptive methods, with an emphasis on LARC.

Initial and repeated screening for gonorrhea during pregnancy.

BACKGROUND AND GOAL: Late pregnancy rescreening is advised for at-risk patients, but data supporting this recommendation are lacking. The intent of this study was to determine the value of a late-pregnancy test for gonorrhea after a negative initial test at the beginning of prenatal care. STUDY DESIGN: A retrospective chart review of clinic records over a 29-month period identified patients with a positive DNA direct assay for gonorrhea either initially or at 34 weeks. RESULTS: Of 751 women, 38 (5.1%) had gonorrhea diagnosed at their first testing; 19 women (2.5%) were positive only at their second screening. For one patient, both tests were positive. CONCLUSION: Repeating screening for gonorrhea at 34 weeks in a high-prevalence population is warranted.