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Lora T. McGlade is editor of GI & Hepatology News and The New Gastroenterologist; she joined the company in 2013. Before that she worked for the company as a freelancer for several years; did bacterial genetic and murine oncogenetic research at NIH; and was a technical editor at the American Journal of Clinical Nutrition. She earned a BS in biological sciences from Cornell University, Ithaca, N.Y., and an MS in journalism from Syracuse (N.Y.) University.
Rethink Fall Risk Assessment When Choosing Between Gabapentin and Duloxetine for Older Adults
TOPLINE:
, with a weighted cumulative incidence of 84.44 vs 158.21 per 1000 person-years at 180 days. Incident gabapentin use showed a 48% lower hazard of falls at 6-month follow-up, with no increase in severe fall-related events.
METHODOLOGY:
- Researchers conducted a new user, active comparator cohort study using IBM MarketScan Research Databases from January 2014 to December 2021.
- Analysis included 57,086 adults aged 65 years or older with postherpetic neuralgia, diabetic neuropathy, or fibromyalgia, excluding those with depression, anxiety, seizures, or cancer in the prior 365 days.
- The primary outcome measured the hazard of experiencing any fall-related visit in the 6 months after initiating gabapentin or duloxetine until treatment discontinuation.
- Secondary outcomes examined severe fall-related events, including falls with hip fractures or emergency department visits/hospitalizations associated with falls.
TAKEAWAY:
- The analytic cohort included 52,152 gabapentin users and 4934 duloxetine users, with a median follow-up duration of 30 days (interquartile range, 30-90 days).
- Weighted cumulative incidence of fall-related visits per 1000 person-years at 30, 90, and 180 days was 103.60, 90.44, and 84.44 for gabapentin users vs 203.43, 177.73, and 158.21 for duloxetine users.
- At 6-month follow-up, incident gabapentin users demonstrated lower hazard of falls (hazard ratio, 0.52; 95% CI, 0.43-0.64), with no difference in hazards of severe falls.
- Results remained consistent across sensitivity and subgroup analyses.
IN PRACTICE:
“One bioplausible explanation for our results is that gabapentin is a highly titratable medication and many in our cohort started on low doses. Alternatively, duloxetine is usually titrated only once or twice. Thus, although it may be that gabapentin is simply safer than duloxetine from a falls perspective, it may also be likely that we are measuring specific clinical scenarios, the peri-initiation and titration period, in which gabapentin may be less likely to cause falls than duloxetine,” the authors wrote.
SOURCE:
The study was led by Alexander Chaitoff, MD, MPH, Department of Internal Medicine, University of Michigan School of Medicine in Ann Arbor, and Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School in Boston. It was published online in Annals of Internal Medicine.
LIMITATIONS:
Despite the design aimed at limiting confounding effects, the observational nature of the study introduces potential bias. Claims data may undercount falls for which patients do not seek care, though this limitation likely affects both medication groups equally. The commercial claims database includes only Medicare supplemental insurance beneficiaries, potentially limiting generalizability. Regional variations in prescribing patterns could not be accounted for in the analysis.
DISCLOSURES:
No funding was provided for this study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
, with a weighted cumulative incidence of 84.44 vs 158.21 per 1000 person-years at 180 days. Incident gabapentin use showed a 48% lower hazard of falls at 6-month follow-up, with no increase in severe fall-related events.
METHODOLOGY:
- Researchers conducted a new user, active comparator cohort study using IBM MarketScan Research Databases from January 2014 to December 2021.
- Analysis included 57,086 adults aged 65 years or older with postherpetic neuralgia, diabetic neuropathy, or fibromyalgia, excluding those with depression, anxiety, seizures, or cancer in the prior 365 days.
- The primary outcome measured the hazard of experiencing any fall-related visit in the 6 months after initiating gabapentin or duloxetine until treatment discontinuation.
- Secondary outcomes examined severe fall-related events, including falls with hip fractures or emergency department visits/hospitalizations associated with falls.
TAKEAWAY:
- The analytic cohort included 52,152 gabapentin users and 4934 duloxetine users, with a median follow-up duration of 30 days (interquartile range, 30-90 days).
- Weighted cumulative incidence of fall-related visits per 1000 person-years at 30, 90, and 180 days was 103.60, 90.44, and 84.44 for gabapentin users vs 203.43, 177.73, and 158.21 for duloxetine users.
- At 6-month follow-up, incident gabapentin users demonstrated lower hazard of falls (hazard ratio, 0.52; 95% CI, 0.43-0.64), with no difference in hazards of severe falls.
- Results remained consistent across sensitivity and subgroup analyses.
IN PRACTICE:
“One bioplausible explanation for our results is that gabapentin is a highly titratable medication and many in our cohort started on low doses. Alternatively, duloxetine is usually titrated only once or twice. Thus, although it may be that gabapentin is simply safer than duloxetine from a falls perspective, it may also be likely that we are measuring specific clinical scenarios, the peri-initiation and titration period, in which gabapentin may be less likely to cause falls than duloxetine,” the authors wrote.
SOURCE:
The study was led by Alexander Chaitoff, MD, MPH, Department of Internal Medicine, University of Michigan School of Medicine in Ann Arbor, and Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School in Boston. It was published online in Annals of Internal Medicine.
LIMITATIONS:
Despite the design aimed at limiting confounding effects, the observational nature of the study introduces potential bias. Claims data may undercount falls for which patients do not seek care, though this limitation likely affects both medication groups equally. The commercial claims database includes only Medicare supplemental insurance beneficiaries, potentially limiting generalizability. Regional variations in prescribing patterns could not be accounted for in the analysis.
DISCLOSURES:
No funding was provided for this study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
, with a weighted cumulative incidence of 84.44 vs 158.21 per 1000 person-years at 180 days. Incident gabapentin use showed a 48% lower hazard of falls at 6-month follow-up, with no increase in severe fall-related events.
METHODOLOGY:
- Researchers conducted a new user, active comparator cohort study using IBM MarketScan Research Databases from January 2014 to December 2021.
- Analysis included 57,086 adults aged 65 years or older with postherpetic neuralgia, diabetic neuropathy, or fibromyalgia, excluding those with depression, anxiety, seizures, or cancer in the prior 365 days.
- The primary outcome measured the hazard of experiencing any fall-related visit in the 6 months after initiating gabapentin or duloxetine until treatment discontinuation.
- Secondary outcomes examined severe fall-related events, including falls with hip fractures or emergency department visits/hospitalizations associated with falls.
TAKEAWAY:
- The analytic cohort included 52,152 gabapentin users and 4934 duloxetine users, with a median follow-up duration of 30 days (interquartile range, 30-90 days).
- Weighted cumulative incidence of fall-related visits per 1000 person-years at 30, 90, and 180 days was 103.60, 90.44, and 84.44 for gabapentin users vs 203.43, 177.73, and 158.21 for duloxetine users.
- At 6-month follow-up, incident gabapentin users demonstrated lower hazard of falls (hazard ratio, 0.52; 95% CI, 0.43-0.64), with no difference in hazards of severe falls.
- Results remained consistent across sensitivity and subgroup analyses.
IN PRACTICE:
“One bioplausible explanation for our results is that gabapentin is a highly titratable medication and many in our cohort started on low doses. Alternatively, duloxetine is usually titrated only once or twice. Thus, although it may be that gabapentin is simply safer than duloxetine from a falls perspective, it may also be likely that we are measuring specific clinical scenarios, the peri-initiation and titration period, in which gabapentin may be less likely to cause falls than duloxetine,” the authors wrote.
SOURCE:
The study was led by Alexander Chaitoff, MD, MPH, Department of Internal Medicine, University of Michigan School of Medicine in Ann Arbor, and Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School in Boston. It was published online in Annals of Internal Medicine.
LIMITATIONS:
Despite the design aimed at limiting confounding effects, the observational nature of the study introduces potential bias. Claims data may undercount falls for which patients do not seek care, though this limitation likely affects both medication groups equally. The commercial claims database includes only Medicare supplemental insurance beneficiaries, potentially limiting generalizability. Regional variations in prescribing patterns could not be accounted for in the analysis.
DISCLOSURES:
No funding was provided for this study.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
Muscle-Building Supplements May Lead Young Men to Steroids
TOPLINE:
Muscle-building dietary supplement (MBS) use among young men substantially increases the odds of subsequent anabolic-androgenic steroid (AAS) initiation. Users of MBS showed elevated odds of incident AAS use within 1-5 years, supporting the gateway hypothesis for escalating risk-taking behaviors to increase muscularity.
METHODOLOGY:
- Analysis included data from two Growing Up Today Study prospective cohorts spanning 14 years (2007-2021).
- Participants included 4073 cisgender boys and young men aged 10-27 years at baseline (mean age, 20.3 years).
- Demographics showed 92.8% White participants and 7.2% other races or ethnicities.
- Researchers assessed past-year substance use for muscle building, including protein supplements, creatine, amino acids, hydroxymethylbutyrate, and dehydroepiandrosterone.
TAKEAWAY:
- Initial survey results showed 11.1% of respondents reported past-year muscle-building supplement use, and 0.4% reported AAS use.
- Over the study period, 37.7% of respondents reported any past-year muscle-building supplement use, while 0.5% reported any past-year AAS use.
- Analysis revealed muscle-building supplement users had (odds ratio [OR], 8.31; 95% CI, 2.59-26.73) higher odds of initiating AAS use by the next survey wave than nonusers.
- Age (adjusted OR [AOR], 0.98; 95% CI, 0.85-1.12) and cohort (AOR, 0.83; 95% CI, 0.30-2.32) were not statistically significant factors.
IN PRACTICE:
“The health risks of MBS use are well documented, as inadequate federal regulation has resulted in a US MBS marketplace rife with inaccurate labeling and adulteration with toxic ingredients. Clinicians, coaches, and parents should counsel against MBS use. Future studies with larger and more diverse samples are needed,” wrote the authors of the study.
SOURCE:
The study was led by Abigail Bulens, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital in Boston. It was published online in JAMA Network Open.
LIMITATIONS:
The study had a wide CI around the OR, potentially affecting the precision of the risk estimates. Additionally, the sample lacked diversity, with 92.8% of participants being White, which may limit the generalizability of findings to other racial and ethnic groups.
DISCLOSURES:
One coauthor received support from grant 1F32MDO17452-01 from the National Institute on Minority Health and Health Disparities. Another coauthor received support from training grant T76-MC-00001 from the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services. The cohorts were supported by National Institutes of Health grants HD045763, HD057368, DK46834, and HLO3533. The funders had no role in the study design, data collection, analysis, interpretation, manuscript preparation, or publication decision.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Muscle-building dietary supplement (MBS) use among young men substantially increases the odds of subsequent anabolic-androgenic steroid (AAS) initiation. Users of MBS showed elevated odds of incident AAS use within 1-5 years, supporting the gateway hypothesis for escalating risk-taking behaviors to increase muscularity.
METHODOLOGY:
- Analysis included data from two Growing Up Today Study prospective cohorts spanning 14 years (2007-2021).
- Participants included 4073 cisgender boys and young men aged 10-27 years at baseline (mean age, 20.3 years).
- Demographics showed 92.8% White participants and 7.2% other races or ethnicities.
- Researchers assessed past-year substance use for muscle building, including protein supplements, creatine, amino acids, hydroxymethylbutyrate, and dehydroepiandrosterone.
TAKEAWAY:
- Initial survey results showed 11.1% of respondents reported past-year muscle-building supplement use, and 0.4% reported AAS use.
- Over the study period, 37.7% of respondents reported any past-year muscle-building supplement use, while 0.5% reported any past-year AAS use.
- Analysis revealed muscle-building supplement users had (odds ratio [OR], 8.31; 95% CI, 2.59-26.73) higher odds of initiating AAS use by the next survey wave than nonusers.
- Age (adjusted OR [AOR], 0.98; 95% CI, 0.85-1.12) and cohort (AOR, 0.83; 95% CI, 0.30-2.32) were not statistically significant factors.
IN PRACTICE:
“The health risks of MBS use are well documented, as inadequate federal regulation has resulted in a US MBS marketplace rife with inaccurate labeling and adulteration with toxic ingredients. Clinicians, coaches, and parents should counsel against MBS use. Future studies with larger and more diverse samples are needed,” wrote the authors of the study.
SOURCE:
The study was led by Abigail Bulens, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital in Boston. It was published online in JAMA Network Open.
LIMITATIONS:
The study had a wide CI around the OR, potentially affecting the precision of the risk estimates. Additionally, the sample lacked diversity, with 92.8% of participants being White, which may limit the generalizability of findings to other racial and ethnic groups.
DISCLOSURES:
One coauthor received support from grant 1F32MDO17452-01 from the National Institute on Minority Health and Health Disparities. Another coauthor received support from training grant T76-MC-00001 from the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services. The cohorts were supported by National Institutes of Health grants HD045763, HD057368, DK46834, and HLO3533. The funders had no role in the study design, data collection, analysis, interpretation, manuscript preparation, or publication decision.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Muscle-building dietary supplement (MBS) use among young men substantially increases the odds of subsequent anabolic-androgenic steroid (AAS) initiation. Users of MBS showed elevated odds of incident AAS use within 1-5 years, supporting the gateway hypothesis for escalating risk-taking behaviors to increase muscularity.
METHODOLOGY:
- Analysis included data from two Growing Up Today Study prospective cohorts spanning 14 years (2007-2021).
- Participants included 4073 cisgender boys and young men aged 10-27 years at baseline (mean age, 20.3 years).
- Demographics showed 92.8% White participants and 7.2% other races or ethnicities.
- Researchers assessed past-year substance use for muscle building, including protein supplements, creatine, amino acids, hydroxymethylbutyrate, and dehydroepiandrosterone.
TAKEAWAY:
- Initial survey results showed 11.1% of respondents reported past-year muscle-building supplement use, and 0.4% reported AAS use.
- Over the study period, 37.7% of respondents reported any past-year muscle-building supplement use, while 0.5% reported any past-year AAS use.
- Analysis revealed muscle-building supplement users had (odds ratio [OR], 8.31; 95% CI, 2.59-26.73) higher odds of initiating AAS use by the next survey wave than nonusers.
- Age (adjusted OR [AOR], 0.98; 95% CI, 0.85-1.12) and cohort (AOR, 0.83; 95% CI, 0.30-2.32) were not statistically significant factors.
IN PRACTICE:
“The health risks of MBS use are well documented, as inadequate federal regulation has resulted in a US MBS marketplace rife with inaccurate labeling and adulteration with toxic ingredients. Clinicians, coaches, and parents should counsel against MBS use. Future studies with larger and more diverse samples are needed,” wrote the authors of the study.
SOURCE:
The study was led by Abigail Bulens, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital in Boston. It was published online in JAMA Network Open.
LIMITATIONS:
The study had a wide CI around the OR, potentially affecting the precision of the risk estimates. Additionally, the sample lacked diversity, with 92.8% of participants being White, which may limit the generalizability of findings to other racial and ethnic groups.
DISCLOSURES:
One coauthor received support from grant 1F32MDO17452-01 from the National Institute on Minority Health and Health Disparities. Another coauthor received support from training grant T76-MC-00001 from the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services. The cohorts were supported by National Institutes of Health grants HD045763, HD057368, DK46834, and HLO3533. The funders had no role in the study design, data collection, analysis, interpretation, manuscript preparation, or publication decision.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
Does Virtual Care for UTIs Lead to Increased Antibiotic Use Without Better Outcomes?
TOPLINE:
Virtual visits for urinary tract infections (UTIs) increased by more than 600% from 2015 to 2022, with overall UTI encounters growing by 325.9%. The rate of antibiotic dispensation climbed by 227.3% per 1000 patients, outpacing the 159.8% increase in positive urine cultures.
METHODOLOGY:
- Researchers conducted a retrospective cohort study analyzing 1,220,698 UTI encounters among 428,855 nonpregnant women aged ≥ 18 years at Kaiser Permanente Southern California from 2015 to 2022.
- Analysis included outpatient UTI encounters in ambulatory and urgent care settings, excluding emergency and inpatient visits.
- Data collection encompassed demographic information, urine tests, antibiotic dispensation, and UTI diagnoses using International Classification of Diseases, 9th and 10th Revision codes.
- Encounters conducted by physicians, physician assistants, nurse practitioners, and registered nurses through in-person, phone, video, and health portal platforms were evaluated.
TAKEAWAY:
- Virtual encounters grew by 603.2% compared with a 122.8% increase for in-person visits, with virtual visits accounting for 60% (733,263) of all UTI encounters.
- The rate of UTI encounters per 1000 adult female patients increased by 241.6%, while membership in the health system grew by only 24.4%.
- Antibiotics were prescribed without urine testing in 42.5% (519,135) of encounters, and among encounters with both antibiotic dispensation and urine testing, 57.1% (278,903) had a positive culture.
- According to the authors, the increasing rate of antibiotic dispensation surpassed the growth in positive urine culture rates, suggesting increased use of empiric antibiotics.
IN PRACTICE:
“Our findings underscore the importance of balancing telemedicine’s accessibility with maintaining antibiotic stewardship and highlight the need for updated guidelines,” wrote the authors of the study. An accompanying editorial said, “Unfortunately, our misguided conceptual model has led to several decades of UTI research focusing on bad bugs rather than investigating the natural host defenses, how we might boost these, what perturbs the ecosystem, and how microbial defense occurs within the bladder.”
SOURCE:
The study was led by Ghanshyam Yadav, MD, Kaiser Permanente Southern California in San Diego. It was published online in Obstetrics & Gynecology. The editorial, written by Nazema Y. Siddiqui, MD, MHSc, from the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, was also published in Obstetrics & Gynecology.
LIMITATIONS:
The retrospective design and analysis at the encounter level did not allow for control of patient and clinician clustering. The study was limited to a single health maintenance organization, which may affect the generalizability of the findings.
DISCLOSURES:
This research received support through a grant from the Regional Research Committee of Kaiser Permanente Southern California (RRC grant number: KP-RRC-20221002). Heidi Brown and Jasmine Tan-Kim disclosed receiving royalties from UpToDate. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Virtual visits for urinary tract infections (UTIs) increased by more than 600% from 2015 to 2022, with overall UTI encounters growing by 325.9%. The rate of antibiotic dispensation climbed by 227.3% per 1000 patients, outpacing the 159.8% increase in positive urine cultures.
METHODOLOGY:
- Researchers conducted a retrospective cohort study analyzing 1,220,698 UTI encounters among 428,855 nonpregnant women aged ≥ 18 years at Kaiser Permanente Southern California from 2015 to 2022.
- Analysis included outpatient UTI encounters in ambulatory and urgent care settings, excluding emergency and inpatient visits.
- Data collection encompassed demographic information, urine tests, antibiotic dispensation, and UTI diagnoses using International Classification of Diseases, 9th and 10th Revision codes.
- Encounters conducted by physicians, physician assistants, nurse practitioners, and registered nurses through in-person, phone, video, and health portal platforms were evaluated.
TAKEAWAY:
- Virtual encounters grew by 603.2% compared with a 122.8% increase for in-person visits, with virtual visits accounting for 60% (733,263) of all UTI encounters.
- The rate of UTI encounters per 1000 adult female patients increased by 241.6%, while membership in the health system grew by only 24.4%.
- Antibiotics were prescribed without urine testing in 42.5% (519,135) of encounters, and among encounters with both antibiotic dispensation and urine testing, 57.1% (278,903) had a positive culture.
- According to the authors, the increasing rate of antibiotic dispensation surpassed the growth in positive urine culture rates, suggesting increased use of empiric antibiotics.
IN PRACTICE:
“Our findings underscore the importance of balancing telemedicine’s accessibility with maintaining antibiotic stewardship and highlight the need for updated guidelines,” wrote the authors of the study. An accompanying editorial said, “Unfortunately, our misguided conceptual model has led to several decades of UTI research focusing on bad bugs rather than investigating the natural host defenses, how we might boost these, what perturbs the ecosystem, and how microbial defense occurs within the bladder.”
SOURCE:
The study was led by Ghanshyam Yadav, MD, Kaiser Permanente Southern California in San Diego. It was published online in Obstetrics & Gynecology. The editorial, written by Nazema Y. Siddiqui, MD, MHSc, from the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, was also published in Obstetrics & Gynecology.
LIMITATIONS:
The retrospective design and analysis at the encounter level did not allow for control of patient and clinician clustering. The study was limited to a single health maintenance organization, which may affect the generalizability of the findings.
DISCLOSURES:
This research received support through a grant from the Regional Research Committee of Kaiser Permanente Southern California (RRC grant number: KP-RRC-20221002). Heidi Brown and Jasmine Tan-Kim disclosed receiving royalties from UpToDate. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Virtual visits for urinary tract infections (UTIs) increased by more than 600% from 2015 to 2022, with overall UTI encounters growing by 325.9%. The rate of antibiotic dispensation climbed by 227.3% per 1000 patients, outpacing the 159.8% increase in positive urine cultures.
METHODOLOGY:
- Researchers conducted a retrospective cohort study analyzing 1,220,698 UTI encounters among 428,855 nonpregnant women aged ≥ 18 years at Kaiser Permanente Southern California from 2015 to 2022.
- Analysis included outpatient UTI encounters in ambulatory and urgent care settings, excluding emergency and inpatient visits.
- Data collection encompassed demographic information, urine tests, antibiotic dispensation, and UTI diagnoses using International Classification of Diseases, 9th and 10th Revision codes.
- Encounters conducted by physicians, physician assistants, nurse practitioners, and registered nurses through in-person, phone, video, and health portal platforms were evaluated.
TAKEAWAY:
- Virtual encounters grew by 603.2% compared with a 122.8% increase for in-person visits, with virtual visits accounting for 60% (733,263) of all UTI encounters.
- The rate of UTI encounters per 1000 adult female patients increased by 241.6%, while membership in the health system grew by only 24.4%.
- Antibiotics were prescribed without urine testing in 42.5% (519,135) of encounters, and among encounters with both antibiotic dispensation and urine testing, 57.1% (278,903) had a positive culture.
- According to the authors, the increasing rate of antibiotic dispensation surpassed the growth in positive urine culture rates, suggesting increased use of empiric antibiotics.
IN PRACTICE:
“Our findings underscore the importance of balancing telemedicine’s accessibility with maintaining antibiotic stewardship and highlight the need for updated guidelines,” wrote the authors of the study. An accompanying editorial said, “Unfortunately, our misguided conceptual model has led to several decades of UTI research focusing on bad bugs rather than investigating the natural host defenses, how we might boost these, what perturbs the ecosystem, and how microbial defense occurs within the bladder.”
SOURCE:
The study was led by Ghanshyam Yadav, MD, Kaiser Permanente Southern California in San Diego. It was published online in Obstetrics & Gynecology. The editorial, written by Nazema Y. Siddiqui, MD, MHSc, from the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, was also published in Obstetrics & Gynecology.
LIMITATIONS:
The retrospective design and analysis at the encounter level did not allow for control of patient and clinician clustering. The study was limited to a single health maintenance organization, which may affect the generalizability of the findings.
DISCLOSURES:
This research received support through a grant from the Regional Research Committee of Kaiser Permanente Southern California (RRC grant number: KP-RRC-20221002). Heidi Brown and Jasmine Tan-Kim disclosed receiving royalties from UpToDate. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
Untreated Infertility Linked to Higher Risk for Systemic Autoimmune Rheumatic Disease After Childbirth
TOPLINE:
The association persists even after accounting for adverse pregnancy outcomes. Women who have experienced infertility without fertility treatment show a 25% higher risk for systemic autoimmune rheumatic disease (SARD) up to 9 years after delivery, compared with those without infertility.
METHODOLOGY:
- Population-based cohort study analyzed 568,053 singleton births among 465,078 women aged 18-50 years without pre-existing SARD in Ontario, Canada, from 2012 to 2021.
- Participants were categorized into four groups: No infertility with unassisted conception (88.0%), infertility without fertility treatment (9.2%), infertility with noninvasive fertility treatment (1.4%), and infertility with invasive fertility treatment (1.4%).
- Researchers used marginal structural Cox proportional hazards models to generate hazard ratios and 95% CIs, adjusting for sociodemographic characteristics, comorbidities, smoking, and adverse pregnancy outcomes.
- Analysis included a median follow-up duration of 6.5 years (interquartile range: 4-9 years) from delivery date until SARD diagnosis, death, loss of health insurance, or study end.
TAKEAWAY:
- The incidence rate of SARD was 12.5 per 10,000 person-years in women with untreated infertility, compared with 9.3 per 10,000 person-years in women without infertility.
- Women with untreated infertility showed an elevated risk for SARD (controlled direct effect hazard ratio [HR], 1.25; 95% CI, 1.12-1.40) even after accounting for adverse pregnancy outcomes.
- Neither noninvasive fertility treatment (total effect HR, 1.06; 95% CI, 0.79-1.42) nor invasive fertility treatment (total effect HR, 0.97; 95% CI, 0.69-1.36) were associated with increased SARD risk.
- The association between untreated infertility and SARD persisted in analyses restricted to women aged < 38 years and in those without endometriosis or other autoimmune diseases.
IN PRACTICE:
“Future research efforts should seek to corroborate this association by infertility cause, with a focus on possible mechanisms related to ovulatory, ovarian, and sexual dysfunction. Greater health provider awareness of SARD symptoms and related gynecological issues that may present in women with infertility could facilitate earlier detection and treatment of SARD during the reproductive years,” wrote the authors of the study.
SOURCE:
The study was led by Natalie V. Scime of the Department of Health and Society, University of Toronto Scarborough in Ontario, Canada. It was published online in Human Reproduction.
LIMITATIONS:
Exposure and outcome misclassification was possible due to the use of published algorithms in health administrative data with unknown or imperfect sensitivity and specificity. The researchers noted that individual-level social and lifestyle factors and underlying causes of infertility were not available, and thus, were not included in the analysis.
DISCLOSURES:
This research received funding through a Banting Postdoctoral Fellowship to Scime and Canada Research Chair to Hilary K. Brown (2019-00158), with support from ICES, funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. One coauthor disclosed consulting for Celltrion, Werfen, Organon, MitogenDx, AstraZeneca, Mallinckrodt Canada, and GlaxoSmithKline. All other authors reported no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
The association persists even after accounting for adverse pregnancy outcomes. Women who have experienced infertility without fertility treatment show a 25% higher risk for systemic autoimmune rheumatic disease (SARD) up to 9 years after delivery, compared with those without infertility.
METHODOLOGY:
- Population-based cohort study analyzed 568,053 singleton births among 465,078 women aged 18-50 years without pre-existing SARD in Ontario, Canada, from 2012 to 2021.
- Participants were categorized into four groups: No infertility with unassisted conception (88.0%), infertility without fertility treatment (9.2%), infertility with noninvasive fertility treatment (1.4%), and infertility with invasive fertility treatment (1.4%).
- Researchers used marginal structural Cox proportional hazards models to generate hazard ratios and 95% CIs, adjusting for sociodemographic characteristics, comorbidities, smoking, and adverse pregnancy outcomes.
- Analysis included a median follow-up duration of 6.5 years (interquartile range: 4-9 years) from delivery date until SARD diagnosis, death, loss of health insurance, or study end.
TAKEAWAY:
- The incidence rate of SARD was 12.5 per 10,000 person-years in women with untreated infertility, compared with 9.3 per 10,000 person-years in women without infertility.
- Women with untreated infertility showed an elevated risk for SARD (controlled direct effect hazard ratio [HR], 1.25; 95% CI, 1.12-1.40) even after accounting for adverse pregnancy outcomes.
- Neither noninvasive fertility treatment (total effect HR, 1.06; 95% CI, 0.79-1.42) nor invasive fertility treatment (total effect HR, 0.97; 95% CI, 0.69-1.36) were associated with increased SARD risk.
- The association between untreated infertility and SARD persisted in analyses restricted to women aged < 38 years and in those without endometriosis or other autoimmune diseases.
IN PRACTICE:
“Future research efforts should seek to corroborate this association by infertility cause, with a focus on possible mechanisms related to ovulatory, ovarian, and sexual dysfunction. Greater health provider awareness of SARD symptoms and related gynecological issues that may present in women with infertility could facilitate earlier detection and treatment of SARD during the reproductive years,” wrote the authors of the study.
SOURCE:
The study was led by Natalie V. Scime of the Department of Health and Society, University of Toronto Scarborough in Ontario, Canada. It was published online in Human Reproduction.
LIMITATIONS:
Exposure and outcome misclassification was possible due to the use of published algorithms in health administrative data with unknown or imperfect sensitivity and specificity. The researchers noted that individual-level social and lifestyle factors and underlying causes of infertility were not available, and thus, were not included in the analysis.
DISCLOSURES:
This research received funding through a Banting Postdoctoral Fellowship to Scime and Canada Research Chair to Hilary K. Brown (2019-00158), with support from ICES, funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. One coauthor disclosed consulting for Celltrion, Werfen, Organon, MitogenDx, AstraZeneca, Mallinckrodt Canada, and GlaxoSmithKline. All other authors reported no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
The association persists even after accounting for adverse pregnancy outcomes. Women who have experienced infertility without fertility treatment show a 25% higher risk for systemic autoimmune rheumatic disease (SARD) up to 9 years after delivery, compared with those without infertility.
METHODOLOGY:
- Population-based cohort study analyzed 568,053 singleton births among 465,078 women aged 18-50 years without pre-existing SARD in Ontario, Canada, from 2012 to 2021.
- Participants were categorized into four groups: No infertility with unassisted conception (88.0%), infertility without fertility treatment (9.2%), infertility with noninvasive fertility treatment (1.4%), and infertility with invasive fertility treatment (1.4%).
- Researchers used marginal structural Cox proportional hazards models to generate hazard ratios and 95% CIs, adjusting for sociodemographic characteristics, comorbidities, smoking, and adverse pregnancy outcomes.
- Analysis included a median follow-up duration of 6.5 years (interquartile range: 4-9 years) from delivery date until SARD diagnosis, death, loss of health insurance, or study end.
TAKEAWAY:
- The incidence rate of SARD was 12.5 per 10,000 person-years in women with untreated infertility, compared with 9.3 per 10,000 person-years in women without infertility.
- Women with untreated infertility showed an elevated risk for SARD (controlled direct effect hazard ratio [HR], 1.25; 95% CI, 1.12-1.40) even after accounting for adverse pregnancy outcomes.
- Neither noninvasive fertility treatment (total effect HR, 1.06; 95% CI, 0.79-1.42) nor invasive fertility treatment (total effect HR, 0.97; 95% CI, 0.69-1.36) were associated with increased SARD risk.
- The association between untreated infertility and SARD persisted in analyses restricted to women aged < 38 years and in those without endometriosis or other autoimmune diseases.
IN PRACTICE:
“Future research efforts should seek to corroborate this association by infertility cause, with a focus on possible mechanisms related to ovulatory, ovarian, and sexual dysfunction. Greater health provider awareness of SARD symptoms and related gynecological issues that may present in women with infertility could facilitate earlier detection and treatment of SARD during the reproductive years,” wrote the authors of the study.
SOURCE:
The study was led by Natalie V. Scime of the Department of Health and Society, University of Toronto Scarborough in Ontario, Canada. It was published online in Human Reproduction.
LIMITATIONS:
Exposure and outcome misclassification was possible due to the use of published algorithms in health administrative data with unknown or imperfect sensitivity and specificity. The researchers noted that individual-level social and lifestyle factors and underlying causes of infertility were not available, and thus, were not included in the analysis.
DISCLOSURES:
This research received funding through a Banting Postdoctoral Fellowship to Scime and Canada Research Chair to Hilary K. Brown (2019-00158), with support from ICES, funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. One coauthor disclosed consulting for Celltrion, Werfen, Organon, MitogenDx, AstraZeneca, Mallinckrodt Canada, and GlaxoSmithKline. All other authors reported no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
When Is the Best Time to Deliver for Pregnant Patients With Chronic Hypertension?
TOPLINE:
Among pregnant patients with chronic hypertension, delivery at 39 weeks of gestation provides an optimal balance between stillbirth risk and neonatal outcomes. Analysis of 227,977 term singleton deliveries shows consistent findings across different patient subgroups.
METHODOLOGY:
- A population-based retrospective cohort study analyzed 227,977 nonanomalous singleton term births in the United States from 2014 to 2018 among patients with chronic hypertension.
- Researchers excluded pregnancies with superimposed preeclampsia, eclampsia, pregestational diabetes, and deliveries occurring before 37 weeks or at 43 or more weeks of gestation.
- Analysis compared rates of stillbirth, infant death within 1 year of life, and neonatal morbidity at each week of term pregnancy.
- Neonatal morbidity was defined as a composite of neonatal intensive care unit admission, ventilation for 6 hours or longer, a low 5-minute Apgar score (≤ 3), and seizures.
TAKEAWAY:
- The rate of stillbirth per 10,000 ongoing pregnancies increased with gestational age and was lowest at 38 weeks (6.5; 95% CI, 5.4-7.7).
- Rates of infant death and neonatal morbidity were lowest at 40 weeks (18.0/10,000 live births; 95% CI, 13.7-23.6) and 39 weeks (637/10,000 live births; 95% CI, 619-654), respectively.
- At 39 weeks of gestation, the risk for delivery was lower (651/10,000; 95% CI, 633-670) than the composite risk for expectant management (750/10,000; 95% CI, 720-781).
- According to the authors, findings were consistent for non-Hispanic Black patients and pregnancies complicated by fetal growth restriction.
IN PRACTICE:
“To prevent one case of stillbirth, infant death, or neonatal morbidity, an estimated 101 patients with chronic hypertension would need to deliver at 39 weeks of gestation as opposed to 40 weeks. Given the approximately 45,000 patients with chronic hypertension who deliver at term each year in the United States, a policy of delivery at 39 weeks of gestation theoretically would prevent 450 adverse perinatal events per year,” wrote the authors of the study.
SOURCE:
The study was led by Ira Hamilton, James Liu, Labeena Wajahat, and Robert Rossi, University of Cincinnati College of Medicine in Cincinnati. It was published online in O&G Open.
LIMITATIONS:
According to the authors, the study could not stratify chronic hypertension based on medication use, number of medications, or degree of control. The researchers note that exact timing of delivery in weeks and days was not reported, limiting precise understanding of optimal delivery timing. Additionally, the study could not examine rates of neonatal morbidity and mortality in patients who developed superimposed preeclampsia during expectant management.
DISCLOSURES:
The authors did not report any potential conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Among pregnant patients with chronic hypertension, delivery at 39 weeks of gestation provides an optimal balance between stillbirth risk and neonatal outcomes. Analysis of 227,977 term singleton deliveries shows consistent findings across different patient subgroups.
METHODOLOGY:
- A population-based retrospective cohort study analyzed 227,977 nonanomalous singleton term births in the United States from 2014 to 2018 among patients with chronic hypertension.
- Researchers excluded pregnancies with superimposed preeclampsia, eclampsia, pregestational diabetes, and deliveries occurring before 37 weeks or at 43 or more weeks of gestation.
- Analysis compared rates of stillbirth, infant death within 1 year of life, and neonatal morbidity at each week of term pregnancy.
- Neonatal morbidity was defined as a composite of neonatal intensive care unit admission, ventilation for 6 hours or longer, a low 5-minute Apgar score (≤ 3), and seizures.
TAKEAWAY:
- The rate of stillbirth per 10,000 ongoing pregnancies increased with gestational age and was lowest at 38 weeks (6.5; 95% CI, 5.4-7.7).
- Rates of infant death and neonatal morbidity were lowest at 40 weeks (18.0/10,000 live births; 95% CI, 13.7-23.6) and 39 weeks (637/10,000 live births; 95% CI, 619-654), respectively.
- At 39 weeks of gestation, the risk for delivery was lower (651/10,000; 95% CI, 633-670) than the composite risk for expectant management (750/10,000; 95% CI, 720-781).
- According to the authors, findings were consistent for non-Hispanic Black patients and pregnancies complicated by fetal growth restriction.
IN PRACTICE:
“To prevent one case of stillbirth, infant death, or neonatal morbidity, an estimated 101 patients with chronic hypertension would need to deliver at 39 weeks of gestation as opposed to 40 weeks. Given the approximately 45,000 patients with chronic hypertension who deliver at term each year in the United States, a policy of delivery at 39 weeks of gestation theoretically would prevent 450 adverse perinatal events per year,” wrote the authors of the study.
SOURCE:
The study was led by Ira Hamilton, James Liu, Labeena Wajahat, and Robert Rossi, University of Cincinnati College of Medicine in Cincinnati. It was published online in O&G Open.
LIMITATIONS:
According to the authors, the study could not stratify chronic hypertension based on medication use, number of medications, or degree of control. The researchers note that exact timing of delivery in weeks and days was not reported, limiting precise understanding of optimal delivery timing. Additionally, the study could not examine rates of neonatal morbidity and mortality in patients who developed superimposed preeclampsia during expectant management.
DISCLOSURES:
The authors did not report any potential conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Among pregnant patients with chronic hypertension, delivery at 39 weeks of gestation provides an optimal balance between stillbirth risk and neonatal outcomes. Analysis of 227,977 term singleton deliveries shows consistent findings across different patient subgroups.
METHODOLOGY:
- A population-based retrospective cohort study analyzed 227,977 nonanomalous singleton term births in the United States from 2014 to 2018 among patients with chronic hypertension.
- Researchers excluded pregnancies with superimposed preeclampsia, eclampsia, pregestational diabetes, and deliveries occurring before 37 weeks or at 43 or more weeks of gestation.
- Analysis compared rates of stillbirth, infant death within 1 year of life, and neonatal morbidity at each week of term pregnancy.
- Neonatal morbidity was defined as a composite of neonatal intensive care unit admission, ventilation for 6 hours or longer, a low 5-minute Apgar score (≤ 3), and seizures.
TAKEAWAY:
- The rate of stillbirth per 10,000 ongoing pregnancies increased with gestational age and was lowest at 38 weeks (6.5; 95% CI, 5.4-7.7).
- Rates of infant death and neonatal morbidity were lowest at 40 weeks (18.0/10,000 live births; 95% CI, 13.7-23.6) and 39 weeks (637/10,000 live births; 95% CI, 619-654), respectively.
- At 39 weeks of gestation, the risk for delivery was lower (651/10,000; 95% CI, 633-670) than the composite risk for expectant management (750/10,000; 95% CI, 720-781).
- According to the authors, findings were consistent for non-Hispanic Black patients and pregnancies complicated by fetal growth restriction.
IN PRACTICE:
“To prevent one case of stillbirth, infant death, or neonatal morbidity, an estimated 101 patients with chronic hypertension would need to deliver at 39 weeks of gestation as opposed to 40 weeks. Given the approximately 45,000 patients with chronic hypertension who deliver at term each year in the United States, a policy of delivery at 39 weeks of gestation theoretically would prevent 450 adverse perinatal events per year,” wrote the authors of the study.
SOURCE:
The study was led by Ira Hamilton, James Liu, Labeena Wajahat, and Robert Rossi, University of Cincinnati College of Medicine in Cincinnati. It was published online in O&G Open.
LIMITATIONS:
According to the authors, the study could not stratify chronic hypertension based on medication use, number of medications, or degree of control. The researchers note that exact timing of delivery in weeks and days was not reported, limiting precise understanding of optimal delivery timing. Additionally, the study could not examine rates of neonatal morbidity and mortality in patients who developed superimposed preeclampsia during expectant management.
DISCLOSURES:
The authors did not report any potential conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Rural Areas Face Steeper Decline in Hospital Obstetric Services Than Urban Centers
TOPLINE:
Between 2010 and 2022, hospital-based obstetric care declined significantly across the United States, with 52.4% of rural hospitals and 35.7% of urban hospitals not offering obstetric services by 2022. Rural hospitals experienced a steeper increase in the percentage of facilities without obstetrics than urban counterparts, despite several national maternity care access initiatives.
METHODOLOGY:
- Researchers conducted a retrospective cohort study of 4964 United States short-term acute care hospitals, including 1982 in rural counties and 2982 in urban counties, analyzing data from 2010 to 2022.
- Analysis utilized American Hospital Association annual surveys and Centers for Medicare & Medicaid Services Provider of Services files, applying an enhanced algorithm to identify hospital-based obstetric services availability.
- Hospital rurality classification followed Office of Management and Budget definitions, with urban hospitals located in metropolitan statistical areas having > 250,000 inhabitants and rural hospitals in nonmetropolitan areas with < 50,000 inhabitants.
TAKEAWAY:
- A total of 537 hospitals lost obstetric services between 2010 and 2022, with 238 rural hospitals and 299 urban hospitals affected, while only 138 hospitals gained obstetric services during this period.
- The percentage of hospitals without obstetrics increased steadily from 35.2% to 42.4% of all hospitals between 2010 and 2022, with rural hospitals consistently showing higher rates than urban facilities.
- By 2022, more than half (52.4%) of rural hospitals and over one third (35.7%) of urban hospitals did not offer obstetric care, representing a significant decline in access to maternal healthcare services.
- Urban areas showed greater potential for service recovery with 112 hospitals gaining obstetric services than only 26 rural hospitals during the study period.
IN PRACTICE:
“Access to obstetric care is an important determinant of maternal and infant health outcomes, and amidst a maternal health crisis in the US, hospital-based obstetric care has declined in both rural and urban communities,” wrote the authors of the study.
SOURCE:
The study was led by Katy B. Kozhimannil, PhD, MPA, Division of Health Policy and Management, University of Minnesota School of Public Health in Minneapolis. It was published online on December 4 in JAMA.
LIMITATIONS:
The study was limited by the lack of data on births outside hospital settings, which represent less than 2% of United States births. Additionally, the denominator for the study outcome declined each year because of hospital closures, particularly affecting rural hospitals. The researchers also noted that while rurality exists on a continuum, they applied a dichotomous county–based measure of hospital location. Furthermore, the hospital-level data did not contain patient-level information, making it impossible to analyze how changes in obstetric status affected patient outcomes.
DISCLOSURES:
This study was supported by the Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health & Human Services under Public Health Service Cooperative Agreement. One coauthor disclosed receiving grants from the Laura and John Arnold Foundation, Ballad Health, and the Commonwealth Fund outside the submitted work. A coauthor reported receiving personal fees from the American Institute of Biological Sciences on behalf of March of Dimes as a grant reviewer. Another coauthor reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development outside the submitted work. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Between 2010 and 2022, hospital-based obstetric care declined significantly across the United States, with 52.4% of rural hospitals and 35.7% of urban hospitals not offering obstetric services by 2022. Rural hospitals experienced a steeper increase in the percentage of facilities without obstetrics than urban counterparts, despite several national maternity care access initiatives.
METHODOLOGY:
- Researchers conducted a retrospective cohort study of 4964 United States short-term acute care hospitals, including 1982 in rural counties and 2982 in urban counties, analyzing data from 2010 to 2022.
- Analysis utilized American Hospital Association annual surveys and Centers for Medicare & Medicaid Services Provider of Services files, applying an enhanced algorithm to identify hospital-based obstetric services availability.
- Hospital rurality classification followed Office of Management and Budget definitions, with urban hospitals located in metropolitan statistical areas having > 250,000 inhabitants and rural hospitals in nonmetropolitan areas with < 50,000 inhabitants.
TAKEAWAY:
- A total of 537 hospitals lost obstetric services between 2010 and 2022, with 238 rural hospitals and 299 urban hospitals affected, while only 138 hospitals gained obstetric services during this period.
- The percentage of hospitals without obstetrics increased steadily from 35.2% to 42.4% of all hospitals between 2010 and 2022, with rural hospitals consistently showing higher rates than urban facilities.
- By 2022, more than half (52.4%) of rural hospitals and over one third (35.7%) of urban hospitals did not offer obstetric care, representing a significant decline in access to maternal healthcare services.
- Urban areas showed greater potential for service recovery with 112 hospitals gaining obstetric services than only 26 rural hospitals during the study period.
IN PRACTICE:
“Access to obstetric care is an important determinant of maternal and infant health outcomes, and amidst a maternal health crisis in the US, hospital-based obstetric care has declined in both rural and urban communities,” wrote the authors of the study.
SOURCE:
The study was led by Katy B. Kozhimannil, PhD, MPA, Division of Health Policy and Management, University of Minnesota School of Public Health in Minneapolis. It was published online on December 4 in JAMA.
LIMITATIONS:
The study was limited by the lack of data on births outside hospital settings, which represent less than 2% of United States births. Additionally, the denominator for the study outcome declined each year because of hospital closures, particularly affecting rural hospitals. The researchers also noted that while rurality exists on a continuum, they applied a dichotomous county–based measure of hospital location. Furthermore, the hospital-level data did not contain patient-level information, making it impossible to analyze how changes in obstetric status affected patient outcomes.
DISCLOSURES:
This study was supported by the Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health & Human Services under Public Health Service Cooperative Agreement. One coauthor disclosed receiving grants from the Laura and John Arnold Foundation, Ballad Health, and the Commonwealth Fund outside the submitted work. A coauthor reported receiving personal fees from the American Institute of Biological Sciences on behalf of March of Dimes as a grant reviewer. Another coauthor reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development outside the submitted work. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Between 2010 and 2022, hospital-based obstetric care declined significantly across the United States, with 52.4% of rural hospitals and 35.7% of urban hospitals not offering obstetric services by 2022. Rural hospitals experienced a steeper increase in the percentage of facilities without obstetrics than urban counterparts, despite several national maternity care access initiatives.
METHODOLOGY:
- Researchers conducted a retrospective cohort study of 4964 United States short-term acute care hospitals, including 1982 in rural counties and 2982 in urban counties, analyzing data from 2010 to 2022.
- Analysis utilized American Hospital Association annual surveys and Centers for Medicare & Medicaid Services Provider of Services files, applying an enhanced algorithm to identify hospital-based obstetric services availability.
- Hospital rurality classification followed Office of Management and Budget definitions, with urban hospitals located in metropolitan statistical areas having > 250,000 inhabitants and rural hospitals in nonmetropolitan areas with < 50,000 inhabitants.
TAKEAWAY:
- A total of 537 hospitals lost obstetric services between 2010 and 2022, with 238 rural hospitals and 299 urban hospitals affected, while only 138 hospitals gained obstetric services during this period.
- The percentage of hospitals without obstetrics increased steadily from 35.2% to 42.4% of all hospitals between 2010 and 2022, with rural hospitals consistently showing higher rates than urban facilities.
- By 2022, more than half (52.4%) of rural hospitals and over one third (35.7%) of urban hospitals did not offer obstetric care, representing a significant decline in access to maternal healthcare services.
- Urban areas showed greater potential for service recovery with 112 hospitals gaining obstetric services than only 26 rural hospitals during the study period.
IN PRACTICE:
“Access to obstetric care is an important determinant of maternal and infant health outcomes, and amidst a maternal health crisis in the US, hospital-based obstetric care has declined in both rural and urban communities,” wrote the authors of the study.
SOURCE:
The study was led by Katy B. Kozhimannil, PhD, MPA, Division of Health Policy and Management, University of Minnesota School of Public Health in Minneapolis. It was published online on December 4 in JAMA.
LIMITATIONS:
The study was limited by the lack of data on births outside hospital settings, which represent less than 2% of United States births. Additionally, the denominator for the study outcome declined each year because of hospital closures, particularly affecting rural hospitals. The researchers also noted that while rurality exists on a continuum, they applied a dichotomous county–based measure of hospital location. Furthermore, the hospital-level data did not contain patient-level information, making it impossible to analyze how changes in obstetric status affected patient outcomes.
DISCLOSURES:
This study was supported by the Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health & Human Services under Public Health Service Cooperative Agreement. One coauthor disclosed receiving grants from the Laura and John Arnold Foundation, Ballad Health, and the Commonwealth Fund outside the submitted work. A coauthor reported receiving personal fees from the American Institute of Biological Sciences on behalf of March of Dimes as a grant reviewer. Another coauthor reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development outside the submitted work. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
Smarter Pregnancy App Links Improved Lifestyle Habits to Lower Maternal Blood Pressure in Early Pregnancy
TOPLINE:
Digital lifestyle coaching through the Smarter Pregnancy program reduces maternal blood pressure (BP) by approximately 2 mm Hg during the first trimester of pregnancy. The program enhances lifestyle behaviors through personalized coaching on vegetable and fruit intake, smoking cessation, and alcohol abstinence.
METHODOLOGY:
- Researchers analyzed data from the Rotterdam Periconception Cohort between 2010 and 2019, including 132 pregnant women who used Smarter Pregnancy for 6-24 weeks in the intervention group and 1091 pregnant women in the control group.
- Participants’ outcomes included changes in systolic, diastolic, and mean arterial BPs between baseline and first trimester measurements, with median gestational age of 7 weeks at inclusion.
- Analysis tracked lifestyle behaviors in the intervention group at 12 and 24 weeks using risk scores for vegetables, fruits, smoking, and alcohol consumption.
- Multivariable analysis adjusted for baseline BP measurements, age, gestational age, geographic origin, parity, and conception mode to evaluate program effectiveness.
TAKEAWAY:
- The intervention group demonstrated significant reductions in systolic (beta, −2.34 mm Hg; 95% CI, −4.67 to −0.01; P = .049), diastolic (beta, −2.00 mm Hg; 95% CI, −3.57 to −0.45; P = .012), and mean arterial BP (beta, −2.22 mm Hg; 95% CI, −3.81 to −0.52; P = .011) compared with controls.
- Among women who underwent assisted reproductive technology (ART), significant reductions were observed in diastolic (beta, −2.38 mm Hg; 95% CI, −4.20 to −0.56) and mean arterial BP (beta, −2.63 mm Hg; 95% CI, −4.61 to −0.56).
- Program usage was associated with decreased lifestyle risk scores at 12 weeks (beta, −0.84; 95% CI, −1.19 to −0.49) and 24 weeks (beta, −1.07; 95% CI, −1.44 to −0.69), indicating improved lifestyle behaviors.
- Lifestyle risk scores significantly decreased in both ART and natural pregnancy subgroups after program completion.
IN PRACTICE:
“The findings suggest that Smarter Pregnancy can be used to coach women on healthy lifestyle behaviors commencing from the preconception period onwards to improve BP outcomes. Of note, although implementing the program during [the] first trimester seems easier, initiating lifestyle coaching as early as preconceptional period can act as preventive measure against adverse health outcomes,” wrote the authors of the study.
SOURCE:
The study was led by Batoul Hojeij, PhD, Erasmus University Medical Center in Rotterdam, the Netherlands. It was published online in the American Journal of Preventive Medicine.
LIMITATIONS:
According to the authors, participants in the intervention group might have had healthier lifestyles due to their motivation to use a digital coaching program. The sample size of naturally conceived pregnancies in the intervention group was small (n = 41), reducing statistical power for subgroup analysis. The high percentage of missing data for baseline BP measurements (64%) could have affected statistical power and led to potential bias, though multiple imputations were used to address this limitation.
DISCLOSURES:
This study was supported by the European Union’s Horizon 2020 research and innovation program (DohART-NET) and the Department of Obstetrics and Gynaecology of the Erasmus MC. Kevin D Sinclair, PhD, DSc, received funding from the Biotechnology and Biological Sciences Research Council.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Digital lifestyle coaching through the Smarter Pregnancy program reduces maternal blood pressure (BP) by approximately 2 mm Hg during the first trimester of pregnancy. The program enhances lifestyle behaviors through personalized coaching on vegetable and fruit intake, smoking cessation, and alcohol abstinence.
METHODOLOGY:
- Researchers analyzed data from the Rotterdam Periconception Cohort between 2010 and 2019, including 132 pregnant women who used Smarter Pregnancy for 6-24 weeks in the intervention group and 1091 pregnant women in the control group.
- Participants’ outcomes included changes in systolic, diastolic, and mean arterial BPs between baseline and first trimester measurements, with median gestational age of 7 weeks at inclusion.
- Analysis tracked lifestyle behaviors in the intervention group at 12 and 24 weeks using risk scores for vegetables, fruits, smoking, and alcohol consumption.
- Multivariable analysis adjusted for baseline BP measurements, age, gestational age, geographic origin, parity, and conception mode to evaluate program effectiveness.
TAKEAWAY:
- The intervention group demonstrated significant reductions in systolic (beta, −2.34 mm Hg; 95% CI, −4.67 to −0.01; P = .049), diastolic (beta, −2.00 mm Hg; 95% CI, −3.57 to −0.45; P = .012), and mean arterial BP (beta, −2.22 mm Hg; 95% CI, −3.81 to −0.52; P = .011) compared with controls.
- Among women who underwent assisted reproductive technology (ART), significant reductions were observed in diastolic (beta, −2.38 mm Hg; 95% CI, −4.20 to −0.56) and mean arterial BP (beta, −2.63 mm Hg; 95% CI, −4.61 to −0.56).
- Program usage was associated with decreased lifestyle risk scores at 12 weeks (beta, −0.84; 95% CI, −1.19 to −0.49) and 24 weeks (beta, −1.07; 95% CI, −1.44 to −0.69), indicating improved lifestyle behaviors.
- Lifestyle risk scores significantly decreased in both ART and natural pregnancy subgroups after program completion.
IN PRACTICE:
“The findings suggest that Smarter Pregnancy can be used to coach women on healthy lifestyle behaviors commencing from the preconception period onwards to improve BP outcomes. Of note, although implementing the program during [the] first trimester seems easier, initiating lifestyle coaching as early as preconceptional period can act as preventive measure against adverse health outcomes,” wrote the authors of the study.
SOURCE:
The study was led by Batoul Hojeij, PhD, Erasmus University Medical Center in Rotterdam, the Netherlands. It was published online in the American Journal of Preventive Medicine.
LIMITATIONS:
According to the authors, participants in the intervention group might have had healthier lifestyles due to their motivation to use a digital coaching program. The sample size of naturally conceived pregnancies in the intervention group was small (n = 41), reducing statistical power for subgroup analysis. The high percentage of missing data for baseline BP measurements (64%) could have affected statistical power and led to potential bias, though multiple imputations were used to address this limitation.
DISCLOSURES:
This study was supported by the European Union’s Horizon 2020 research and innovation program (DohART-NET) and the Department of Obstetrics and Gynaecology of the Erasmus MC. Kevin D Sinclair, PhD, DSc, received funding from the Biotechnology and Biological Sciences Research Council.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Digital lifestyle coaching through the Smarter Pregnancy program reduces maternal blood pressure (BP) by approximately 2 mm Hg during the first trimester of pregnancy. The program enhances lifestyle behaviors through personalized coaching on vegetable and fruit intake, smoking cessation, and alcohol abstinence.
METHODOLOGY:
- Researchers analyzed data from the Rotterdam Periconception Cohort between 2010 and 2019, including 132 pregnant women who used Smarter Pregnancy for 6-24 weeks in the intervention group and 1091 pregnant women in the control group.
- Participants’ outcomes included changes in systolic, diastolic, and mean arterial BPs between baseline and first trimester measurements, with median gestational age of 7 weeks at inclusion.
- Analysis tracked lifestyle behaviors in the intervention group at 12 and 24 weeks using risk scores for vegetables, fruits, smoking, and alcohol consumption.
- Multivariable analysis adjusted for baseline BP measurements, age, gestational age, geographic origin, parity, and conception mode to evaluate program effectiveness.
TAKEAWAY:
- The intervention group demonstrated significant reductions in systolic (beta, −2.34 mm Hg; 95% CI, −4.67 to −0.01; P = .049), diastolic (beta, −2.00 mm Hg; 95% CI, −3.57 to −0.45; P = .012), and mean arterial BP (beta, −2.22 mm Hg; 95% CI, −3.81 to −0.52; P = .011) compared with controls.
- Among women who underwent assisted reproductive technology (ART), significant reductions were observed in diastolic (beta, −2.38 mm Hg; 95% CI, −4.20 to −0.56) and mean arterial BP (beta, −2.63 mm Hg; 95% CI, −4.61 to −0.56).
- Program usage was associated with decreased lifestyle risk scores at 12 weeks (beta, −0.84; 95% CI, −1.19 to −0.49) and 24 weeks (beta, −1.07; 95% CI, −1.44 to −0.69), indicating improved lifestyle behaviors.
- Lifestyle risk scores significantly decreased in both ART and natural pregnancy subgroups after program completion.
IN PRACTICE:
“The findings suggest that Smarter Pregnancy can be used to coach women on healthy lifestyle behaviors commencing from the preconception period onwards to improve BP outcomes. Of note, although implementing the program during [the] first trimester seems easier, initiating lifestyle coaching as early as preconceptional period can act as preventive measure against adverse health outcomes,” wrote the authors of the study.
SOURCE:
The study was led by Batoul Hojeij, PhD, Erasmus University Medical Center in Rotterdam, the Netherlands. It was published online in the American Journal of Preventive Medicine.
LIMITATIONS:
According to the authors, participants in the intervention group might have had healthier lifestyles due to their motivation to use a digital coaching program. The sample size of naturally conceived pregnancies in the intervention group was small (n = 41), reducing statistical power for subgroup analysis. The high percentage of missing data for baseline BP measurements (64%) could have affected statistical power and led to potential bias, though multiple imputations were used to address this limitation.
DISCLOSURES:
This study was supported by the European Union’s Horizon 2020 research and innovation program (DohART-NET) and the Department of Obstetrics and Gynaecology of the Erasmus MC. Kevin D Sinclair, PhD, DSc, received funding from the Biotechnology and Biological Sciences Research Council.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
US Alcohol-Related Deaths Double Over 2 Decades, With Notable Age and Gender Disparities
TOPLINE:
US alcohol-related mortality rates increased from 10.7 to 21.6 per 100,000 between 1999 and 2020, with the largest rise of 3.8-fold observed in adults aged 25-34 years. Women experienced a 2.5-fold increase, while the Midwest region showed a similar rise in mortality rates.
METHODOLOGY:
- Analysis utilized the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to examine alcohol-related mortality trends from 1999 to 2020.
- Researchers analyzed data from a total US population of 180,408,769 people aged 25 to 85+ years in 1999 and 226,635,013 people in 2020.
- International Classification of Diseases, Tenth Revision, codes were used to identify deaths with alcohol attribution, including mental and behavioral disorders, alcoholic organ damage, and alcohol-related poisoning.
TAKEAWAY:
- Overall mortality rates increased from 10.7 (95% CI, 10.6-10.8) per 100,000 in 1999 to 21.6 (95% CI, 21.4-21.8) per 100,000 in 2020, representing a significant twofold increase.
- Adults aged 55-64 years demonstrated both the steepest increase and highest absolute rates in both 1999 and 2020.
- American Indian and Alaska Native individuals experienced the steepest increase and highest absolute rates among all racial groups.
- The West region maintained the highest absolute rates in both 1999 and 2020, despite the Midwest showing the largest increase.
IN PRACTICE:
“Individuals who consume large amounts of alcohol tend to have the highest risks of total mortality as well as deaths from cardiovascular disease. Cardiovascular disease deaths are predominantly due to myocardial infarction and stroke. To mitigate these risks, health providers may wish to implement screening for alcohol use in primary care and other healthcare settings. By providing brief interventions and referrals to treatment, healthcare providers would be able to achieve the early identification of individuals at risk of alcohol-related harm and offer them the support and resources they need to reduce their alcohol consumption,” wrote the authors of the study.
SOURCE:
The study was led by Alexandra Matarazzo, BS, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. It was published online in The American Journal of Medicine.
LIMITATIONS:
According to the authors, the cross-sectional nature of the data limits the study to descriptive analysis only, making it suitable for hypothesis generation but not hypothesis testing. While the validity and generalizability within the United States are secure because of the use of complete population data, potential bias and uncontrolled confounding may exist because of different population mixes between the two time points.
DISCLOSURES:
The authors reported no relevant conflicts of interest. One coauthor disclosed serving as an independent scientist in an advisory role to investigators and sponsors as Chair of Data Monitoring Committees for Amgen and UBC, to the Food and Drug Administration, and to Up to Date. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
US alcohol-related mortality rates increased from 10.7 to 21.6 per 100,000 between 1999 and 2020, with the largest rise of 3.8-fold observed in adults aged 25-34 years. Women experienced a 2.5-fold increase, while the Midwest region showed a similar rise in mortality rates.
METHODOLOGY:
- Analysis utilized the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to examine alcohol-related mortality trends from 1999 to 2020.
- Researchers analyzed data from a total US population of 180,408,769 people aged 25 to 85+ years in 1999 and 226,635,013 people in 2020.
- International Classification of Diseases, Tenth Revision, codes were used to identify deaths with alcohol attribution, including mental and behavioral disorders, alcoholic organ damage, and alcohol-related poisoning.
TAKEAWAY:
- Overall mortality rates increased from 10.7 (95% CI, 10.6-10.8) per 100,000 in 1999 to 21.6 (95% CI, 21.4-21.8) per 100,000 in 2020, representing a significant twofold increase.
- Adults aged 55-64 years demonstrated both the steepest increase and highest absolute rates in both 1999 and 2020.
- American Indian and Alaska Native individuals experienced the steepest increase and highest absolute rates among all racial groups.
- The West region maintained the highest absolute rates in both 1999 and 2020, despite the Midwest showing the largest increase.
IN PRACTICE:
“Individuals who consume large amounts of alcohol tend to have the highest risks of total mortality as well as deaths from cardiovascular disease. Cardiovascular disease deaths are predominantly due to myocardial infarction and stroke. To mitigate these risks, health providers may wish to implement screening for alcohol use in primary care and other healthcare settings. By providing brief interventions and referrals to treatment, healthcare providers would be able to achieve the early identification of individuals at risk of alcohol-related harm and offer them the support and resources they need to reduce their alcohol consumption,” wrote the authors of the study.
SOURCE:
The study was led by Alexandra Matarazzo, BS, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. It was published online in The American Journal of Medicine.
LIMITATIONS:
According to the authors, the cross-sectional nature of the data limits the study to descriptive analysis only, making it suitable for hypothesis generation but not hypothesis testing. While the validity and generalizability within the United States are secure because of the use of complete population data, potential bias and uncontrolled confounding may exist because of different population mixes between the two time points.
DISCLOSURES:
The authors reported no relevant conflicts of interest. One coauthor disclosed serving as an independent scientist in an advisory role to investigators and sponsors as Chair of Data Monitoring Committees for Amgen and UBC, to the Food and Drug Administration, and to Up to Date. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
US alcohol-related mortality rates increased from 10.7 to 21.6 per 100,000 between 1999 and 2020, with the largest rise of 3.8-fold observed in adults aged 25-34 years. Women experienced a 2.5-fold increase, while the Midwest region showed a similar rise in mortality rates.
METHODOLOGY:
- Analysis utilized the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to examine alcohol-related mortality trends from 1999 to 2020.
- Researchers analyzed data from a total US population of 180,408,769 people aged 25 to 85+ years in 1999 and 226,635,013 people in 2020.
- International Classification of Diseases, Tenth Revision, codes were used to identify deaths with alcohol attribution, including mental and behavioral disorders, alcoholic organ damage, and alcohol-related poisoning.
TAKEAWAY:
- Overall mortality rates increased from 10.7 (95% CI, 10.6-10.8) per 100,000 in 1999 to 21.6 (95% CI, 21.4-21.8) per 100,000 in 2020, representing a significant twofold increase.
- Adults aged 55-64 years demonstrated both the steepest increase and highest absolute rates in both 1999 and 2020.
- American Indian and Alaska Native individuals experienced the steepest increase and highest absolute rates among all racial groups.
- The West region maintained the highest absolute rates in both 1999 and 2020, despite the Midwest showing the largest increase.
IN PRACTICE:
“Individuals who consume large amounts of alcohol tend to have the highest risks of total mortality as well as deaths from cardiovascular disease. Cardiovascular disease deaths are predominantly due to myocardial infarction and stroke. To mitigate these risks, health providers may wish to implement screening for alcohol use in primary care and other healthcare settings. By providing brief interventions and referrals to treatment, healthcare providers would be able to achieve the early identification of individuals at risk of alcohol-related harm and offer them the support and resources they need to reduce their alcohol consumption,” wrote the authors of the study.
SOURCE:
The study was led by Alexandra Matarazzo, BS, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. It was published online in The American Journal of Medicine.
LIMITATIONS:
According to the authors, the cross-sectional nature of the data limits the study to descriptive analysis only, making it suitable for hypothesis generation but not hypothesis testing. While the validity and generalizability within the United States are secure because of the use of complete population data, potential bias and uncontrolled confounding may exist because of different population mixes between the two time points.
DISCLOSURES:
The authors reported no relevant conflicts of interest. One coauthor disclosed serving as an independent scientist in an advisory role to investigators and sponsors as Chair of Data Monitoring Committees for Amgen and UBC, to the Food and Drug Administration, and to Up to Date. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
PCOS Linked to Reduced Fertility and Later Childbirth
TOPLINE:
Women with polycystic ovary syndrome (PCOS) have 26% higher nulliparity rates and give birth at more advanced ages despite similar family aspirations and higher rates of fertility treatment. Later PCOS diagnosis is associated with double the rate of advanced maternal age at childbirth.
METHODOLOGY:
- A prospective cohort study followed 14,247 Australian women from 1996 (age, 18-23 years) to 2021 (age, 43-48 years), comparing 981 women with self-reported PCOS against 13,266 without PCOS.
- Participants completed surveys approximately every 3 years, with data collection including childbirth events, fertility issues, and treatment history from 20 weeks of gestational age, including stillbirths.
- Analysis focused on comparing parity, maternal age at deliveries, and factors associated with advanced maternal age between groups, with adjustments made for education level, area of residence, marital status, body mass index group, hypertension, and type 2 diabetes.
TAKEAWAY:
- Compared with women without PCOS, those with PCOS had fewer births (1.9 ± 1.2 vs 1.7 ± 1.3; P < .001) and higher nulliparity rates (18% vs 23%; P = .003).
- PCOS was associated with increased odds of advanced maternal age at first childbirth (adjusted odds ratio [aOR], 1.34; 95% CI, 1.04-1.75) and higher rates of gestational diabetes (aOR, 3.90; 95% CI, 2.99-5.10).
- Late PCOS diagnosis was linked to increased odds of advanced maternal age at first childbirth (aOR, 1.98; 95% CI, 1.22-3.22), emphasizing the importance of early diagnosis.
- Compared with women without PCOS, those with PCOS were older at first childbirth (28.8 ± 5.5 vs 29.5 ± 5.5 years) and second childbirth (31.1 ± 5.0 vs 32.1 ± 5.2 years) (P < .001 for both).
IN PRACTICE:
“Women with PCOS have increased infertility and have higher rates of seeking and using ovulation induction and IVF than those without PCOS. Moreover, women with PCOS are older at both first and second childbirth, have longer interconception periods, are of advanced maternal age, and have higher nulliparity and lower fecundity compared with women without PCOS,” the authors of the study wrote.
SOURCE:
This study was led by Maria Forslund, MD, PhD, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg in Sweden. It was published online in American Journal of Obstetrics & Gynecology.
LIMITATIONS:
This study relied on self-reported PCOS diagnosis, though these data were previously validated in the cohort. While dropouts from the study were common, a previous modeling study showed no serious bias in estimates of associations between risk factors and health outcomes in the longitudinal models.
DISCLOSURES:
Forslund received support from the Swedish Medical Society (SLS-984944; SLS986952). The study was funded by the Australian Government’s Department of Health and Aged Care. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Women with polycystic ovary syndrome (PCOS) have 26% higher nulliparity rates and give birth at more advanced ages despite similar family aspirations and higher rates of fertility treatment. Later PCOS diagnosis is associated with double the rate of advanced maternal age at childbirth.
METHODOLOGY:
- A prospective cohort study followed 14,247 Australian women from 1996 (age, 18-23 years) to 2021 (age, 43-48 years), comparing 981 women with self-reported PCOS against 13,266 without PCOS.
- Participants completed surveys approximately every 3 years, with data collection including childbirth events, fertility issues, and treatment history from 20 weeks of gestational age, including stillbirths.
- Analysis focused on comparing parity, maternal age at deliveries, and factors associated with advanced maternal age between groups, with adjustments made for education level, area of residence, marital status, body mass index group, hypertension, and type 2 diabetes.
TAKEAWAY:
- Compared with women without PCOS, those with PCOS had fewer births (1.9 ± 1.2 vs 1.7 ± 1.3; P < .001) and higher nulliparity rates (18% vs 23%; P = .003).
- PCOS was associated with increased odds of advanced maternal age at first childbirth (adjusted odds ratio [aOR], 1.34; 95% CI, 1.04-1.75) and higher rates of gestational diabetes (aOR, 3.90; 95% CI, 2.99-5.10).
- Late PCOS diagnosis was linked to increased odds of advanced maternal age at first childbirth (aOR, 1.98; 95% CI, 1.22-3.22), emphasizing the importance of early diagnosis.
- Compared with women without PCOS, those with PCOS were older at first childbirth (28.8 ± 5.5 vs 29.5 ± 5.5 years) and second childbirth (31.1 ± 5.0 vs 32.1 ± 5.2 years) (P < .001 for both).
IN PRACTICE:
“Women with PCOS have increased infertility and have higher rates of seeking and using ovulation induction and IVF than those without PCOS. Moreover, women with PCOS are older at both first and second childbirth, have longer interconception periods, are of advanced maternal age, and have higher nulliparity and lower fecundity compared with women without PCOS,” the authors of the study wrote.
SOURCE:
This study was led by Maria Forslund, MD, PhD, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg in Sweden. It was published online in American Journal of Obstetrics & Gynecology.
LIMITATIONS:
This study relied on self-reported PCOS diagnosis, though these data were previously validated in the cohort. While dropouts from the study were common, a previous modeling study showed no serious bias in estimates of associations between risk factors and health outcomes in the longitudinal models.
DISCLOSURES:
Forslund received support from the Swedish Medical Society (SLS-984944; SLS986952). The study was funded by the Australian Government’s Department of Health and Aged Care. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Women with polycystic ovary syndrome (PCOS) have 26% higher nulliparity rates and give birth at more advanced ages despite similar family aspirations and higher rates of fertility treatment. Later PCOS diagnosis is associated with double the rate of advanced maternal age at childbirth.
METHODOLOGY:
- A prospective cohort study followed 14,247 Australian women from 1996 (age, 18-23 years) to 2021 (age, 43-48 years), comparing 981 women with self-reported PCOS against 13,266 without PCOS.
- Participants completed surveys approximately every 3 years, with data collection including childbirth events, fertility issues, and treatment history from 20 weeks of gestational age, including stillbirths.
- Analysis focused on comparing parity, maternal age at deliveries, and factors associated with advanced maternal age between groups, with adjustments made for education level, area of residence, marital status, body mass index group, hypertension, and type 2 diabetes.
TAKEAWAY:
- Compared with women without PCOS, those with PCOS had fewer births (1.9 ± 1.2 vs 1.7 ± 1.3; P < .001) and higher nulliparity rates (18% vs 23%; P = .003).
- PCOS was associated with increased odds of advanced maternal age at first childbirth (adjusted odds ratio [aOR], 1.34; 95% CI, 1.04-1.75) and higher rates of gestational diabetes (aOR, 3.90; 95% CI, 2.99-5.10).
- Late PCOS diagnosis was linked to increased odds of advanced maternal age at first childbirth (aOR, 1.98; 95% CI, 1.22-3.22), emphasizing the importance of early diagnosis.
- Compared with women without PCOS, those with PCOS were older at first childbirth (28.8 ± 5.5 vs 29.5 ± 5.5 years) and second childbirth (31.1 ± 5.0 vs 32.1 ± 5.2 years) (P < .001 for both).
IN PRACTICE:
“Women with PCOS have increased infertility and have higher rates of seeking and using ovulation induction and IVF than those without PCOS. Moreover, women with PCOS are older at both first and second childbirth, have longer interconception periods, are of advanced maternal age, and have higher nulliparity and lower fecundity compared with women without PCOS,” the authors of the study wrote.
SOURCE:
This study was led by Maria Forslund, MD, PhD, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg in Sweden. It was published online in American Journal of Obstetrics & Gynecology.
LIMITATIONS:
This study relied on self-reported PCOS diagnosis, though these data were previously validated in the cohort. While dropouts from the study were common, a previous modeling study showed no serious bias in estimates of associations between risk factors and health outcomes in the longitudinal models.
DISCLOSURES:
Forslund received support from the Swedish Medical Society (SLS-984944; SLS986952). The study was funded by the Australian Government’s Department of Health and Aged Care. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
Does Antibiotic Use During Influenza Infection Worsen Lung Immunity?
TOPLINE:
Antibiotic use during influenza infection increases lung eosinophils, impairing immunity against secondary bacterial pneumonia. This study highlights the detrimental effects of antibiotics on lung health during viral infections.
METHODOLOGY:
- Researchers conducted a murine model study to evaluate the impact of antibiotic use during influenza infection on lung immunity. Mice were treated with a broad-spectrum antibiotic cocktail (vancomycin, neomycin, ampicillin, and metronidazole) starting 7 days before influenza infection.
- The study included intranasal infection with influenza virus followed by a secondary challenge with methicillin-resistant Staphylococcus aureus (MRSA).
- Finally, in sub-study, a total of three cohorts of hospitalized patients were evaluated to correlate eosinophil levels with antibiotic use, systemic inflammation, and outcomes.
TAKEAWAY:
- Antibiotic use during influenza infection impairs lung immunity, leading to increased lung eosinophils and reduced macrophage function.
- The study found that antibiotic treatment during influenza infection caused fungal dysbiosis, driving lung eosinophilia and impairing MRSA clearance.
- The detrimental effects of antibiotics on lung immunity were specific to the two-hit model of influenza followed by MRSA infection in mice.
- In hospitalized patients, eosinophil levels positively correlated with antibiotic use, systemic inflammation, and worsened outcomes.
IN PRACTICE:
“Our study highlights the pernicious effects of antibiotic use during viral infections and defines a mechanism whereby antibiotics perturb the gut mycobiome and result in lung eosinophilia. In turn, lung eosinophils, via release of MBP-1, suppress alveolar macrophage clearance of bacteria,” the authors of the study wrote.
SOURCE:
This study was led by Marilia Sanches Santos Rizzo Zuttion, Cedars-Sinai Medical Center in Los Angeles. It was published online in The Journal of Clinical Investigation.
LIMITATIONS:
This study’s limitations included the use of a murine model, which may not fully replicate human immune responses. Additionally, the study focused on a specific antibiotic cocktail, and results may vary with different antibiotics. The findings were also specific to the two-hit model of influenza followed by MRSA infection, limiting generalizability to other infections.
DISCLOSURES:
This study was supported by grants from the National Institutes of Health. Marilia Sanches Santos Rizzo Zuttion received research funding from Pfizer Inc. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Antibiotic use during influenza infection increases lung eosinophils, impairing immunity against secondary bacterial pneumonia. This study highlights the detrimental effects of antibiotics on lung health during viral infections.
METHODOLOGY:
- Researchers conducted a murine model study to evaluate the impact of antibiotic use during influenza infection on lung immunity. Mice were treated with a broad-spectrum antibiotic cocktail (vancomycin, neomycin, ampicillin, and metronidazole) starting 7 days before influenza infection.
- The study included intranasal infection with influenza virus followed by a secondary challenge with methicillin-resistant Staphylococcus aureus (MRSA).
- Finally, in sub-study, a total of three cohorts of hospitalized patients were evaluated to correlate eosinophil levels with antibiotic use, systemic inflammation, and outcomes.
TAKEAWAY:
- Antibiotic use during influenza infection impairs lung immunity, leading to increased lung eosinophils and reduced macrophage function.
- The study found that antibiotic treatment during influenza infection caused fungal dysbiosis, driving lung eosinophilia and impairing MRSA clearance.
- The detrimental effects of antibiotics on lung immunity were specific to the two-hit model of influenza followed by MRSA infection in mice.
- In hospitalized patients, eosinophil levels positively correlated with antibiotic use, systemic inflammation, and worsened outcomes.
IN PRACTICE:
“Our study highlights the pernicious effects of antibiotic use during viral infections and defines a mechanism whereby antibiotics perturb the gut mycobiome and result in lung eosinophilia. In turn, lung eosinophils, via release of MBP-1, suppress alveolar macrophage clearance of bacteria,” the authors of the study wrote.
SOURCE:
This study was led by Marilia Sanches Santos Rizzo Zuttion, Cedars-Sinai Medical Center in Los Angeles. It was published online in The Journal of Clinical Investigation.
LIMITATIONS:
This study’s limitations included the use of a murine model, which may not fully replicate human immune responses. Additionally, the study focused on a specific antibiotic cocktail, and results may vary with different antibiotics. The findings were also specific to the two-hit model of influenza followed by MRSA infection, limiting generalizability to other infections.
DISCLOSURES:
This study was supported by grants from the National Institutes of Health. Marilia Sanches Santos Rizzo Zuttion received research funding from Pfizer Inc. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
Antibiotic use during influenza infection increases lung eosinophils, impairing immunity against secondary bacterial pneumonia. This study highlights the detrimental effects of antibiotics on lung health during viral infections.
METHODOLOGY:
- Researchers conducted a murine model study to evaluate the impact of antibiotic use during influenza infection on lung immunity. Mice were treated with a broad-spectrum antibiotic cocktail (vancomycin, neomycin, ampicillin, and metronidazole) starting 7 days before influenza infection.
- The study included intranasal infection with influenza virus followed by a secondary challenge with methicillin-resistant Staphylococcus aureus (MRSA).
- Finally, in sub-study, a total of three cohorts of hospitalized patients were evaluated to correlate eosinophil levels with antibiotic use, systemic inflammation, and outcomes.
TAKEAWAY:
- Antibiotic use during influenza infection impairs lung immunity, leading to increased lung eosinophils and reduced macrophage function.
- The study found that antibiotic treatment during influenza infection caused fungal dysbiosis, driving lung eosinophilia and impairing MRSA clearance.
- The detrimental effects of antibiotics on lung immunity were specific to the two-hit model of influenza followed by MRSA infection in mice.
- In hospitalized patients, eosinophil levels positively correlated with antibiotic use, systemic inflammation, and worsened outcomes.
IN PRACTICE:
“Our study highlights the pernicious effects of antibiotic use during viral infections and defines a mechanism whereby antibiotics perturb the gut mycobiome and result in lung eosinophilia. In turn, lung eosinophils, via release of MBP-1, suppress alveolar macrophage clearance of bacteria,” the authors of the study wrote.
SOURCE:
This study was led by Marilia Sanches Santos Rizzo Zuttion, Cedars-Sinai Medical Center in Los Angeles. It was published online in The Journal of Clinical Investigation.
LIMITATIONS:
This study’s limitations included the use of a murine model, which may not fully replicate human immune responses. Additionally, the study focused on a specific antibiotic cocktail, and results may vary with different antibiotics. The findings were also specific to the two-hit model of influenza followed by MRSA infection, limiting generalizability to other infections.
DISCLOSURES:
This study was supported by grants from the National Institutes of Health. Marilia Sanches Santos Rizzo Zuttion received research funding from Pfizer Inc. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.