Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 40, Number 2, June 2008
FYI


PREGNANT? GO DO A BIATHLON

Exercise—lots of it—during the second trimester of pregnancy was associated with reduced risks of preterm birth among women who delivered at a Danish hospital in 1989–1991.1 In a sample of 5,749 healthy women surveyed at about 16 weeks’ gestation, the risk of preterm delivery among those who trained in two or more sports was only a fraction that among women who participated in no sports (odds ratio, 0.1 in analyses adjusting for potentially confounding social, lifestyle and obstetric factors). Similarly, the risk was reduced for women who spent more than three hours each week engaged in moderate or heavy physical activity, including sports (0.3). Women who trained in one sport and those who reported light physical activity showed a tendency toward a reduced risk of preterm delivery, but the results were only marginally significant. The analysts acknowledge that because of limitations of their study design, the findings must be interpreted cautiously. However, they point out that rates of preterm delivery have been on the rise in North America and Europe, and encourage further efforts to explore “potentially preventable risk factors.”

1. Hegaard HK et al., Leisure time physical activity is associated with a reduced risk of preterm delivery, American Journal of Obstetrics & Gynecology, 2008, 198(2):180.e1–180.e5.

SEX EDUCATION: WHAT WORKS?

In the face of ongoing debate about comprehensive versus abstinence-only sex education, an analysis of data from the 2002 National Survey of Family Growth suggests that if either approach is having an effect, it is the comprehensive strategy.1 Teenage survey respondents who had had comprehensive sex education were less likely than those who had had no formal sex education to report involvement in a pregnancy (adjusted odds ratio, 0.4); the same was not true for participants who had received abstinence-only instruction. In addition, adolescents who had received comprehensive instruction were marginally less likely than those who had had no sex education to be sexually experienced (0.7); again, no similar relationship was apparent for youth who had received abstinence-only education. Neither type of sex education was associated with adolescents’ likelihood of ever having had an STD. Despite a number of study limitations, the investigators conclude that “formal comprehensive sex education programs [may] reduce the risk for teen pregnancy without increasing the likelihood that adolescents will engage in sexual activity.”

1. Kohler PK, Manhart LE and Lafferty WE, Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy, Journal of Adolescent Health, 2008, 42(4):344–351.

WHO SMOKES WHILE PREGNANT?

Nicotine dependence is a key predictor of cigarette smoking during pregnancy, according to findings from the 2001–2002 National Epidemiological Survey on Alcohol and Related Conditions.1 The survey included 453 pregnant women between the ages of 18 and 50, of whom 12% were current smokers. Among a subgroup of these women who reported a lifetime history of smoking daily, analyses controlling for demographic characteristics, smoking history and the presence of specific psychiatric or substance disorders revealed significantly elevated odds of smoking during pregnancy for those who had less than a high school education (odds ratio, 2.2) or were nicotine-dependent (4.7); the odds were marginally raised for those who had begun smoking cigarettes by age 14 (1.5). Results were similar for women who had smoked in the previous 12 months; for this subgroup, smoking by age 14 was a significant predictor of smoking during pregnancy. Further analysis, based on small numbers, suggested that the prevalence of smoking was elevated among nicotine-dependent women at every educational level. The researchers remark that the findings highlight not only the need to reach pregnant women with effective smoking cessation programs, but also the need to prevent nicotine dependence, “particularly among individuals with lower levels of education,…to reduce inequalities in tobacco-related diseases.”

1. Gilman ST et al., Social factors, psychopathology, and maternal smoking during pregnancy, American Journal of Public Health, 2008, 98(3):448–453.

RAPID HIV TESTS NOT WIDELY USED IN COMMUNITY SETTINGS

Despite the logistical and cost advantages of rapid HIV tests, they are seldom used in private, nonprofit community health settings that provide HIV testing.1 Findings from a 2005–2006 nationally representative survey of such sites in urban areas indicate that only 17%—including 22% of community clinics and 10% of community-based organizations—provide rapid tests. Use of rapid HIV tests is more common in the South than in the West (odds ratio from multivariate analysis, 2.9) and is positively associated with the prevalence of AIDS in the community (1.7). The likelihood that rapid tests are used is also elevated at clinics or organizations that have multiple locations (1.9) or on-site laboratories (3.1), or that perform other diagnostic services (13.4). “Rapid HIV testing,” the investigators note, “gives community health settings great flexibility to provide testing to high-risk clients who may not routinely visit health care settings.” Research on barriers to HIV testing in community health settings and efforts to streamline service provision, they conclude, could help expand the use of rapid testing and “ultimately help to realize the…goal of universal awareness of HIV status in a way that is feasible for and acceptable to both clients and health care providers.”

1. Bogart LM et al., Scope of rapid HIV testing in private nonprofit urban community health settings in the United States, American Journal of Public Health, 2008, 98(4):736–742.

ANTIDEPRESSANTS IN PREGNANCY

Nearly 7% of deliveries covered by seven HMO plans in 2001–2005 were to women who received an antidepressant during pregnancy.1 Six percent of the almost 120,000 deliveries included in a retrospective study were to women who were given selective serotonin reuptake inhibitors, and 37% of these women had prescriptions for their antidepressant filled one or more times per trimester. The overall use of antidepressants and the use of selective serotonin reuptake inhibitors increased sharply from 1996 to 2004, when both trends plateaued. The researchers note that prenatal exposure to antidepressants, particularly selective serotonin reuptake inhibitors, has been linked to a broad range of adverse health outcomes for both women and their infants. Moreover, they add that their findings are generalizable “at a minimum” to the one in four U.S. residents who are enrolled in HMOs. Therefore, the investigators consider antidepressant use during pregnancy “an important drug safety issue” and stress that further research “is urgently needed…to assist prescribers and patients in making informed treatment decisions.”

1. Andrade SE et al., Use of antidepressant medications during pregnancy: a multisided study, American Journal of Obstetrics & Gynecology, 2008, 198(2):194.e1–194.e5.

GET OUT OF JAIL, BUT KEEP TAKING YOUR MEDS

If the experiences of a small sample of HIV-infected individuals in San Francisco jails are any indication, interventions are needed to ensure that once inmates are released, they adhere to prescribed medical regimens.1 For all 177 inmates in the sample, the current incarceration was at least the second within a year; at the time of their previous release, those known to have HIV infection had been linked to a program that would provide up to five months of HIV-related services, and those taking highly active antiretroviral therapy (HAART) had been given a week’s supply of their medications and a prescription for a month’s refill. However, in the month preceding their reincarceration, 59% of those who were on HAART had not taken their drugs, and 52% of those who had taken them had missed two or more doses a week. Other findings pointing to a need for postrelease interventions were low use of available services and substantial levels of unprotected sex and other risky behaviors. According to the researchers, interventions that begin during incarceration and continue after release “are critical to improving health outcomes for inmates who are HIV infected and preventing further HIV transmission in the community.”

1. Clements-Nolle K et al., Highly active antiretroviral therapy use and HIV transmission risk behaviors among individuals who are HIV infected and were recently released from jail, American Journal of Public Health, 2008, 98(4):661–666.

NEW PREGNANCY DATA OUT

The latest federal statistics show that in 2004, U.S. women had an estimated 6.4 million pregnancies, of which 4.1 million ended in live births, 1.2 million were terminated by abortions and 1.1 million ended in fetal losses.1 The overall pregnancy rate has been fairly stable in recent years and now stands at 103 pregnancies per 1,000 women aged 15–44; rates among women in their teens and early 20s, however, have declined steadily since the mid-1990s. Teenagers’ 2004 pregnancy rate of 72 per 1,000 was the lowest ever recorded for 15–19-year-olds. Black and Hispanic women have considerably higher pregnancy rates than white women (139 and 146, respectively, compared with 84 per 1,000), and rates peak in younger age-groups among these minority populations than among whites. For U.S. women overall, fertility rates have climbed slowly and abortion rates have fallen steadily since the 1990s. For teenagers, both measures dropped substantially through 2004, when 41 births and 20 abortions occurred per 1,000 teenagers; however, preliminary data suggest that teenagers’ birthrate rose between 2005 and 2006.

1. Ventura SJ et al., Estimated pregnancy rates by outcome for the United States, 1990–2004, National Vital Statistics Reports, 2008, Vol. 56, No. 15.

MISSED HIV DIAGNOSES: MAJOR OOPS

Early diagnosis of HIV infection is important for individual and public health, but opportunities for early diagnosis are often missed.1 A review of the records of 76 symptomatic clients of a British HIV clinic showed that 40 had visited a health care provider after developing symptoms, but only 21 had had their infection correctly diagnosed at that time. Of the 19 whose infections were missed, 17 were men who have sex with men, and 15 had seen a general practitioner. According to the researchers, these findings highlight two important problems: Symptomatic individuals do not always seek medical care, and providers do not always assess symptomatic patients for the presence of HIV infection. Therefore, the authors conclude that strategies to facilitate the diagnosis of HIV “need to consider both patient and provider.” In particular, individuals in high-risk groups should be encouraged to seek care when they experience symptoms of infection, and providers who do not specialize in this area should be taught to recognize signs of acute infection.

1. Sudarshi D et al., Missed opportunities for diagnosing primary HIV infection, Sexually Transmitted Infections, 2008, 84(1):14–16.