JEALOUS? COULD BE YOUR PILL
The amount of synthetic estrogen in combined oral contraceptives may help explain why pill users have stronger jealous responses than nonusers, according to Dutch researchers.1 In an online survey of 275 women taking combined pills, those using preparations with low doses (30–35 mcg) of ethinyl estradiol reported significantly higher levels of jealousy on a 15-item scale than did users of ultra-low-dose formulations (which contain 20 mcg of estrogen). The progestin concentration of the pills was not associated with jealousy. Given these findings, the investigators recommend that future research on the effects of estrogen on emotional outcomes distinguish not only between pill users and nonusers, but among users of different types of combined oral contraceptives. Furthermore, they note that the "push" to develop pills with lower doses of ethinyl estradiol is driven by consideration of physical side effects of estrogen, but that the potential psychological side effects also merit attention.
1. Cobey KD et al., Hormonal birth control use and relationship jealousy: evidence for estrogen dosage effects, Personality and Individual Differences, 2010, DOI: 10.1016/j.paid.2010.09.012, accessed Dec. 30, 2010.
MEDICATIONS NOT TO TAKE
The pill is the most common contraceptive method used by women who take medications with known risks of causing birth defects, but results of a study of prescription medication claims suggest that many such women do not adhere to their oral contraceptive regimens.1 The study was based on pharmacy records from 2008–2009 on more than six million women aged 18–44, nearly 150,000 of whom had prescriptions for Category X medications—drugs that the Food and Drug Administration considers inappropriate for use by women who are or may become pregnant, because the medications’ teratogenic risks outweigh their benefits and safer alternatives are available. Eighteen percent of women taking Category X drugs also took the pill. Of these women, 60% were classified as adhering to their oral contraceptive regimen, meaning that they appeared to have missed no more than two pills per month; adherence was classified as low for 19% and low moderate for 22%. Adherence was inversely related to women’s total number of medications and was more likely among women taking statins than among those on other types of Category X drugs. The investigators speculate that a poor understanding of the risks or inadequate counseling may explain lack of adherence among women taking teratogenic medications, and they encourage future research to explore interventions to improve adherence.
1. Steinkeller A, Chen W and Denison SE, Adherence to oral contraception in women on Category X medications, American Journal of Medicine, 2010, 123(10):929–934.
TRYING TO CONCEIVE? RELAX!
High levels of alpha-amylase, a biomarker for stress that is found in the saliva, were associated with reduced odds of conception in a British study involving 274 women aged 18–40 who were trying to become pregnant.1 The association was evident in analyses adjusting for both women’s and their partners’ ages, women’s alcohol consumption and frequency of intercourse during the fertile window—that is, the period beginning five days before the expected date of ovulation and ending one day after ovulation. Alpha-amylase level also was negatively related to the odds of conception on each day of the fertile period. According to the researchers, the findings suggest that couples trying to conceive should attempt to minimize stress, and "this message becomes even more important, … given the longstanding concern that stressors during pregnancy adversely affect fetal and infant well-being."
1. Buck Louis GM et al., Stress reduced conception probabilities across the fertile window: evidence in support of relaxation, Fertility and Sterility, 2010, DOI: 10.1016/j.fertnstert.2010.06.078.
AFTER PID, WHAT CARE DO TEENAGERS NEED?
Adolescents who receive a diagnosis of pelvic inflammatory disease (PID) may need follow-up care that is particularly focused on risky behaviors.1 In a study of 831 women aged 14–38 enrolled in a large trial assessing PID treatment strategies, teenagers were significantly more likely than adults to test positive for gonorrhea or chlamydia 30 days after receiving a PID diagnosis (20% vs. 5%), despite reporting a higher level of condom use. Significantly greater proportions of teenagers than of older women were pregnant 35 months after learning that they had PID (53% vs. 38%) and 84 months after diagnosis (72% vs. 53%). Teenagers also became pregnant or had another bout of PID sooner than adults did (hazard ratio, 1.5 for each of these outcomes). Levels of adherence to the PID treatment regimen were similar in both age-groups, as were reports of chronic pelvic pain, infertility and recurrent PID 35 and 84 months after diagnosis. The researchers emphasize that all women need care to prevent chronic pain and infertility related to PID, but that adolescents need "more aggressive risk reduction interventions."
1. Trent M et al., Adverse adolescent reproductive health outcomes after pelvic inflammatory disease, Archives of Pediatrics & Adolescent Medicine, 2011, 165(1):49–54.
U.S. TEENAGE BIRTHRATES VARY WIDELY BY STATE
According to preliminary data, in 2008, the birthrate among U.S. teenagers (15–19-year-olds) was 41.5 per 1,000, but marked differences were evident among states.1 New Hampshire registered the lowest rate (19.8), and Mississippi the highest (65.7). On a broader level, rates tended to be highest in the South and lowest in the Northeast and upper Midwest. Final data for 2007 show that historic racial and ethnic disparities persist: Whereas white teenagers gave birth at a rate of 27.2 per 1,000, the rate was 64.2 among blacks and 81.8 among Hispanics. Rates in each racial and ethnic group also varied widely within jurisdictions (including the District of Columbia)—from 4.3 to 54.8 for whites, from 17.4 to 95.1 for blacks and from 31.1 to 188.3 for Hispanics.
1. Mathews TJ et al., State disparities in teenage birth rates in the United States, NCHS Data Brief, Hyattsville, MD: National Center for Health Statistics, 2010, No. 46.
OVERWEIGHT, OBESITY AND BIRTH OUTCOMES
Meta-analyses based on 84 studies confirm that overweight and obesity are associated with some poor birth outcomes.1 The studies, covering roughly 30 years of research in both developed and developing countries, compared overweight and obese women’s risks of having a preterm birth (i.e., one occurring before 37 weeks’ gestation) or a low-birth-weight infant (i.e., one weighing less than 2,500 g) with those of normal-weight women. Overall, the combined data showed no association between overweight and obesity and the risk of preterm birth, but overweight and obese women had an elevated risk of having an induced preterm birth (relative risk, 1.3). In addition, when the analyses included imputed missing values, the overall preterm birth risk was elevated among overweight and obese women (1.2). These women had a reduced risk of having a low-birth-weight infant (0.8); the differential disappeared when imputed missing values were added to the calculations. Noting that preterm birth is "the leading source" of neonatal morbidity and mortality, as well as childhood morbidity, the analysts recommend that overweight and obesity be addressed in prepregnancy counseling so that women "are informed of their perinatal risks and can try to optimise their weight."
1. McDonald SD et al., Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses, BMJ, 2010, 341:c3428, DOI: 10.1136/bmj.c3428, accessed 1/3/11.
BETTER LATE THAN NEVER?
Only 14% of girls and women who initiated the three-dose human papillomavirus (HPV) vaccine regimen at an academic medical center in 2006–2008 had all three shots in seven months, and only 28% completed the regimen within a year;1 at the time, the Centers for Disease Control and Prevention recommended that all three injections be taken within six months. Furthermore, roughly 20–30% of those beginning the regimen had the second and third injections either sooner or later than recommended. Whites and users of injectable contraceptives were more likely than others to complete the vaccine series within seven months and within 12 months. Patients covered by private insurance were more likely than those with public coverage to complete it within seven months, and those with public coverage were more likely than the uninsured to do so within 12 months. Analysts who examined these data note that complete, timely compliance with the regimen is important because the effectiveness of the vaccine if taken in different conditions is unknown.
1. Widdice LE et al., Adherence to the HPV vaccine dosing intervals and factors associated with completion of 3 doses, Pediatrics, 2011, 127(1):77–84.
DON'T OVERDO STRUCTURE
Too much structure may not be helpful in contraceptive counseling, according to results of a study conducted among women seeking vacuum aspiration to terminate a pregnancy or treat an incomplete miscarriage.1 Researchers randomized 222 women attending a private practice in 2008–2009 to receive the usual care (which included counseling by the physician who performed the procedure) or the usual care preceded by counseling by a nonphysician using a flipchart with simple text and graphics providing key information about various contraceptive methods. The two groups of women did not differ with respect to type of contraceptive method they chose (about half elected very effective methods), whether they started using it immediately (e.g., by having an IUD inserted on the same day) or method continuation at a three-month follow-up. Because integrated counseling is routine at the study site, the researchers suggest that supplementary counseling may have been unnecessary. Still, they conclude that "interventions to improve contraceptive use deserve continued study."
1. Langston AM, Rosario L and Westhoff CL, Structured contraceptive counseling—a randomized controlled trial, Patient Education and Counseling, 2010,(3):362–367.
• The first-ever population-based study of the incidence of neonatal herpes simplex virus found that the infection occurred in 9.6 of every 100,000 U.S. newborns in 2006. Incidence did not vary significantly among regions of the country or among racial and ethnic groups, but it was higher in cases for which Medicaid or Medicare was the expected primary payer (15.1) than in those covered by private sources (5.4) or self-pay (2.8). [Flagg EW and Weinstock H, Incidence of neonatal herpes simplex virus infection in the United States, 2006, Pediatrics, 2011, 127:e1–e8, DOI: 10.1542/peds.2010-0134, accessed Jan. 4, 2011.]
• A meta-analysis of 67 studies has found that comprehensive beha-vioral interventions to reduce teenagers’ HIV risk are successful at lowering their STD rates, frequency of sexual activity and numbers of partners; at encouraging them to delay sexual initiation; and at improving condom use and related skills. Interventions aimed at reducing levels of sexual activity were generally not successful if they focused on abstinence. Positive effects were evident for as long as three years after an intervention. [Johnson BT et al., Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985–2008, Archives of Pediatrics & Adolescent Medicine, 2011, 165(1):77–84.]