Community-based Cohort Of Women Research Articles

Incident Bacterial Vaginosis in a Community-Based Cohort of Women

Incident Bacterial Vaginosis in a Community-Based Cohort of Women

Association of Caesarean delivery and breastfeeding difficulties during the delivery hospitalization: a community-based cohort of women and full-term infants in Alberta, Canada.

Breastfeeding difficulties are the most common reason for breastfeeding cessation, particularly in the early postpartum. Caesarean delivery is associated with earlier breastfeeding cessation than is the case with vaginal delivery, but differences in breastfeeding difficulties by mode of delivery have not been thoroughly examined. Our objective was to explore the association between Caesarean delivery and types of breastfeeding difficulties. We conducted a secondary analysis of data from a prospective cohort study of mothers who delivered full-term, singleton infants in Calgary, Alberta, Canada (N = 418). Women completed self-report questionnaires during the delivery hospitalization. Mode of delivery was defined as vaginal or Caesarean, and further classified as planned or unplanned Caesarean. Breastfeeding difficulties were measured using the Breastfeeding Experiences Scale and operationalized with binary variables for presence of various types of maternal (i.e. physical, supply, social) and infant (i.e. latch, behaviour/health) difficulties that were reported as moderate to unbearable. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Overall, 37.1% of women had a Caesarean delivery and 80.9% experienced a breastfeeding difficulty during the delivery hospitalization. Of the difficulties studied, Caesarean delivery was significantly associated with low milk supply (AOR = 1.62, 95% CI = 1.16-2.28) and infant behaviour/health difficulties (AOR = 1.33, 95% CI = 1.01-1.75). The association with low milk supply persisted when examining both planned (AOR = 2.42, 95% CI = 1.19-4.92) and unplanned (AOR = 2.21, 95% CI = 1.16-4.22) Caesarean deliveries. Mothers who deliver by Caesarean have higher odds of reporting low milk supply and infant behaviour/health difficulties than women who deliver vaginally.

Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome: data from a large community-based cohort study.

Polycystic ovary syndrome (PCOS) affects 6%-21% of women. PCOS is the primary cause of anovulatory infertility, with major health and economic costs, yet we are unaware of any community-based, natural history studies on fertility and fertility treatments published to date. We aim to compare infertility, fertility treatment use, and relationship to body mass index (BMI) in women reporting PCOS to women not reporting PCOS in a community-based population. This is a cross-sectional analysis of a longitudinal cohort study, the Australian Longitudinal Study on Women's Health (ALSWH). For the ALSWH, women from the general community were randomly selected from the national public insurance database. Mailed survey data were collected at multiple time points. At survey 4, there were 9145 respondents aged 28-33 years. Of 8612 women with known PCOS status, 478 women reported having PCOS. Information regarding fertility status was available for 4856 women. This was the subgroup used in this analysis. The main outcomes measures are self-reported PCOS status, BMI, infertility, and use of fertility therapies including ovulation induction and in vitro fertilization (IVF). Logistic regression was used to examine factors associated with infertility and use of fertility treatment. Self-reported PCOS prevalence was 5.8% (95% confidence interval [CI]: 5.3%-6.4%). Infertility was noted by 72% of 309 women reporting PCOS, compared with 16% of 4547 women not reporting PCOS (p<0.001). Infertility was 15-fold higher in women reporting PCOS (adjusted odds ratio 14.9, 95% CI 10.9-20.3), independent of BMI. Of women reporting infertility, there was greater use of fertility hormone treatment, (62%, n=116 vs. 33%, n=162, p<0.001) in women reporting PCOS; however, IVF use was similar. In this community-based cohort of women, infertility and use of fertility hormone treatment was significantly higher in women reporting PCOS. Considering the prevalence of PCOS and the health and economic burden of infertility, strategies to optimize fertility are important.

Occupational stigma as a primary barrier to health care for street-based sex workers in Canada

Individuals working in the sex industry continue to experience many negative health outcomes. As such, disentangling the factors shaping poor health access remains a critical public health priority. Within a quasi-criminalised prostitution environment, this study aimed to evaluate the prevalence of occupational stigma associated with sex work and its relationship to barriers to accessing health services. Analyses draw on baseline questionnaire data from a community-based cohort of women in street-based sex work in Vancouver, Canada (2006–2008). Of a total of 252 women, 141 (55.9%) reported occupational sex work stigma (defined as hiding occupational sex work status from family, friends and/or home community), while 125 (49.6%) reported barriers to accessing health services in the previous six months. In multivariable analysis, adjusting for sociodemographic, interpersonal and work environment risks, occupational sex work stigma remained independently associated with an elevated likelihood of experiencing barriers to health access. Study findings indicate the critical need for policy and societal shifts in views of sex work as a legitimate occupation, combined with improved access to innovative, accessible and non-judgmental health care delivery models for street-based sex workers that include the direct involvement of sex workers in development and implementation.

The role of modifiable pre‐pregnancy risk factors in preventing adverse fetal outcomes among women with type 1 and type 2 diabetes

We investigated the fetal outcomes of pregnancy in women with pre-existing diabetes in relation to pre-pregnancy risk factors using a community-based cohort of women in Tayside, Scotland. There were 211 pregnancies in 132 women with insulin-requiring type 1 and 2 diabetes between January 1993 and December 2005. Adverse fetal outcome was classified as spontaneous miscarriage, termination for medical reasons, stillbirth, neonatal death, or congenital malformation and occurred in 61 (29%) pregnancies. Mothers with poor glycemic control pre-conceptually and at booking (HbA(1c)=7.5%) had almost a three-fold increase in adverse fetal outcome compared with mothers having fair control, odds ratio (OR) 2.59 (95% CI 1.11-6.03), and 2.71 (95% CI 1.39-5.28), respectively. Mothers who were still smoking at the booking visit had a two-fold increase in adverse fetal outcome (OR 2.12, 95% CI 1.09-4.10). Further improvement in the management of diabetes and pregnancy is needed through enhanced preconception services addressing the full spectrum of modifiable risk factors.

Community‐based, Prospective, Controlled Study of Obstetric and Neonatal Outcome of 179 Pregnancies in Women with Epilepsy

This study evaluated obstetric and neonatal outcome in a community-based cohort of women with active epilepsy (WWAE) compared with the general pregnant population receiving modern obstetric care. We reviewed the total population who gave birth between January 1989 and October 2000 at Kuopio University Hospital. Obstetric, demographic, and epilepsy data were collected prospectively from 179 singleton pregnancies of women with epilepsy and from 24,778 singleton pregnancies of unaffected controls. The obstetric data from the pregnancy register was supplemented with detailed neurologic data retrieved from the medical records. The data retrieved were comprehensive because of a follow-up strategy according to a predecided protocol. During pregnancy, the seizure frequency was unchanged, or the change was for the better in the majority (83%) of the patients. We found no significant differences between WWAE and controls in the incidence of preeclampsia, preterm labor, or in the rates of caesarean sections, perinatal mortality, or low birth weight. However, the rate of small-for-gestational-age infants was significantly higher, and the head circumference was significantly smaller in WWAE. Apgar score at 1 min was lower in children of WWAE, and the need for care in the neonatal ward and neonatal intensive care were increased as compared with controls. The frequency of major malformations was 4.8% (-0.6-10.2%; 95% confidence interval) in the 127 children of WWAE. Pregnancy course is uncomplicated and neonatal outcome is good in the majority of cases when a predecided protocol is used for the follow-up of WWAE in antenatal and neurologic care. Long-term follow-up of the neurologic and cognitive development of the children of WWAE is still needed.