Health Outcomes For Women Research Articles

Secular trends and urban-rural disparities in the median age at menarche among Chinese han girls from 1985 to 2019.

Menarche is a substantial milestone of female puberty. Timing of age at menarche is considered the key to understanding the potential linkages with women's health outcomes later in life. This study aimed to explore the secular trends and urban‒rural disparities in the median age at menarche among Chinese Han girls from 1985 to 2019. Data were extracted from the 1985, 1995, 2005, 2014, and 2019 Chinese National Surveys on Students' Constitution and Health, which were nationally representative cross-sectional studies, and a total of 173,535 Han girls aged 9-18years were examined. Girls were asked whether menarche had occurred. The median age at menarche was estimated by probit analysis. Z tests were used to compare the differences between survey years and between urban and rural areas. The median age at menarche among Chinese Han girls decreased from 13.37years in 1985 to 12.00years in 2019, and the overall decrease was more significant in rural areas (1.77years) than in urban areas (0.99years). The average five-year change in the decrease in the median age at menarche showed an accelerating and then slowing pace; and it was observed similarly in both urban and rural areas. The urban‒rural disparities shrank from 0.64years in 1985 to 0.44years in 1995, then to 0.27years in 2005, 0.24years in 2014, and finally to -0.14years in 2019. The median age at menarche among Chinese Han girls continued to decline from 1985 to 2019 but at a slowing pace in the last five years. Urban‒rural disparities gradually narrowed. Sexual and reproductive health education and interventions to prevent the decline in the age of menarche are needed, especially in rural areas.

The role of child marriage and marital disruptions on hypertension in women - A nationally representative study from India

Child marriage is associated with negative health trajectories among women in low- and middle-income countries (LMICs). Marital disruptions in LMICs are also associated with adverse socioeconomic and health outcomes in women. Yet, little is known about the compounded health effects of experiencing both child marriage and marital disruptions. Using nationally representative data from India among women aged 18–49 years, we examined the effects of marital age (i.e., marriage before or after 18 years) and martial disruptions (i.e., widowed/divorced/separated) on the odds of having hypertension. Findings suggest that together, marital disruptions and child marriage increase the risk of hypertension. Specifically, women married as children and who experienced marital disruptions were 1.2 (95% CI: 1.2–1.3) times more likely to have hypertension compared to women who married as adults and currently in marriage. Additionally, among women married as children, those who experienced martial disruptions had a higher risk (AOR = 1.1, 95% CI: 1.0–1.2) of hypertension compared to their currently married peers. These results suggest public health strategies must consider contextual effects of being widowed/divorced/separated among women who were married as children. Simultaneously, prevention initiatives should be strengthened to reduce the incidence of child marriage in LMICs and associated downstream health consequences.

Challenges and Opportunities for Data Science in Women's Health.

The intersection of women's health and data science is a field of research that has historically trailed other fields, but more recently it has gained momentum. This growth is being driven not only by new investigators who are moving into this area but also by the significant opportunities that have emerged in new methodologies, resources, and technologies in data science. Here, we describe some of the resources and methods being used by women's health researchers today to meet challenges in biomedical data science. We also describe the opportunities and limitations of applying these approaches to advance women's health outcomes and the future of the field, with emphasis on repurposing existing methodologies for women's health.

The Areola study: design and rationale of a cohort study on long-term health outcomes in women with implant-based breast reconstructions

BackgroundImplant-based breast reconstructions contribute considerably to the quality of life of breast cancer patients. A knowledge gap exists concerning the potential role of silicone breast implants in the development of so-called “breast implant illness” (BII) and autoimmune diseases in breast cancer survivors with implant-based reconstructions. BII is a constellation of non-specific symptoms reported by a small group of women with silicone breast implants. MethodsThe Areola study is a multicenter retrospective cohort study with prospective follow-up aiming to assess the risk of BII and autoimmune diseases in female breast cancer survivors with and without silicone breast implants. In this report, we set out the rationale, study design, and methodology of this cohort study. The cohort consists of breast cancer survivors who received surgical treatment with implant-based reconstruction in six major hospitals across the Netherlands in the period between 2000 and 2015. As a comparison group, a frequency-matched sample of breast cancer survivors without breast implants will be selected. An additional group of women who received breast augmentation surgery in the same years will be selected to compare their characteristics and health outcomes with those of breast cancer patients with implants. All women who are still alive will be invited to complete a web-based questionnaire covering health-related topics. The entire cohort including deceased women will be linked to population-based databases of Statistics Netherlands. These include a registry of hospital diagnostic codes, a medicines prescription registry, and a cause-of-death registry, through which diagnoses of autoimmune diseases will be identified. Outcomes of interest are the prevalence and incidence of BII and autoimmune diseases. In addition, risk factors for the development of BII and autoimmune disorders will be assessed among women with implants. DiscussionThe Areola study will contribute to the availability of reliable information on the risks of BII and autoimmune diseases in Dutch breast cancer survivors with silicone breast implants. This will inform breast cancer survivors and aid future breast cancer patients and their treating physicians to make informed decisions about reconstructive strategies after mastectomy. RegistrationThis study is registered at ClinicalTrials.gov on June 2, 2022 (NCT05400954).

Effectiveness of the Internet of Things for Improving Working-Aged Women’s Health in High-Income Countries: Protocol for a Systematic Review and Network Meta-analysis

Women often experience many unique health issues and conditions throughout their working lives. The Internet of Things (IoT) is a system of interrelated digital devices that can enable data exchanges over a network without human-to-human or human-to-computer interaction. The usage of applications and IoT in improving women's health has recently increased worldwide. However, there has been no consensus on the effectiveness of IoT in improving women's health outcomes. This systematic review and network meta-analysis (NMA) aims to assess and synthesize the role of apps and the IoT in improving women's health and to identify the ranking of interventions for ensuring better results for each stated outcome. Our systematic review and NMA will be conducted in accordance with the guidelines of the Cochrane Handbook. We will comprehensively search the following electronic databases: PubMed (including MEDLINE), Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (ie, CINAHL), PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry, along with other resources to identify relevant randomized controlled trials that have assessed the effects of various apps and the IoT with regard to improving working-aged women's health in high-income countries. We will segment and analyze the results of the included studies based on age categories (women undergoing a preconception period, those undergoing gestational and postpartum periods, and menopausal and pre- and postmenopausal women) and the medical history (women who have a specific medical condition-eg, cancer or diabetes-and women who do not have them) separately. Two independent reviewers will perform the study selection, data extraction, and quality assessment. Our primary outcomes include health status, well-being, and quality of life. We will perform pairwise meta-analysis and NMA to estimate the direct, indirect, and relative effects of apps and the IoT on women's health outcomes. We will also assess the hierarchy of interventions, statistical inconsistencies, and certainties of evidence for each outcome. We plan to conduct the search in January 2023 and are currently discussing search strategies with the literature search specialists. The final report is planned for submission to a peer-reviewed journal in September 2023. To the best of our knowledge, this review will be the first to identify the ranking of IoT intervention for ensuring working-aged women's health outcomes. These findings may be of great use to researchers, policy makers, and others with an interest in the field. International Prospective Register of Systematic Reviews (PROSPERO) CRD42022384620; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=384620. PRR1-10.2196/45178.

Brain responses to food viewing in women during pregnancy and post partum and their relationship with metabolic health: study protocol for the FOODY Brain Study, a prospective observational study

IntroductionFood cravings are common in pregnancy and along with emotional eating and eating in the absence of hunger, they are associated with excessive weight gain and adverse effects on metabolic...

Long-term health effects of a school construction program.

Non-communicable diseases (NCDs) disproportionately affect people in low- and middle-income countries (LMICs), yet context-specific evidence on policies that impact NCD risk factors is lacking. We estimate the impact of a massive Indonesian primary school expansion program in the 1970s on NCD risk factors in later life using data from two surveys with very large sample sizes. We find that in non-Java regions of Indonesia, the program led to significant increases in the likelihood of overweight and high waist circumference among women, but not among men. The increase for women can be partly explained by increased consumption of high-calorie packaged and take-away meals. We find no meaningful impacts on high blood pressure for either sex. Despite the increase in body weight, the program had a negligible impact on diabetes and cardiovascular disease diagnosis. It led to an improvement in women's self-reported health outcomes in their early-40s, but these benefits largely disappeared once they reached their mid-40s.

Role of Maternal and Child Health Handbook on Improving Maternal, Newborn, and Child Health Outcomes: A Systematic Review and Meta-Analysis.

The objective of this review is to assess and synthesize the role of the maternal and child health (MCH) handbook on improving healthcare service utilization, behavior change, and health outcomes for women and children. A systematic search of all relevant existing reports was conducted on 14 January 2021, using the following online bibliographic databases: PubMed, EMBASE, MEDLINE, The Cochrane Library, Academic Search Premier, Emcare, APA PsycINFO, and Web of Science. Two reviewers independently performed study selection, data extraction, and quality assessment. We included 7 trials from 1430 articles, and a total of 2643 women. As overall risk of bias assessment, most domains of the Cochrane risk-of-bias assessment tool showed a high or unclear risk of bias. The risk of ≥6 antenatal care (ANC) visits was 19% higher (RR 1.19, 95% CI 1.09 to 1.30, I2 = 47%, 2 studies, 955 women, moderate certainty of evidence) and skilled birth attendants during delivery was 13% higher (RR 1.13, 95% CI 1.04 to 1.24, I2 = 0%, 2 studies, 1094 women, low certainty of the evidence) in the intervention group than in the control group. The MCH handbook can increase maternal health service utilization and early breastfeeding practice. It also leads to a sense of autonomy during ANC, better communication with healthcare providers, and support from family members.

Determinants of pelvic organ prolapse among gynecologic patients, Northeastern Ethiopia, 2020: A case-control study.

The majority of women in developing countries, including Ethiopia, do not seek medical help; as a result, they face substantial impacts on their health. There is a lack of attention to screening women at high risk for pelvic organ prolapse. Identifying the determinants of pelvic organ prolapse is essential for the early screening and prevention of adverse health outcomes in women. To identify the determinants of pelvic organ prolapse among gynecologic patients at Akesta Hospital, 2020. An unmatched case-control study was conducted among 70 cases and 140 controls. The study participants were selected using a systematic sampling technique. Data were collected by reviewing patient charts. The data were entered into EpiData version 4.6 and analyzed using SPSS version 25. Text, tables, and figures were used for data presentation. P values less than 0.2 in binary logistic regression were entered in multivariable logistic regression. Finally, P values less than 0.05 were considered significant factors for the determinants of pelvic organ prolapse. A total of 189 respondents participated in the study. Of the total respondents, 63 were cases and 126 were controls. Patients whose parity was four or above developed pelvic organ prolapse three times more likely than those whose parity number was less than four (adjusted odds ratio = 3.05; 95% confidence interval: 1.35-6.90; P = 0.007). Patients who are overweight are 8.5 times more likely to develop pelvic organ prolapse than patients with normal weight (adjusted odds ratio = 8.5, 95% confidence interval: 2.75-26.51; P = 0.001). Patients with a history of intestinal obstruction were five times more likely to develop pelvic organ prolapse than their counterparts (adjusted odds ratio = 4.87, 95% confidence interval: 1.61-14.75, P = 0.005). Educational level, being overweight, having four parities and above, minimum duration of labor, history of urinary retention, and intestinal obstruction were determinants of pelvic organ prolapse. Screening should target women with illiteracy, overweight, and whose parity is four and above. Early diagnosis and treatment of urinary retention and intestinal obstruction should be provided to women with pelvic organ prolapse.

Exposure of reproductive-aged pregnant and nonpregnant women to common environmental pollutants and endocrine-disrupting chemicals: A cross-sectional survey at the University of the Philippines-Philippine General Hospital

CONTEXT: Exposure to environmental pollutants (EP) and Endocrine-disrupting chemicals (EDCs) is associated with several general negative health effects which compromise women's reproductive health, maternal, and neonatal outcomes. Unfortunately, many nonpregnant and pregnant women are unaware of their active exposure to these potentially slow-acting toxic substances, EPs, and EDCs. At any stage of life, and in the long-term minute exposures, there is no established safe level of exposure to these substances. Due to the potentially harmful effects on women in general, and to the pregnant and her unborn child in particular, it is important to establish the prevalence of their exposure.AIMS: The aim of this study was to determine the magnitude (prevalence) of exposure among nonpregnant and pregnant women aged 18–49 years to common EPs/EDCs such as bisphenol A, pesticides, phthalates, and perfluorinated compounds among others.SETTINGS AND DESIGN: This study was conducted at the Philippine General Hospital, University of the Philippines Manila.SUBJECTS AND METHODS: The study participants were nonpregnant and pregnant women, with low-risk singleton pregnancy, and had a prenatal checkup and eventual delivery at the Philippine General Hospital. After consent, women were asked to answer a survey focused on their sociodemographics and frequency of exposure to EP- and EDC-containing items.STATISTICAL ANALYSIS USED: Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 α-level of significance. The computer software STATA 13.1 was used for data analysis.RESULTS: One hundred and fifty-nine survey responses by women were analyzed. Possible EDC-containing household items (carpets, linoleum, upholstered, and stain-resistant furniture) are more prevalent in the homes of pregnant women compared to nonpregnant women. Pregnant women are also exposed to wallpapers compared to nonpregnant individuals. Nonpregnant women were 1.5 times more exposed to lotions. Unexposure to hand sanitizers is 1.3 times higher among pregnant individuals.CONCLUSIONS: There are differences in the prevalence of exposure to household EDC-containing items between pregnant and nonpregnant women, with pregnant women having a higher prevalence of exposure.

Factors Influencing Discontinuation of Long-Term Contraceptive Methods

Discontinuation of contraception represents a very important reproductive health problem and has adverse consequences on women's reproductive health outcomes. Worldwide, a large number of women become at risk of conception after discontinuation of contraception. The purpose of this study was to determine the reasons for discontinuation and the factors that influence the discontinuation of long-term contraceptive methods. The research method used is a literature review with article searches using four databases consisting of Pubmed, Sage, Science Direct and Proquest with a publication range of 2012-2022. The keywords used are associated factor and discontinuation of long acting reversible contraception. The findings indicate that the factors that influence the long-term discontinuation of contraceptive methods are marital status, education, counseling, age, parity, occupation, contraceptive satisfaction, partner support, duration to health facilities, desire to get pregnant again and side effects. The most common reason for discontinuing a long-term contraceptive method is due to health problems or side effects. Therefore, health workers should properly advise women about the common side effects of using long-term contraceptive methods and how to manage these side effects.

Does Quality Certification Work? An Assessment of Manyata, a Childbirth Quality Program in India's Private Sector.

In India, more than 60% of hospital beds are in private facilities, yet several studies have observed suboptimal quality of care in private facilities. We aimed to understand the role of Manyata, a quality improvement initiative in private facilities focused on mentorship and clinical standards, to improve the knowledge and skills of health care providers, their adherence to key childbirth-related clinical practices, and health outcomes for women and newborns. We conducted a secondary analysis of Manyata program data collected from 466 private facilities across 3 states (Jharkhand, Maharashtra, and Uttar Pradesh) in India from October 2016 to February 2019. We calculated means and 95% confidence intervals for knowledge and skills assessment, adherence to facility standards was analyzed by calculating the proportion of facilities passing a given quality standard at baseline and endline, and changes in pregnancy outcomes were assessed with autoregression modeling. From assessments conducted before and after training among providers in Manyata, we observed a significant increase in average knowledge score (6.3 vs. 13.2 of 20) and skill score (8.0 vs. 34.3 of 40). Overall, a significant increase occurred in adherence to clinical standards between baseline and endline assessments (29% vs. 93%). The standards with the greatest improvements were identification and management of eclampsia/preeclampsia, postpartum hemorrhage, and neonatal resuscitation. There were no significant changes over time in absolute rate of reported complications; however, referral rates from private facilities for preeclampsia and newborn sepsis identification and management declined. Our analysis indicates private facilities' adherence to quality standards and nurses' childbirth knowledge and practical skills increased during Manyata. Additional efforts are needed to ensure high-quality care during cesarean deliveries at private facilities. Future studies with rigorous design are required to evaluate the impact of this quality improvement initiative in improving pregnancy outcomes.

INVOLUNTARY JOB LOSS AND GENDERED HEALTH OUTCOMES IN MIDDLE AGE AND LATER LIFE: A LIFE COURSE ANALYSIS

Abstract Job loss is associated with a range of negative health outcomes. However, the causality of job loss and poor health is unclear, due to issues of endogeneity and reverse causality (i.e., adverse health causing job loss). We also need a better understanding of the long-term effects of job loss, and how the life stage in which job loss occurred yields different health outcomes for women and men in later life. To address these gaps, we take advantage of a quasi-experimental setting — the policy-driven layoffs of the State-Owned-Enterprises (SOEs) during the 1990s – mid-2000s in urban China. Using the life history survey of the China Health and Retirement Longitudinal Study 2014 and the 2015 wave, we examine the long-term effects of job loss on self-rated health (scored 1 – 5) of individuals in middle age and later life (aged 45+). After controlling for individual childhood health, life-time work history, as well as demographics and socioeconomic status, results from linear regressions show that overall, job loss from SOEs reduces self-rated health by 0.12 (p < .05) for both women and men. However, job loss hurts females’ self-rated health the most when job loss occurred in early-life, a life stage in which childbearing and child caregiving were most intensive (aged 35 or earlier; β = -0.24, p < .05), whereas males’ self-rated health is hardest hit if job loss occurred in mid-life (aged 36 – 45; β = -0.35, p < .01). The results suggest that involuntary job loss produce gendered health outcomes due to gendered life courses.

Offering a lifestyle intervention to women of premenopausal age as primary prevention for cardiovascular disease? – assessing its cost-effectiveness

BackgroundThere is limited evidence of cost-effective primary prevention interventions for cardiovascular disease (CVD) in young women. This study aimed to assess the value for money of primary prevention of CVD in this population.MethodsA Markov microsimulation model consisting of both first-ever and recurrent CVD events was developed to simulate the lifetime intervention impact on cost and health outcomes in women of premenopausal age (30 to 54 years) from the Australian healthcare system perspective. The latest wave of the Australian National Health Survey defined the modelled population’s characteristics. The intervention effectiveness of a lifestyle modification program involving changes in diet and physical activity demonstrated to be effective in this population was sourced from a systematic review and meta-analysis. The first-ever and recurrent CVD probabilities were derived from the CVD risk calculators accounting for socio-demographic and clinical characteristics. Costs and utility weights associated with CVD events and long-term management post-CVD were informed by national statistics/published literature. Sensitivity analyses were undertaken to examine the robustness of base case results.ResultsThe lifestyle modification program was associated with both higher costs and benefits (in terms of quality-adjusted life years, QALYs) as a primary prevention measure of CVD in premenopausal women, with an ICER of $96,377/QALY or $130,469/LY. The intervention led to fewer first-ever (N = −19) and recurrent CVD events (N = -23) per 10,000 women over the modelled life horizon. The avoided cost due to reduced hospitalisations (−$24) and management (−$164) of CVD could partially offset the cost associated with the intervention ($1560). Sensitivity analysis indicated that time horizon, starting age of the intervention, discount rate, and intervention effectiveness were the key drivers of the results. If the intervention was scaled up to the national level (N = 502,095 at-risk premenopausal women), the total intervention cost would be $794 million with $95 million in healthcare cost-savings.ConclusionOffering a lifestyle modification program to premenopausal women in Australia as primary prevention of CVD is not cost-effective from a healthcare system perspective. We should continue to search for new or adapt/optimise existing effective and cost-effective primary prevention measures of CVD for women.

Time to first antenatal care booking and its determinants among pregnant women in Ethiopia: survival analysis of recent evidence from EDHS 2019

Antenatal care is one of the components of the maternal and child continuum of care. Timely booking ANC during pregnancy is of utmost importance to guarantee the best possible health outcomes for women and children. Inappropriate timing of the first ANC booking is associated with poor pregnancy outcomes, including perinatal death, stillbirth, and early neonatal death. According to WHO focused ANC recommendation, every mother should start booking ANC within the first 12weeks of gestational age. However, in developing countries, including Ethiopia, many pregnant mothers were not booking ANC at the recommended time. Thus, this study aims to assess the time to first ANC booking and its determinants in Ethiopia. A survival analysis was conducted to determine time to first ANC booking among 3917 weighted study subjects. The data were extracted from EDHS 2019 using STATA version 17 software. A Kaplan Meier survivor curve was computed to estimate the time of first ANC booking. A Long-rank test was used to compare the difference in survival curves. Weibull Inverse Gaussian shared frailty model was used to identify significant predictors. On multivariable analysis, variables having a p-value of ≤ 0.05 are considered statistically significant. The overall median survival time was four months. The significant determinant of time to first ANC booking are residence (rural [ϕ = 1.111, 95CI: 1.060, 1.164), mother educational level (primary education [ϕ = 0.945, 95CI: 0.915, 0.977], secondary and above educational [ϕ = 0.857, 95CI: 0.819, 0.896]) and wealth index (middle [0.948 (ϕ = 0.948, 95CI: 0.911, 0.986) and rich [ϕ = 0.904, 95CI: 0.865, 0.945]) CONCLUSION: The median time for first ANC booking is 4month, which is higher than the WHO recommended time. The timing of the first ANC booking in Ethiopia was mainly influenced by the residence of women, mother educational level, and wealth index. It is strongly recommended to expose mothers to educational materials and other awareness-creation campaigns, as well as to support disadvantaged women, such as the uneducated, poor, and those living in rural or remote areas.

When women win, we all win-Call for a gendered global NCD agenda.

Gender is a social determinant of health, interacting with other factors such as income, education, and housing and affects health care access and health care outcomes. This paper reviews key literature and policies on health disparities and gender disparities within health. It examines noncommunicable disease (NCD) health outcomes through a gender lens and challenges existing prevailing measures of success for NCD outcomes that focus primarily on mortality. Chronic respiratory disease, one of the four leading contributors to NCD mortality, is highlighted as a case study to demonstrate the gender gap. Women have different risk factors and higher morbidity for chronic respiratory disease compared to men but morbidity is shadowed by a penultimate research focus on mortality, which results in less attention to the gap in women's NCD outcomes. This, in turn, affects how resources, programs, and interventions are implemented. It will likely slow progress in reducing overall NCD burden if we do not address risk factors in an equitable fashion. The article closes with recommendations to address these gender gaps in NCD outcomes. At the policy level, increasing representation and inclusion in global public health leadership, prioritizing NCDs among marginalized populations by global health societies and political organizations, aligning the gendered global NCD agenda with other well-established movements will each catalyze change for gender-based disparities in global NCDs specifically. Lastly, incorporating gender-based indicators and targets in major NCD-related goals and advancing gender-based NCD research will strengthen the evidence base for women's unique NCD risks and health outcomes.

Climate change and women's health: Turning leadership into action.

Climate change is considered the greatest long-term challenge we face, and it comes with a direct impact on women's health and pregnancy outcomes. There are many balances that physicians make in deciding elements of care, but environmental impact has not been a consideration. Health care leaders must recognize the impact of their decisions on carbon footprints and creatively look towards changes that will improve global conditions.

Evaluating Anemia Related Morbidity in Premenopausal Female Minority and Disadvantaged Populations

Title: Evaluating anemia related morbidity in premenopausal female minority and disadvantaged populations Authors: Alexander Krule, M.D. M.S., Kristy Abraham, M.D., David Dulce, Sandra Cuellar Puri Pharm. D., Ameen Salahudeen, M.D. Ph.D., Amina Chaudhry, M.D. Introduction: In the United States, there are pronounced racial disparities in anemia prevalence among adult women under 50 years of age with 3.3% of white, 8.7% of Latina, and 24.4 % of Black women affected. The most common etiology of this anemia is iron deficiency anemia (IDA) affecting up to 12% of reproductive-aged American women across all racial groups with a disparate increased burden of IDA among Black women where 19% have iron deficiency. This presents an opportunity for multimodal interventions for patients and the medical community to improve health outcomes in women with iron deficiency anemia. The purpose of this study is to assess the severity and burden of iron deficiency anemia in the Black versus non-Black communities at University of Illinois (UI Health). Methods: We underwent a retrospective chart review of patients at UI Health with anemia from 1 June 2011 - 21 May 2021. Included patients were 18-40 years old, listed female sex in their charts, and had a diagnosis of iron deficiency anemia defined as serum hemoglobin less than 12 mg/dL and serum ferritin less than 30 ng/mL or transferrin saturation less than 19%. Exclusion criteria were male sex, amenorrhea, induced menopause, primary ovarian insufficiency, history of bariatric procedures circumventing the duodenum, autoimmune disease, and heart failure. In total, 951 patients with iron deficiency anemia were identified, of which 756 met criteria for analysis. We then grouped patients by listed race and ethnicity and stratified patients by severity of anemia as defined by the World Health Organization (WHO). WHO anemia severity grades anemia based on hemoglobin ranging from Grade 0 for hemoglobin values within reference range to Grade III and Grade IV for severe and life-threatening hemoglobin values below 7.9 and 6.5 g/dL, respectively. Statistical differences between groups were analyzed by ANOVA and logistic regression models. Results: Of the 756 patients included in the analysis, 68% identified as Black, 21% as Latinx, 12% as White, 5% as Asian, and 0.7% as American Indian/Alaskan Native. A one-way ANOVA revealed that there was a statistically significant difference in mean hemoglobin values between groups. Testing of the a priori hypotheses were conducted using Bonferroni adjusted alpha levels of .0125 (0.5/4) per test and showed a significantly lower mean serum hemoglobin for Black patients (M=9.7, SD=0.6) than non-Black patients (M=10.4, SD=0.4, F(4,1242)=14.8, p<10-11). In an unadjusted logistic regression model, Black race was significantly associated with more severe degree of anemia compared to non-Black race (OR=1.79, 95% CI [1.38,2.32]). Conclusion: More than two-thirds of female patients of reproductive age in the UI Health patient population with iron deficiency anemia self-report as Black. Black patients in this population have clinically significant lower hemoglobin levels than non-Black patients, and have a significantly increased hazard ratio for severe anemia. In our health system, symptomatic patients with severe and life-threatening anemia require emergent blood transfusion as standard of care, incurring further risk of morbidity and potentially mortality. Given the disparity we observe, and increased hazard for severe and potentially life-threatening anemia warrants further assessment into the delivery of healthcare to this underrepresented patient population. Evaluating what barriers may exist in delivering care to IDA patients in screening, diagnosis, and management of oral versus parenteral iron therapy should also be further studied. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Reproductive health in Turner syndrome: A narrative review.

Turner syndrome (TS), a common chromosomal abnormality affecting females, is associated with partial or complete loss of the second sex chromosome. Although the classic karyotype is 45, X, the detection of mosaic TS is increasing. TS is a multi-system disorder with significant endocrine, cardiovascular and reproductive impacts. Accelerated ovarian follicular loss leads to primary amenorrhoea or premature ovarian insufficiency and infertility. Early diagnosis and counselling regarding hormone replacement therapy and future reproductive capacity, including fertility preservation, are essential to improve reproductive outcomes. Pubertal induction or estrogen replacement is usually required to optimise long-term health outcomes; however, initiation may be delayed due to delayed diagnosis. Spontaneous pregnancy occurs in a small number of women; however, many require donor oocytes and assisted reproductive technology to achieve a pregnancy. Pregnancy is a high risk especially when associated with congenital heart disease. Prepregnancy counselling by the multidisciplinary team (MDT) to identify contraindications and optimise pre-existing health issues is essential. Pregnancy management should be led by a maternal-fetal medicine unit with input from the MDT. This review examines reproductive health outcomes in women with TS and how best to manage them to reduce health risks and improve maternal and neonatal outcomes.

Socially Assigned Race and the Health of Racialized Women and Their Infants.

While historically most public health research has relied upon self-identified race as a proxy for experiencing racism, a growing literature recognizes that socially assigned race may more closely align with racialized lived experiences that influence health outcomes. We aim to understand how women's health behaviors, health outcomes, and infant health outcomes differ for women socially assigned as nonwhite when compared with women socially assigned as white in Massachusetts. Using data from the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) Reactions to Race module, we documented the associations between socially assigned race (white vs. nonwhite) and women's health behaviors (e.g., initiation of prenatal care, breastfeeding), women's health outcomes (e.g., gestational diabetes, depression before pregnancy), and infant health outcomes (e.g., preterm birth, low birth weight [LBW]). Multivariable models adjusted for age, marital status, education level, nativity, receipt of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance during pregnancy, infant sex, plurality, and gestational age. Additional models adjusted for treatment by race, how often one thinks about race, and nativity. Women socially assigned as nonwhite had higher odds of breastfeeding (adjusted odds ratio [AOR]: 1.86, 95% confidence interval [CI]: 1.54 to 2.25), lower odds of consuming alcohol (AOR: 0.27, 95% CI: 0.24 to 0.31), and lower odds of smoking (AOR: 0.30, 95% CI: 0.24 to 0.38) compared with those socially assigned as white. However, women socially assigned as nonwhite had higher odds of reporting gestational diabetes (AOR: 1.97, 95% CI: 1.49 to 2.61). Mothers socially assigned as nonwhite also had higher odds of giving birth to an LBW (AOR: 1.66, 95% CI: 1.29 to 2.14) and small-for-gestational age (AOR: 1.46, 95% CI: 1.19 to 1.80) infant compared with women socially assigned as white. In comparison with women socially assigned as white, we observed poorer health outcomes for women who were socially assigned nonwhite despite engaging in more beneficial pregnancy-related health behaviors. Socially assigned race can provide an important context for women's experiences that can influence their health and the health of their infants.