Implications For Family Planning Research Articles

SAT674 Lipodystrophy: A Hidden Culprit In Uncontrolled Diabetes

Abstract Disclosure: F. El Sayed: None. A. Banka: None. Introduction: Lipodystrophies are rare disorders with selective absence/accumulation of fat tissue. The “common” genetic forms include Congenital Generalized Lipodystrophy or Familial Partial Lipodystrophy (FPLD). Non-genetic factors like autoimmune disorders, chronic infections, or malnutrition can also contribute to a lipodystrophy phenotype. Clinical case: A 49-year-old female with diabetes mellitus, hypertriglyceridemia, gait disturbances, hypertension, hereditary hemorrhagic telangiectasias, asthma, presents with suspected lipodystrophy. She notes truncal obesity as a child, with progression as an adult and subsequent loss of volume from her arms and legs around age 30. Family history is significant for multiple family members with diabetes mellitus. On physical exam, the patient has a BMI of 22.86 kg/m2. She walks with a cane and has abdominal fat deposition, a dorsocervical fat pad, and reduced fat and muscle mass in her lower extremities. Her diabetes is poorly controlled with multiple complications including retinopathy, microalbuminuria, neuropathy, CVA, and CAD. Her medications include metformin, pioglitazone, detemir, aspart, and an insulin sliding scale for diabetes management, and rosuvastatin, fenofibrate, and omega-3-acid ethyl esters for hyperlipidemia. Her last A1C was 12.7%, and urine analysis was positive for glucosuria and ketonuria. Her lipid panel revealed high triglycerides (800s) and low HDL levels. Other pertinent labs include elevated GDF15 at 761 pg/mL. and lactate elevation at 3.4 mml/L. Given suspicion for hypercortisolism, she underwent a dexamethasone suppression test which was negative for Cushing’s disease. She subsequently underwent exome sequencing with mitochondrial deletion testing, which led to the diagnosis of FPLD. Discussion: FPLD results in loss of fat from the extremities starting around puberty, often leading to metabolic complications. Although both sexes are affected, women usually present with more severe disease. Currently, multiple genes are associated with FPLD, most commonly LMNA and PPARG which both follow autosomal dominant inheritance. Conclusion: Presently, there is no cure for lipodystrophy syndromes. However, in patients with diabetes and resistant metabolic syndrome features, a diagnosis of lipodystrophy should be considered. Further evaluation with genetic testing is warranted and has implications for family planning and medical management. Presentation: Saturday, June 17, 2023

Mutagenic effect of chemotherapy on sperm DNA and implications for family planning.

Mutagenic effect of chemotherapy on sperm DNA and implications for family planning.

Implications of Medical Board Certification Practices on Family Planning and Professional Trajectory for Early Career Female Radiation Oncologists

PurposeOur purpose was to evaluate the effect of the current structure and schedule of the American Board of Radiology (ABR) radiation oncology initial certification (RO-IC) examinations, with a primary focus on implications for family planning and early professional barriers among female radiation oncologists. Methods and MaterialsA survey was conducted of crowdsourced ABR candidates and diplomates for radiation oncology between June and July of 2020. The primary study cohort was early career female radiation oncologists of the 2016 through 2021 graduating classes. ResultsThe survey response rate of early career female radiation oncologists was 37% (126 of an estimated 337). Among this cohort, 58% (73 of 126) reported they delayed or are currently delaying/timing pregnancy or adoption to accommodate the annual schedule of the 4 qualifying and certifying examinations required to achieve board certification in radiation oncology. One in every 3 respondents who had attempted to become pregnant reported experiencing infertility (25 of 79, 32%). Women who reported intentionally delaying pregnancy to accommodate the ABR RO-IC examination schedule were significantly more likely to experience infertility (46% vs 18%, P = .008). Seven women (6%) reported at least a 1-year delay in sitting for a RO-IC examination due to an unavoidable scheduling conflict related to childbirth and/or the peripartum period. A majority reported that full board certification had a significant effect on achieving academic promotion or professional partnership (52%), annual compensation (54%), and nonclinical professional commitments (58%) — these rates mirror those of surveyed early career male counterparts (n = 101). ConclusionsThe current structure and scheduling of the ABR RO-IC examinations imposes noteworthy hurdles for many female radiation oncologists when entering the workforce. The recent transition to virtual examination platforms creates an important opportunity to increase flexibility in the structure and scheduling of the board examination process to improve equitable board certification practices.

Age at last birth and risk of developing breast cancer: a meta-analysis.

Results from epidemiologic studies on age at last birth (ALB) and the risk of developing breast cancer were inconsistent. Therefore, we conducted this meta-analysis to evaluate the association between ALB and the risk of developing breast cancer quantitatively. Relevant articles published up to May 2019 were identified by searching systematically in PubMed, Web of Science, China National Knowledge Infrastructure, and Wan Fang Med Online. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Dose-response relationship was assessed by restricted cubic spline model. Fourteen studies with 132 133 cases and 1 314 005 participants were eligible for this meta-analysis. The pooled RR (95% CI) of breast cancer for the highest vs. the lowest stratification of ALB was 1.22 (1.04-1.42). In the subgroup analysis, significant positive associations were also found in studies conducted in Europe (RR: 1.21, 95% CI: 1.06-1.38), studies with results adjusted for parity (RR: 1.26, 95% CI: 1.04-1.54), and studies with results adjusted for age at first birth (RR: 1.37, 95% CI: 1.08-1.74). The results of the dose-response analysis indicated that the departure from linearity was NS between ALB and the risk of breast cancer (Pnonlinearity = 0.711), but the linear associations were NS. This meta-analysis suggested that ALB was positively associated with the risk of breast cancer. The risk of developing breast cancer increased gradually with the ALB for women. Our findings may have implications for family planning.

Genetics 101: understanding transmission and genetic testing of inherited bleeding disorders

Abstract Haemophilia is an X-linked inherited disorder that affects males and females, though the bleeding risk in girls and women has traditionally been under-recognised. About one third of haemophilia cases occur in individuals where there is no known family history. The gene mutations for rare bleeding disorders are not carried on the X chromosome and are therefore not sex-linked; however, the risk of passing on the condition is greatly increased for consanguineous parents where both parents may carry a copy of the fault in the genetic code which causes the condition. Genetic testing should be offered to every prospective mother, ideally before conception. This should be supported by counselling as the implications for family planning are profound. Von Willebrand factor (VWF) has an important role in primary and secondary haemostasis. Loss of function or low levels of VWF are associated with spontaneous bleeding causing nosebleeds, heavy periods and bruising as well as jpost-surgical bleeding. Joint bleeding and intracranial haemorrhage can also occur in those with a severe type of VWF. Diagnosis depends on bleeding assessment, family history and measurement of VWF. There are three types of VWD: Types 1 and 3 are caused by low or absent levels of VWD; Type 2 is caused by loss of function. Of these, Type 3 VWD is associated with the most severe bleeding risk but there is wide variation in bleeding phenotype among the other sub-types. The correlation between genetic mutation and bleeding phenotype is weak in VWD; therefore genetic testing is mainly useful for interpreting the risk when planning a family and to allow prenatal diagnosis in severe bleeding disorders. Genetic testing is essential for prospective parents to make fully informed decisions about having a family and how or whether to proceed with a pregnancy. The rationale for prenatal testing is to determine the bleeding status of the foetus and to inform decisions about managing delivery. Women may choose to terminate a pregnancy to avoid having a child with severe haemophilia. For some couples the option of adoption or not having children may be explored. Options for prenatal diagnostic testing include non-invasive methods, e.g. assessment of free foetal DNA in maternal plasma to determine the sex of a baby from 10 weeks in pregnancy, and invasive methods, e.g. chorionic villus sampling or amniocentesis, to determine the inheritance of the genetic mutation. Invasive methods are associated with a very small increased risk of pregnancy loss or early labour, which many couples feel is an unacceptable risk. Advanced techniques such as preimplantation screening also available, but require a huge commitment as this involves an IVF technique.

Social and traditional practices and their implications for family planning: a participatory ethnographic study in Renk, South Sudan

BackgroundUnderstanding what determines family size is crucial for programmes that aim to provide family planning services during and after conflicts. Recent research found that development agents in post conflict settings do not necessarily take time to understand the context adequately, translate their context understanding into programming, or adjust programming in the light of changes. South Sudan, a country that has been suffering from war for almost 50 years, has one of the highest maternal death rates and the lowest contraceptive utilization rates in the world.MethodsThis research used Participatory Ethnographic Evaluation and Research (PEER) to provide a contextualised understanding of social and traditional practices and their implications for family planning. Fourteen women were recruited from 14 villages in Renk County in South Sudan in the period 2010–2012. They were trained to design research instruments, conduct interviews, collect narratives and stories and analyse data to identify, prioritize and address their maternal health concerns.ResultsAs a result of wars, people are under pressure to increase their family sizes and thus increase the nation’s population. This is to compensate for the men perished in war and the high child death rates. Large family size is regarded as a national obligation. Women are caught up in a vicious cycle of high fertility and a high rate of child mortality. Determinants of large family size include: 1) Social and cultural practices, 2) Clan lineage and 3) Compensation for loss of family members. Three strategies are used to increase family size: 1) Marry several women, 2) Husbands taking care of women, and 3) Financial stability. Consequences of big families include: 1) Financial burden, 2) Fear of losing children, 3) Borrowing children and 4) Husband shirking responsibility.ConclusionThe desire to have a big family will remain in South Sudan until families realise that their children will live longer, that their men will not be taken by the war, and that the costs of living will be met. In order to generate demand for family planning in South Sudan, priority should be given first to improve infant and child health.

Family planning and the Zika era.

To review the current evidence regarding the impact of the Zika virus epidemic on pregnancy and the implications for family planning and reproductive health services for women in affected countries. In the past 2 years, over the course of the Zika epidemic, much has been learned about the virus. Specifically in regard to pregnancy, a causative relationship has been established between the Zika virus and adverse fetal outcomes, and sexual transmission of the virus has been documented. Broad recommendations by government agencies and public health officials regarding avoidance of pregnancy for women at risk of acquiring the Zika virus have theoretical and documented implications for abortion and contraception demand and access. Additional research is needed to better understand the impact of Zika virus health recommendations and advisories on women's decision making around pregnancy, as well as their impact on demand, access and safety of family planning services.

Media Impacts on Women’s Fertility Desires: A Prolonged Exposure Experiment

Media exposure may have implications for family planning, a public health issue of key importance. Drawing on social comparison theory and social identity theory, a prolonged exposure experiment examined whether media portrayals of women’s social roles affect fertility desires among 166 American, nonstudent, never married, childless women ages 21–35 years old. After sign-up and baseline sessions, participants viewed magazine pages five days in a row. Stimuli presented women in either mother/homemaker roles, beauty ideal roles, or professional roles. Three days later, participants again indicated their number of desired children and time planned until first birth. Exposure to mother/homemaker and beauty ideal portrayals increased the number of desired children across time. Exposure to professional portrayals increased the time planned until 1st birth compared to beauty ideal portrayals—this impact was partially mediated by a shift toward more progressive gender norms (per social identity theory) and assimilation (per social comparison theory).

Constrained Agency on Contraceptive Use among Somali Refugee Women in the Kakuma Refugee Camp in Kenya

This report discusses constraints on contraceptive use and implications for family planning among Somali refugee women settled in the Kakuma refugee camp in Kenya. It is based on a postgraduate study on the various perceptions and attitudes among Somali refugee women to contraception, and their interaction with family planning service providers. The study was conducted in two stages with 32 respondents, who included married and unmarried women and men between the ages of 19 and 58. The first stage included four focus group discussions with 22 participants, and explored general views on contraceptive use and family planning. The second stage comprised face-to-face individual interviews with 10 key respondents. The findings suggest that even though the majority of Somali refugee women do not use contraceptives, it is not by choice, but due to the numerous barriers they face. Hence, instead of supporting choice policy approaches, there is a need to redress their concerns about contraceptives and remove the constraints that hinder their use.

Perceptions of and Attitudes towards Male Infertility in Northern Botswana: Some Implications for Family Planning and AIDS Prevention Policies

This paper discusses the perceptions of male infertility in northern Botswana and their implications for efficacious family planning and AIDS prevention programmes in the country. HIV rates are rapidly increasing in northern Botswana and it is estimated that nearly 30% of the population are infected. A significant factor in these increases is the perception that infertility is caused by the use of contraceptives. Male infertility in particular is understood as a result of female contraceptive use and is highly stigmatised. In an area with such high HIV rates, these perceptions directly contribute to the lack of efficacious family planning and HIV prevention programmes in the country.

Predictive factors for determination of menopausal age

In western Europe the average age at menopause is 52 years. This means that a woman spends approximately 30 years of her life in the postmenopausal status. The possibility to predict the actual age AT menopause would have major implications for family planning, sterility treatment and for the decision to apply HRT. There are numerous associations between socio-economic factors and the age at menopause. A positive correlation has been shown between cigarette smoking and menopausal age. Furthermore several lifestyle factors have an influence on the onset of menopause. However it is not clear in how far generative and socio-economic factors such as marital status interfere with ovarian function.

Contraceptive methods and the transmission of HIV: implications for family planning.

Heterosexual transmission is the predominant mode of spread of the Human Immunodeficiency Virus (HIV) in most of the world. Whether the use of hormonal contraceptives, IUDs and spermicides is associated with an increased or decreased risk for HIV acquisition remains controversial. Several mechanisms whereby contraceptive methods may influence the transmission of HIV have been proposed. As contraceptive use increases among women of reproductive age, the group most vulnerable to HIV infection, any associations between contraceptive method and HIV risk become even more important. The available studies of these associations are predominantly cross-sectional and give conflicting results. We review the published evidence for associations between HIV and individual contraceptive methods. At this time no definitive conclusions regarding these associations can be drawn. Further research, especially prospective epidemiological studies and basic biological research on mechanisms of heterosexual transmission and the effect of contraceptives on these mechanisms, is urgently needed.

Outcome of teenage pregnancy in Maputo, Mozambique

To evaluate the perinatal outcome of teenage pregnancies in comparison with a population of older, high-risk women. Data about 15,207 high-risk women delivered during 1989 at the Central Hospital of Maputo, Mozambique, were collected retrospectively from the clinical records. Of these women 2185 were less than 19 years old. Frequencies were compared through the chi 2-test or, when required, Fisher's exact test. Odds ratios and 95% confidence intervals were computed. Frequency of operative vaginal deliveries (forceps and/or vacuum extraction), cesarean section rate and low birth rate were significantly higher among women under 19 than in the older ones. Also, maternal mortality and stillbirth rates were greater among teenagers, although the differences were not statistically significant. Among the selected, high-risk hospital population of a developing country young maternal age, both by itself and in association with other risk factors, represents an important predictor of adverse perinatal outcome for mothers and babies. Implications for family planning and reproductive education programs are discussed.

The relationship of family size and spacing to the growth of preschool Mayan children in Guatemala.

The height of preschool Mayan children is analyzed with respect to family size and the spacing of their siblings, controlling for parental heights and weights. Data on 643 cases were abstracted from the records of two previous longitudinal studies on the health of children under age five years living in the highlands of Guatemala. Height at age three years is estimated from the linear regression equations fitted for each child to measurements of height repeated at three-month intervals from ages one to four years. Family size is expressed in terms of birth rank, live siblings, and the number of dependent and independent family members. Family spacing is measured as birth intervals, i.e., the number of months between the birth of the index child and his previous and subsequent siblings. Most previous studies have reported that height decreases as family size increases. This study shows that Mayan children from both small and large families are taller than those from middle-sized families. Evidence is presented to support the hypothesis that children in large families are relatively tall because their early-born siblings contribute to the family fortunes. Birth intervals are positively correlated with height. The findings are discussed in terms of their implications for family planning.

The differential evaluation of "large" and "small" families in rural Colombia: implications for family planning.

A survey was conducted among 91 recently delivered and currently pregnant women in rural Colombia during the summer of 1970. The women were asked to indicate the number of children they felt constituted a large family and a small family too few and too many children. Normative judgments are correlated with various demographic characteristics of the respondents. All data are tabulated. Smaller norms are indicated by women of lower parity younger women those from lower socioeconomic groups those coming from larger families of orientation and those holding modern values. Health-related factors were unimportant in reasons for and against having either large or small families. Family-related factors were positively associated with large family preferences. Welfare of children and economic factors were positively related to small family preferences. The number of respondents who considered large families good was equal to the number who did not do so. 3/4 of the women interviewed evaluated small families positively. In a normative sense these women preferred family sizes close to their definition of small families. However their definition of small families is actually a moderate number of children from the demographic point of view. Family planning workers must emphasize the value of a specific size family rather than merely stressing small families. Findings from this study are similar to findings from a larger sampling of rural Colombian women.