Medication Use In Women Research Articles

Association of the Mediterranean diet with arterial stiffness, inflammation, and medication use in women with systemic lupus erythematosus: An exploratory study

Patients with systemic lupus erythematosus (SLE) face increased cardiovascular risk not fully explained by traditional cardiovascular risk factors. Arterial stiffness, inflammation and disease-related therapies may be contributors to augmented cardiovascular risk, whereas healthy dietary habits could help in their management. The aim of the present study was to analyze the association of the adherence to the Mediterranean Diet with arterial stiffness, inflammation, and disease-related medication in women with SLE. A total of 76 women with SLE were included in this cross-sectional exploratory study. The adherence to the Mediterranean Diet was assessed using the Mediterranean Diet Score. Arterial stiffness was measured through pulse wave velocity (PWV). Inflammatory profile was evaluated through high-sensitivity C-reactive protein (hsCRP). The use (yes / no) and doses (mg /day and cumulative dose over the last 3 years) of corticosteroids and immunosuppressants were also registered. No association of the overall adherence to the Mediterranean Diet with PWV, hsCRP or medication use was found (all P>.05). Lower intake of full dairy products was related to greater odds of corticosteroids use (odds=1.72; P=.004), and both higher current (β=0.29; P=.024) and cumulative (β=0.21; P=.040) doses. Lower intake of red wine was associated with lower odds of immunosuppressants use (odds=0.63; P=.008). No association of the adherence to the Mediterranean Diet with arterial stiffness, inflammation or disease-related medication was observed in women with SLE with mild disease activity. However, higher dairy products and lower red wine consumption were related to lower use of disease-related medication. Future intervention studies are needed to better understand how nutritional education promoting Mediterranean Diet food groups can complement conventional SLE treatments.

181-LB: Congenital Malformations and Medication Use in Women With Type 2 Diabetes—Preliminary Results

Background: Congenital malformations occur more frequently in pregnancies of women with type 2 diabetes, mainly attributed to poor glycemic control. However, using certain medications may also contribute. Aim: To describe medication use by conception time in women with type 2 diabetes. Methods: In this retrospective cohort, women with singleton pregnancies from two tertiary care hospitals were enrolled. Data on maternal age, time of diabetes diagnosis, medication use, BMI, HbA1c, and congenital malformations were collected from medical records between May 2005 and June 2021. We excluded four neonates with genetic/chromosomic diseases. Poisson regression with robust estimates was used to evaluate risk factors for congenital malformations. Results: We included 634 women; 212 (33.5%) presented overt diabetes; 136 (21.5%) arrived at prenatal care in the first trimester; 18 (2.8%) had a miscarriage; 560 (88.3%) delivered alive newborns, and 17 (2.7%), stillbirth. Only 227 women (35.8%) had an HbA1c measured in the first trimester, and 304 (48.6%) had an HbA1c before 28 weeks of gestation. Congenital malformations were diagnosed in 77 (13.7%) neonates; of these, 56 (73%) were cardiac defects, isolated or combined with other malformations. Few women used folate in the first trimester (115; 18.1%), almost always introduced after pregnancy diagnosis; 353 (55%) used oral antidiabetics; 116 (18.3%), any anti-hypertensive medication, and 16 (2.5%), statins. In adjusted models including age, BMI and HbA1c, sulfonylurea was associated with increased risk of congenital malformation: RR 2.7, 95% CI 1.3-5.6, p=0.009, when HbA1c in the first trimester entered the model (n=200); and RR 1.64, 95% CI 1.0-2.6, p=0.038, with an HbA1c measured before 28 weeks (n=539). Conclusion: In this cohort of women with type 2 diabetes, congenital malformations were more frequent than in the general population. Sulfonylurea was the only medication associated with an increased risk of congenital malformation. Disclosure A. A. J. Reichelt: None. G. L. Guerra: None. M. A. De campos: None. V. N. Hirakata: None. M. R. Oppermann: None. Funding FIPE-HCPA (2016-0331)

Impact of multimorbidity on the use of sleep medications among women: a population-based study in Southern Brazil.

To investigate the association between multimorbidity and sleep medication use in women. A population-based cross-sectional study was conducted on women (20-69years) in Southern Brazil. Sleep medications were identified using the Therapeutic and Chemical Anatomical Classification. Multimorbidity was operationalized according to two cutoff points: diagnosis of either two or more or three or more chronic conditions and presence or absence of obesity. Explanatory variables included sociodemographic, behavioral, and health factors including obesity and common mental disorders (CMD) (assessed using the Self-Reporting Questionnaire 20 for CMD). Crude and adjusted prevalence ratios (PR) and 95% confidence intervals (95%CIs) were estimated with Poisson regression with robust variance using various adjustment models. In a sample of 1128 women, the prevalence of sleep medications was 14.3% (95%CI 12.2-16.3). After adjustments, the association between multimorbidity and sleep medication use yielded the following PR: multimorbidity ≥ 2:1.78 (95%CI, 1.23-2.56) and multimorbidity ≥ 3:1.90 (95%CI, 1.36-2.68). When obesity was included in the model, the effect was in the same direction but smaller, indicating that the presence of multimorbidity had an independent effect on the use of sleep medications, even after adjusting for CMD. The presence of multimorbidity increased the probability of using sleep medications by approximately 80%, regardless of the observed cutoff point, inclusion of obesity in multimorbidity, and adjustment for CMD. Specific aspects of some chronic conditions may interfere with sleep quality, predisposing women to begin use of these medications at early ages and, consequently, to continue their use throughout later life.

Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018.

Hypertension (HTN) in pregnancy is a leading cause of maternal mortality in the United States. Contraception is widely used, and estrogen-based combined hormonal forms are known to increase blood pressure (BP). With nearly half of pregnancies unplanned and many antihypertensive medications teratogenic, appropriate contraception is critical in child-bearing age women with HTN. Using the National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2018, we evaluated contraception and antihypertensive medication use in women of child-bearing age (20-50 years). Women who had undergone sterilization or menopause were excluded. HTN was defined based on a self-reported provider diagnosis and BP ≥130/80 mm Hg or antihypertensive medication use. Contraception included non-barrier methods (pills/patch/ring, injections, long-acting reversible contraceptives) or consistent condom use. Multivariable logistic regression was used to model the odds of contraception use. Temporal trends in contraception use were reported. Of the 8726 women, 12.4% had HTN with mean age (standard error) 36.0 (0.3) years. In women with HTN, 9.2% used non-barrier contraception and 10.4% used condoms only. Over half (52.7%) of women with HTN on antihypertensive medications were taking medications contraindicated in pregnancy, with no difference seen by contraceptive status. In logistic regression models, contraceptive use was lower in the older-aged women. In women with HTN on non-barrier contraception, combined hormonal contraceptive use declined, from 100% (2001-2006) to 81.4% (2013-2018, P < 0.001). Many women with self-reported HTN are not using adequate contraception. Of the small proportion on non-barrier contraceptives, the majority are using estrogen-based, BP-raising methods.

Multicentre evaluation of the pharmacological management of women with bipolar disorder in the perinatal period

AimsThe pharmacological management of women with bipolar disorder in the perinatal period is challenging. This population has a high recurrence rate, but some medications can be a concern in pregnancy and breastfeeding. Little is known about prescribing practices in perinatal services, and the impact of medication on recurrence rates.The aims of this study are: 1) to describe the use of medication in women with bipolar disorder in the perinatal period and 2) to evaluate the impact of medication on the rate of postpartum recurrence.MethodClinical data were collected from pregnant women with a diagnosis of bipolar disorder in the nine participating centres in the UK and who were not experiencing an episode of illness entering the postpartum period. Using a proforma, data were collected for the period between conception and three months postpartum: sociodemographic, reproductive, the severity of illness, medication and recurrence.Data were analysed for association using χ2 tests and logistic regression.ResultIn this sample of 167 women, 91 (55%) were taking medication at delivery: 62 (37%) antipsychotics, 41 (25%) antidepressants, and 25 (15%) mood stabilisers. In 12 cases medication was reduced before delivery. Of those who were taking medication at delivery six decreased of stopped after delivery and one increased the dose. 42% of women in this sample experienced a recurrence, with 30% of the sample experiencing a manic/psychotic episode. There was no significant association between taking medication and recurrence χ 2(1) = 0.07, p = 0.79. There continued to be no association in a multivariable analysis when adjusted for parity, severity (previous admissions, age at first treatment, bipolar subtype), type of medication during pregnancy and immediate postpartum changes aOR 0.33 95%CI [0.03; 3.40], p = 0.35.ConclusionA high number of women with bipolar disorder are taking medication before delivery and in the majority, antipsychotics are prescribed. The postnatal recurrence rate in both medicated and unmedicated women is high. These results are in line with existing literature. Further work is needed in larger samples to provide clinical guidance for women and their clinicians.

Cardiac medication use in patients with suspected ischaemia without obstructive coronary arteries: sex differences and psychological distress.

BackgroundIschaemia without obstructive coronary arteries (INOCA) is more prevalent in women and associated with psychological distress. Pharmacological treatment goals are angina relief and cardiovascular risk management. The present study aims to examine sex differences in cardiac and non-cardiac medication use, as well as medication and sex differences related to consistent psychological distress in patients with suspected INOCA.DesignA TweeSteden mild stenosis observational cohort study in patients with suspected INOCA as detected by ischaemic reason for referral and non-obstructive arteries based on coronary angiography or computed tomography.MethodsMedication documented in the hospital records of 488 patients (53% women) was coded as angina relief medication, blood-pressure-lowering medication, antithrombotics, statins, and non-cardiac medication, using the Anatomical Therapeutic Chemical code. Depressive symptoms and anxiety were recoded as ‘consistent distress’ (above the cut-off score for depression and anxiety on validated questionnaires), ‘inconsistent distress’ (above the cut-off for depression or anxiety) or ‘no distress’ (below the cut-off).ResultsNo sex differences were observed in cardiac medication use. Women used anxiolytic benzodiazepines more often (12% vs 4%, p = 0.002) compared to men. Consistent distress was more prevalent in women (22% vs 15%, p = 0.004) and was related to the use of more angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and diuretics in women and to calcium antagonist use as well as lower adherence levels in men. Women who reported chest pain more often received angina relief medication and blood-pressure-lowering medication than men.ConclusionNo sex differences were observed in cardiac medication use in patients with suspected INOCA. Psychological distress may reflect hypertension and subsequent medication use in women, and experiencing chest pain and subsequent medication use in men.

Multicentre evaluation of perinatal pharmacological management in women with bipolar disorder

IntroductionThe pharmacological management of women with bipolar disorder in the perinatal period is challenging. This population has a high recurrence rate, but some medications can be a concern in pregnancy and breastfeeding. Little is known about prescribing practices in perinatal services, and the impact of medication on recurrence rates.ObjectivesTo describe 1. the use of medication in women with bipolar disorder in the perinatal period and 2. the impact of medication on the rate of recurrence.MethodsClinical data was collected from pregnant women with diagnosis of bipolar disorder in the nine participating centres and who were not experiencing an episode of illness entering the postpartum period. Data were analysed for association using χ2 tests and logistic regression.ResultsIn this sample of 167 women, 55% were taking medication at delivery: 37% antipsychotics, 15% mood stabilisers, 25% antidepressants. In 12 cases medication was reduced before delivery. 42% experienced a recurrence, with 30% being a manic/psychotic episode. There was no significant association between taking medication and recurrence c2(1)=0.72, p=0.79. There continued to be no association when adjusted for severity (previous admissions, age at first treatment, bipolar subtype) and type of medication OR 0.57 95%CI [0.08; 4.29], p=0.59.ConclusionsA high number of bipolar women are taking medication before delivery and in the majority antipsychotics are prescribed. The postnatal recurrence rate in both medicated and unmedicated women is high. Further work is needed in larger samples to provide clinical guidance for women and their clinicians.DisclosureNo significant relationships.

Dietary Habits and Medications to Control Hypertension Among Women of Child-Bearing Age in the United States from 2001 to 2016.

Hypertension (HTN) in pregnancy is a leading cause of maternal morbidity and mortality in the United States. Although the Dietary Approaches to Stop Hypertension (DASH) diet is recommended for all adults with HTN, rates of DASH adherence and antihypertensive medication use in women of child-bearing age are unknown. Our objectives were to determine DASH adherence and antihypertensive medication use in women of child-bearing age. In the National Health and Nutrition Examination Surveys from 2001 to 2016, we estimated DASH adherence among women of child-bearing age (20-50 years). We derived a DASH score (0-9) based on 9 nutrients, with DASH adherence defined as DASH score ≥4.5. HTN was defined by blood pressure (BP) ≥130/80 mm Hg or antihypertensive medication use. DASH scores were compared across BP categories and antihypertensive medication use was categorized. Of the 7,782 women, the mean age (SE) was 32.8 (0.2) years, 21.4% were non-Hispanic Black, and 20.3% had HTN. The mean DASH score was 2.11 (0.06) for women with self-reported HTN and 2.40 (0.03) for women with normal BP (P < 0.001). DASH adherence was prevalent in 6.5% of women with self-reported HTN compared with 10.1% of women with normal BP (P < 0.05). Self-reported HTN is predominantly managed with medications (84.8%), while DASH adherence has not improved in these women from 2001 to 2016. Moreover, 39.5% of US women of child-bearing age are taking medications contraindicated in pregnancy. Given the benefits of optimized BP during pregnancy, this study highlights the critical need to improve DASH adherence and guide prescribing among women of child-bearing age.

Association between the timing of asthma diagnosis and medication use during pregnancy.

To assess whether asthma medication use during pregnancy differs in women newly diagnosed with asthma early in pregnancy (first 19weeks of pregnancy) compared to those newly diagnosed up to 2years pre-pregnancy. A retrospective population-based cohort study. To conduct this study, we used the Quebec Asthma and Pregnancy Database (QAPD) constructed by linking two administrative health databases from the province of Quebec (Canada): the Régie de l'Assurance Maladie du Québec and Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière databases. A cohort comprising pregnant women newly diagnosed with asthma at any time in the 2 years prior to pregnancy or during the first 19 weeks of pregnancy was selected from the QAPD. We assessed the number of filled prescriptions of inhaled corticosteroids (ICS), ICS/long-acting β2 agonists(LABA), and short-acting β2 agonists (SABA), as well as the number of days' supply of oral corticosteroid (OCS) from the 20th week of pregnancy until delivery. Poisson regression was used to compare the rates of asthma medication use in women diagnosed pre-pregnancy versus early in pregnancy. The cohort included 1731 women newly diagnosed with asthma pre-pregnancy and 359 women newly diagnosed with asthma early in pregnancy. Women diagnosed early in pregnancy were more likely to use ICS (adjusted rate ratio: 1.9, 95% confidence interval (CI): 1.6-2.3) andSABA (adjusted rate ratio: 2.0, 95% CI: 1.7-2.4) from the 20th week of pregnancy until delivery than those newly diagnosed pre-pregnancy. No significant differences were observed in the use of ICS/LABA [adjusted rate ratio: 0.9, 95% CI: 0.7-1.3] and OCS [adjusted rate ratio: 0.8, 95% CI: 0.6-1.2]. The higher use of ICS and SABA observed in women newly diagnosed with asthma early in pregnancy may suggest a more persistent asthma phenotype caused by pregnancy-triggered hormonal changes.

Medications used disproportionately during pregnancy: Priorities for research on the risks and benefits of medications when used during pregnancy.

To identify medications used disproportionately more or less among pregnant women relative to women of childbearing age. Medication use among pregnant women in New South Wales, Australia was identified using linked perinatal and pharmaceutical dispensing data from 2006 to 2012. Medication use in women of childbearing age (including pregnant women) was identified using pharmaceutical dispensing data for a 10% random sample of the Australian population. Pregnant social security beneficiaries (n = 111 612) were age-matched (1:3) to female social security beneficiaries in the 10% sample. For each medication, the risk it was dispensed during pregnancy relative to being dispensed during an equivalent time period among matched controls was computed. Medications were mapped to Australian pregnancy risk categories. Of the 181 included medications, 35 were statistically significantly more commonly dispensed to pregnant women than control women. Of these, 23 are categorised as posing no increased risk to the foetus. Among medications suspected of causing harm or having insufficient safety data, the strongest associations were observed for hydralazine, ondansetron, dalteparin sodium and ranitidine. Use was less likely during pregnancy than control periods for 127 medications, with the strongest associations observed for hormonal contraceptives and progestogens. Most medications found to be used disproportionately more by pregnant women are indicated for pregnancy-related problems. A large number of medications were used disproportionately less among pregnant women, where avoidance of some of these medications may pose a greater risk of harm. For many other medications avoided during pregnancy, current data are insufficient to inform this risk-benefit assessment.

Medication of comorbidities in females with sleep-disordered breathing during long-term CPAP therapy.

Treating sleep disordered breathing (SDB) with nasal continuous positive airway pressure (CPAP) may reduce mortality, but the studies on the effect on medication use are few. Women tend to have more mild sleep apnoea and partial airway obstruction and are therefore expected to have less co-morbidity. The purpose of this study was to evaluate the effect of CPAP therapy on medication use in women as overall medication, and in different subcategories of diseases, and to evaluate the impact of nocturnal airway obstruction type as partial or complete. From the database of the Department of Pulmonary Diseases in Turku University Hospital from 1994 to 1998, 601 consecutive females with SDB were enrolled, and the type of SDB was evaluated. All were offered CPAP therapy. The medication use measured as defined daily doses (DDD) in overall medication and in nine subcategories were collected three years before and three years after CPAP initiation. In final analyses, 182 women were included. In CPAP users (n=66), comorbidities were more frequent and DDDs higher overall, in asthma, in chronic obstructive pulmonary disease, and in severe mental disorders, both before and after CPAP initiation. The medication use was similar regardless of the type of SDB. The change in medication use was similar as in controls. CPAP therapy did not decrease medication use in three-year follow-up. However, possibly continuous rise in medication use was prevented, as the change in medication use was similar in controls. Complete and partial obstruction had similar effects.

Cardiovascular Outcomes in Relation to Antihypertensive Medication Use in Women with and Without Cancer: Results from the Women's Health Initiative.

Recent clinical trials have evaluated angiotensin-converting enzyme (ACE) inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta blockers (BBs) in relation to cardiotoxicity in patients with cancer, typically defined by ejection fraction declines. However, these trials have not examined long-term, hard clinical endpoints. Within a prospective study, we examined the risk of heart failure (HF) and coronary heart disease (CHD) events in relation to use of commonly used antihypertensive medications, including ACEis/ARBs, BBs, calcium channel blockers (CCB), and diuretics, comparing women with and without cancer. In a cohort of 56,997 Women's Health Initiative study participants free of cardiovascular disease who received antihypertensive treatment, we used multivariable-adjusted Cox regression models to calculate the hazard ratios (HRs) of developing CHD, HF, and a composite outcome of cardiac events (combining CHD and HF) in relation to use of ACEis/ARBs, CCBs, or diuretics versus BBs, separately in women with and without cancer. Whereas there was no difference in risk of cardiac events comparing ACEi/ARB with BB use among cancer-free women (HR = 0.99 [0.88-1.12]), among cancer survivors ACEi/ARB users were at a 2.24-fold risk of total cardiac events (1.18-4.24); p-interaction = .06). When investigated in relation to CHD only, an increased risk was similarly observed in ACEi/ARB versus BB use for cancer survivors (HR = 1.87 [0.88-3.95]) but not in cancer-free women (HR = 0.91 [0.79-1.06]; p-interaction = .04). A similar pattern was also seen in relation to HF but did not reach statistical significance (p-interaction = .23). These results from this observational study suggest differing risks of cardiac events in relation to antihypertensive medications depending on history of cancer. Although these results require replication before becoming actionable in a clinical setting, they suggest the need for more rigorous examination of the effect of antihypertensive choice on long-term cardiac outcomes in cancer survivors. Although additional research is needed to replicate these findings, these data from a large, nationally representative sample of postmenopausal women indicate that beta blockers are favorable to angiotensin-converting enzyme inhibitors in reducing the risk of cardiac events among cancer survivors. This differs from the patterns observed in a noncancer cohort, which largely mirrors what is found in the randomized clinical trials in the general population.

Effect of desogestrel 75 µg on headache frequency and intensity in women with migraine: a prospective controlled trial

Objective: In contrast with combined hormonal contraception, progestin-only contraception is not associated with an increase in venous thromboembolism or stroke. Women with migraine are at increased risk of ischaemic stroke. Several studies have reported a reduction in migraine frequency and intensity with desogestrel 75 µg, a progestin-only pill. At present the quality of data is limited by retrospective study designs, lack of control groups and small sample sizes. We present the first prospective nonrandomised controlled trial. Methods: A total of 150 women with migraine visiting our clinic for contraceptive counselling were screened. The intervention group comprised women who opted for contraception with desogestrel (n = 98); the control group comprised women who continued their usual contraceptive (n = 36). Participants completed daily diaries for 90 days before the intervention and 180 days after the intervention. Results: In the intervention group, we found improvements in migraine frequency (p < .001), migraine intensity (p < .001) and the number of triptans used (p < .001). These improvements were already significant after 90 days of desogestrel use (p < .001). Disability scores also decreased significantly. No improvement was seen in the nonintervention group. Conclusion: These data demonstrate for the first time in a prospective controlled setting that daily use of the progestin desogestrel is associated with a decrease in migraine frequency, migraine intensity and pain medication use in women with migraine, with and without aura, who had previously been experiencing at least three days of migraine per month. Trial registration: The study is registered in the University of Zürich database (www.research-projects.uzh.ch/unizh.htm).

Psychotropic medication use and intimate partner violence at 4 years postpartum: Results from an Australian pregnancy cohort study

BackgroundIn the perinatal period, maternal mental health problems and intimate partner violence often co-occur. We aimed to examine associations between psychotropic medication use and intimate partner violence (IPV) in an Australian population-based sample. MethodsProspective cohort study of 1507 first-time mothers recruited in early pregnancy (mean gestation 15 weeks) from public maternity hospitals in Melbourne Australia. Follow-up questionnaires at 12 months and four years included validated measures of intimate partner violence (Composite Abuse Scale), and maternal mental health (Edinburgh Postnatal Depression Scale, SF-36). Data on use of psychotropic medications was collected using a self-report measure at four years postpartum. ResultsAt four years postpartum, almost one in eight mothers (13.9%) were taking psychotropic medication. The prevalence of psychotropic medication use in women experiencing concurrent IPV was considerably higher compared to women not experiencing IPV (25% vs 11%, Odds Ratio = 2.68, 95% CI 1.73–4.15). Women experiencing IPV were significantly more likely to be taking psychotropic medication, even after adjusting for sociodemographic factors and depressive symptoms (Adj OR = 1.86, 95% CI 1.16 to 2.96). Only 5% of women reporting IPV at four years postpartum had discussed this with a general practitioner. LimitationsLimitations include use of a self-report measure to assess psychotropic medication use, lack of data on the use of psychological counselling and/or other specialist mental health services and potential for attrition to bias results (addressed using multiple imputation). ConclusionsOur findings reinforce the need for health professionals treating women for depressive symptoms to inquire about IPV and tailor responses accordingly.

P080 DYSMENORRHEA IN WOMEN WITH ULCERATIVE COLITIS

Dysmenorrhea and ulcerative colitis (UC) are conditions that commonly affect women of reproductive age. Despite their similar symptoms, the relationship between the two is poorly understood. The aims of this study were to explore the relationships between dysmenorrhea, UC disease activity, and health-related quality of life (HRQoL) as well as determine the impact of dysmenorrhea on pain severity and pain medication use in women with UC. This was a case-control study comparing menstruating women with UC (cases) to healthy, age-matched controls. All subjects completed a series of questionnaires to assess the prevalence of dysmenorrhea, menstrual cycle characteristics, and the experience of menstrual distress as measured by the Moos Menstrual Distress Questionnaire (MDQ). In addition, menstrual pain severity, pain medication use, UC disease activity, and HRQoL were analyzed and compared among cases and controls with dysmenorrhea and between cases with and without dysmenorrhea. Logistic regression models were performed to assess relationships Fifty women with UC and 65 healthy controls were studied, and the prevalence of dysmenorrhea was somewhat higher in women with UC compared to controls (62%, 46% respectively, p=0.091). We found no difference in MDQ scores during the premenstrual or menstrual phases between cases and controls with dysmenorrhea. However, cases with dysmenorrhea had lower menstrual distress scores during the intermenstrual phase compared to controls with dysmenorrhea (p=0.042). Cases with dysmenorrhea had lower HRQoL compared to controls with dysmenorrhea according to some measures. No differences were found in HRQoL or UC disease activity scores between cases with and without dysmenorrhea. No significant difference was found between menstrual pain scores in cases and controls with dysmenorrhea; however, pain medication use significantly differed with controls reporting higher levels of non-steroidal anti-inflammatory drug (NSAID) use (p<0.0001). Cases with dysmenorrhea reported higher pain scores compared to cases without (p<0.0001). Dysmenorrhea is common among women with and without UC resulting in higher pain scores in comparison to individuals without dysmenorrhea. When comparing cases and controls with dysmenorrhea, no difference in menstrual distress was found during the premenstrual and menstrual phases of the menstrual cycle suggesting that women with dysmenorrhea experience menstrual distress similarly regardless of UC status. Despite women with UC and dysmenorrhea having similar pain scores to their healthy counterparts with dysmenorrhea, pain medication use was lower among cases. This suggests that women with UC may be undertreating their menstrual pain by avoiding use of NSAIDs due to the conventional advice to avoid these agents in the setting of IBD.

P080 DYSMENORRHEA IN WOMEN WITH ULCERATIVE COLITIS

Dysmenorrhea and ulcerative colitis (UC) are conditions that commonly affect women of reproductive age. Despite their similar symptoms, the relationship between the two is poorly understood. The aims of this study were to explore the relationships between dysmenorrhea, UC disease activity, and health-related quality of life (HRQoL) as well as determine the impact of dysmenorrhea on pain severity and pain medication use in women with UC. This was a case-control study comparing menstruating women with UC (cases) to healthy, age-matched controls. All subjects completed a series of questionnaires to assess the prevalence of dysmenorrhea, menstrual cycle characteristics, and the experience of menstrual distress as measured by the Moos Menstrual Distress Questionnaire (MDQ). In addition, menstrual pain severity, pain medication use, UC disease activity, and HRQoL were analyzed and compared among cases and controls with dysmenorrhea and between cases with and without dysmenorrhea. Logistic regression models were performed to assess relationships. Fifty women with UC and 65 healthy controls were studied, and the prevalence of dysmenorrhea was somewhat higher in women with UC compared to controls (62%, 46% respectively, p=0.091). We found no difference in MDQ scores during the premenstrual or menstrual phases between cases and controls with dysmenorrhea. However, cases with dysmenorrhea had lower menstrual distress scores during the intermenstrual phase compared to controls with dysmenorrhea (p=0.042). Cases with dysmenorrhea had lower HRQoL compared to controls with dysmenorrhea according to some measures. No differences were found in HRQoL or UC disease activity scores between cases with and without dysmenorrhea. No significant difference was found between menstrual pain scores in cases and controls with dysmenorrhea; however, pain medication use significantly differed with controls reporting higher levels of non-steroidal anti-inflammatory drug (NSAID) use (p<0.0001). Cases with dysmenorrhea reported higher pain scores compared to cases without (p<0.0001). Dysmenorrhea is common among women with and without UC resulting in higher pain scores in comparison to individuals without dysmenorrhea. When comparing cases and controls with dysmenorrhea, no difference in menstrual distress was found during the premenstrual and menstrual phases of the menstrual cycle suggesting that women with dysmenorrhea experience menstrual distress similarly regardless of UC status. Despite women with UC and dysmenorrhea having similar pain scores to their healthy counterparts with dysmenorrhea, pain medication use was lower among cases. This suggests that women with UC may be undertreating their menstrual pain by avoiding use of NSAIDs due to the conventional advice to avoid these agents in the setting of IBD.

Medication Use in Women and Men With Sudden Unexpected Death.

In Wake County, NC, sudden unexpected death accounts for 10% to 15% of all natural deaths in individuals 18 to 64 years old. Medications such as aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, and β-blockers are recommended in guidelines to reduce cardiovascular events and even sudden death (β-blockers). However, guidelines are often underpracticed, even in high-risk patients, with noted disparities in women. We assessed the relation between prescription of evidence-based medications and sudden unexpected death in Wake County, NC. We analyzed 399 cases of sudden unexpected death for the time period March 1, 2013 to February 28, 2015 in Wake County, NC. Medications were assessed from available medical examiner reports and medical records and grouped using the third level of the Anatomical Therapeutic Chemical Classification System (ATC) codes. This study was reviewed and exempt by the University of North Carolina's institutional review board. Among 126 female and 273 male victims, women were prescribed more medications overall than men (6.5 vs 4.3, P = 0.001); however, the use of guideline-directed therapies was not different between genders in the chronic conditions associated with sudden death. Overall, there was remarkably low use of evidence-based medications. Our findings highlight the need to improve prescribing of evidence-based medications and to further explore the relationship between undertreatment and sudden unexpected death.

Prescribing Patterns and Use of Pain Medications in Women Following Orthopedic Surgical Procedures

Prescribing Patterns and Use of Pain Medications in Women Following Orthopedic Surgical Procedures

Breast-feeding and medication use in mothers of newborn infants

s ingediend voor het Amsterdam Kindersymposium 2013 51 Breast-feeding and medication use in mothers of newborn infants Marinka L.F. Hol (1), Willemijn E. Corpeleijn (1), Johannes B. van Goudoever (1,2), Sintha D. Sie (3), Mirjam M. van Weissenbruch (3) (1) Department of Paediatrics, VU University Medical Center, Amsterdam (2) Department of Paediatrics, Emma Children’s Hospital – Academic Medical Center, Amsterdam (3) Department of Paediatrics, IC Neonatology, VU University Medical Center, Amsterdam INTRODUCTION Human milk feeding off ers substantial benefi ts to both term and preterm infants. When medication is used during lactation, the nursing infant might be exposed to the medication. We aimed to investigate the incidence and type of medication use in women delivering in our hospital and to investigate whether or not medication use infl uences the likelihood of a mother to breast-feed. Furthermore we wanted to investigate whether the used medication is contra-indicated during lactation. METHODS Mothers of newborn infants admitted to the Neonatal Intensive Care Unit or to the Maternity Ward were included. Information on medication use was collected from medical records. During a structured interview with the mother information on medication use, alternative medication use and their thoughts on medication use during lactation was collected. Afterwards, the decision whether or not a medication was contra-indicated during lactation was judged based on scientifi c literature. RESULTS Sixty-two mothers were included, of whom 79% started breastfeeding. Infants had a median birth weight of 2598 grams, and a median gestational age of 34 weeks. 51% of the children were born premature. 87% of the women used medication on a daily basis and 54% used alternative medication. 42% of the women used medication that was potentially contra-indicated during lactation. 24% of all interviewed women stated that their medication use had infl uenced their decision to breastfeed. CONCLUSION Medication use, especially alternative medication, during lactation is an underestimated problem. Caregivers and lactating women should be aware that alternative medication is not always as safe as presumed.

Gender-Specific Correlates of Complementary and Alternative Medicine Use for Knee Osteoarthritis

Knee osteoarthritis (OA) increases healthcare use and cost. Women have higher pain and lower quality of life measures compared to men even after accounting for differences in age, body mass index (BMI), and radiographic OA severity. Our objective was to describe gender-specific correlates of complementary and alternative medicine (CAM) use among persons with radiographically confirmed knee OA. Using data from the Osteoarthritis Initiative, 2,679 women and men with radiographic tibiofemoral OA in at least one knee were identified. Treatment approaches were classified as current CAM therapy (alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and three types of biologically based therapies) or conventional medication use (over-the-counter or prescription). Gender-specific multivariable logistic regression models identified sociodemographic and clinical/functional correlates of CAM use. CAM use, either alone (23.9% women, 21.9% men) or with conventional medications (27.3% women, 19.0% men), was common. Glucosamine use (27.2% women, 28.2% men) and chondroitin sulfate use (24.8% women; 25.7% men) did not differ by gender. Compared to men, women were more likely to report use of mind-body interventions (14.1% vs. 5.7%), topical agents (16.1% vs. 9.5%), and concurrent CAM strategies (18.0% vs. 9.9%). Higher quality of life measures and physical function indices in women were inversely associated with any therapy, and higher pain scores were positively associated with conventional medication use. History of hip replacement was a strong correlate of conventional medication use in women but not in men. Women were more likely than men to use CAM alone or concomitantly with conventional medications.