Unplanned Pregnancies In Women Research Articles

Unplanned Pregnancy in Women with Lupus Nephritis Is Common and Is Associated with Poor Fetal Outcomes

Unplanned Pregnancy in Women with Lupus Nephritis Is Common and Is Associated with Poor Fetal Outcomes

Contraceptive use in women with mental illness in Soweto, South Africa.

The psychosocial and medical implications of unplanned pregnancy in women with mental illness (MI) are vast. International guidelines make clear recommendations about family planning for women with MI, particularly those exposed to known human teratogens; however, there is limited research related to contraceptive usage among women with MI. The aim of this study was to investigate the prevalence of consistent contraceptive use and family planning education (FPE) among a population of women of childbearing age with MI. This quantitative cross-sectional study was conducted at Chris Hani Baragwanath psychiatric unit in Soweto, South Africa. A convenience sample comprising 190 eligible women of childbearing age with MI was employed for the study. The women were invited to participate by means of a structured questionnaire which was administered by the researcher. Clinical information was obtained from the patients' medical records. Consistent contraceptive usage occurred in 44.7% of participants. Family planning education was low (26.8%). Relationship status was associated with using contraception consistently (p = 0.0229). Teratogen exposure was not associated with either contraceptive use or FPE. Family planning education was not associated with contraceptive use. Women with MI may have increased risk for unplanned pregnancy if they are not in a relationship because of perceived lack of need for contraception. Family planning education must be prioritised in women with MI, especially among women prescribed teratogenic medication, highlighting the risks associated with unplanned pregnancy.

Contraceptive counseling and choices in pregnancies with maternal cardiac disease

Objective Unplanned pregnancies in women with maternal cardiac disease (MCD) are associated with increased morbidity and mortality, but the majority of these individuals do not use highly reliable contraception on postpartum hospital discharge. Contraceptive counseling in this population outside of pregnancy is incomplete and counseling during pregnancy remains poorly characterized. Our objective was to evaluate the provision and quality of contraceptive counseling for individuals with MCD during pregnancy. Methods All individuals with MCD who delivered between 2008 and 2021 at a tertiary care institution with a multidisciplinary cardio-obstetrics team were sent a 27-question survey. A subset of questions were derived from the validated Interpersonal Quality in Family Planning (IQFP) survey, which emphasizes interpersonal connection, adequate information, and decision support for the individual. Each participant received a $15 gift card for survey completion. We performed chart review for clinical and demographic details, including cardiac risk score. Results Of 522 individuals to whom the survey was sent, 133 responded and met inclusion criteria. Overall, 67% discussed contraception with their general obstetrician, 36% with their maternal-fetal medicine (MFM) specialist, and 24% with their cardiologist. Compared to individuals with low cardiac risk scores, those with high cardiac risk scores had a nonsignificant trend toward being more likely to discuss contraception with a MFM provider (52% vs 33%, p = .08). 65% reported that their provider was ‘excellent’ or ‘good’ in all IQFP domains. Respondents valued providers who respected their autonomy and offered thorough counseling. Respondents disliked feeling pressured or uninformed about the safety of contraceptive options. Conclusion Most individuals with MCD reported excellent contraceptive counseling during pregnancy. Additional work is needed to understand barriers to and enablers for effective, patient-centered contraceptive counseling and use in this population.

Clustering of characteristics associated with unplanned pregnancies: the generation R study

BackgroundUnplanned or unintended pregnancies form a major public health concern because they are associated with unfavorable birth outcomes as well as social adversity, stress and depression among parents-to-be. Several risk factors for unplanned pregnancies in women have previously been identified, but studies usually take a unidimensional approach by focusing on only one or few factors, disregarding the possibility that predictors might cluster. Furthermore, data on predictors in men are largely overlooked. The purpose of this study is to determine predictors of unplanned versus planned pregnancy, to determine predictors of ambivalent feelings regarding pregnancy, and to investigate how characteristics of men and women with an unplanned pregnancy cluster together.MethodsThis study was embedded in Generation R, a multiethnic population-based prospective cohort from fetal life onwards. Pregnancy intention was reported by 7702 women and 5367 partners. Information on demographic, mental, physical, social, and sexual characteristics was obtained. Logistic regression, multinomial regression and cluster analyses were performed to determine characteristics that were associated with an unplanned pregnancy, with ambivalent feelings regarding the unplanned pregnancy and the co-occurrence of characteristics in women and men with unplanned pregnancy.ResultsTwenty nine percent of the pregnancies were unplanned. Logistic regression analyses showed that 42 of 44 studied predictors were significantly associated with unplanned pregnancy. The most important predictors were young age, migration background, lower educational level, lower household income, financial difficulties, being single, lower cognitive ability, drug use prior to pregnancy, having multiple sexual partners in the year prior to the pregnancy, younger age of first sexual contact and a history of abortion. Multinomial regression analyses showed that a Turkish or Moroccan background, Islamic religion, little financial opportunities, being married, having ≥3 children, high educational level, more mental health and social problems and older age of first sexual contact were associated with prolonged ambivalent feelings regarding pregnancy. Different combinations of characteristics were observed in the four clusters of women and men with unplanned pregnancy.ConclusionsMany predictors are related with unplanned pregnancies, ambivalent feelings toward the pregnancy, and we identified very heterogeneous groups of women and men with unplanned pregnancies. This calls for heterogeneous measures to prevent unplanned pregnancies.

1053-P: Prevalence, Predictors, and Consequences of Unplanned Pregnancy in Women with Preexisting Diabetes

Objective: Women with diabetes who have unplanned pregnancies are more likely to have poor glycemic control in early pregnancy which is associated with poor maternal and fetal outcomes. We assessed the prevalence, predictors, and consequences of unplanned pregnancy among women with preexisting diabetes. Methods: We used EHR data of 486 women aged 18-49 with preexisting type 1 or 2 diabetes who received pregnancy care at a university hospital in North Carolina between 10/2015 and 02/2020. The outcome was unplanned pregnancy while the predictors were maternal demographic, socioeconomic, and health factors. The consequences assessed were maternal infection, cesarean delivery, postpartum contraception, preterm delivery, NICU admission, macrosomia, LBW, fetal abnormality, and fetal death. We estimated statistical associations as odds ratios (OR) and 95% confidence intervals (CI) . Results: Of the 554 pregnancies that occurred in the sample, 32% were documented as unplanned, 25% as planned, and 43% had no documented intention. The predictors of unplanned pregnancy were age younger than 25 (OR 2.7; CI 1.5-5.0) , African American race (OR 2.7; CI 1.6-4.5) , being single (OR 1.9; CI 1.3-2.9) , having 2+ comorbidities (OR 2.1; CI 1.2-3.7) , and having 3+ previous pregnancies (OR 2.1; CI 1.2-3.9) . Adjusting for maternal factors including early pregnancy HbA1c, unplanned pregnancy increased the odds of macrosomia (OR 2.2; CI 1.2-4.2) and fetal death (OR 1.8; 95% CI 1.1-3.0) , but not maternal infection, cesarean delivery, preterm delivery, NICU admission, LBW, or fetal abnormality. Women with unplanned pregnancies were more likely to receive postpartum contraception (OR 1.7; CI 1.1-2.6) . Conclusion: Unplanned pregnancies remain common among women with preexisting diabetes and are associated with adverse pregnancy outcomes independent of maternal HbA1c at the start of the pregnancy. Further efforts are needed to expand preconception care and support pregnancy planning in these women. Disclosure C.C.Okigbo: None. C.Mclaughlin: None. M.Kirkman: Research Support; Bayer AG, Novo Nordisk. Funding Society of Family Planning Research Fund (SFPRF13-ES12)

Unplanned Pregnancy in women with mental disorder

IntroductionFew studies have investigated the level of planning of pregnancy among women with mental disorder and associated risk factors.ObjectivesThe purpose of this study was to determine the associated factors to UP and psychopathological consequences.MethodsA cross sectional study was conducted at the Perinatal Mental Health Unit of the Hospital Clínic in Barcelona. The total sample comprised 675 consecutive pregnant women with diagnosis of mental disorder (DSM-IV criteria), seen between January 2006 and December 2018. Clinical, psychometric and socio-demographic variables were collected at the first visit. Pregnancy planning was assessed by a question “Was this pregnancy planned?” with three possible answers: 1) Yes, it was planned and has been well received; 2) No, it was not planned but it has been well received; and 3) No, it was an accident. Response 1 was coded as “planned pregnancy” and responses 2 and 3 as “Unplanned Pregnancy”.Results38.4% of the sample had an UP. Younger age, lower levels of education, Latin-American population, multiparity, financials problems and poor relationship with the partner were associated with UP in women with mental disorder. The mean EPDS and STAI scores and the presence of self-harming thoughts were significantly higher in women with UP.ConclusionsUP was associated with more depressive and anxious symptoms and more self-harming thoughts. It is necessary to promote reproductive health care for women with mental disorders and to take into account their reproductive life plan, especially in those with risk factors described.DisclosureNo significant relationships.

OUTCOMES OF PREGNANCY IN WOMEN WITH TYPE 1 DIABETES MELLITUS: A STUDY FROM RESOURCE CONSTRAINTS SOCIETY

OBJECTIVE: To evaluate the outcomes of pregnancy in women with type 1 diabetes mellitus (T1DM). METHODS: This prospective cohort study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi-Pakistan from January 2007 to December 2020. All women diagnosed with T1DM and pregnancy, visiting the outpatient department of BIDE were included after written informed consent. Predesigned questionnaire was developed for data records. It includes demographic details, diabetes mellitus & obstetric history, clinical examination, treatment details, maternal, perinatal and neonatal outcomes. RESULTS: There were 31 pregnancies in which mean age of women was 35.03±9.70 years, duration of diabtes before pregnancy was 128.46±75.50 months and median gestational age at delivery was 34.30±3.9 weeks. Only 5 (16.1%) pregnancies were planned and 7 (22.6%) women have HbA1c <7%. Furthermore, 26 (83.9%) women received folic acid in first trimester. Moreover, 27 (87.1%) live birth and 4 (12.9%) miscarriages occurred, 16 (51.6%) women required assisted delivery/cesarean section and 5 (16.1%) neonates are of low birth weights. Hypoglycemia was noted in 6 (19.4%) neonates and jaundice in 2 (6.5%). One (3.2%) neonate required intensive care unit admission and 14 (45.2%) women breasts fed their child. CONCLUSION: In our study, majority of unplanned pregnancies in women with T1DM rendering this high-risk group into more complications. Prenatal counselling regarding conception may improve the pregnancy outcomes.

The Effect of Unplanned Pregnancy among Women Collage in Wadajir Distract Moqdisho Somalia

Unplanned pregnancy is a pregnancy that is either mistimed or unwanted at the time of conception. It is a core concept in understanding the fertility of populations and the unmet need for contraception. Unintended pregnancy is associated with an increased risk of morbidity for women, and with health behaviors during pregnancy with adverse effects. And the aim of this study is to establish the level of effect of the unplanned pregnancy in women college in Wadajir district. This study used a cross-sectional study design. And the aim of this study is to establish the level of effect of the unplanned pregnancy on women college in Wadajir district. This study was being used cross sectional study design. This research had undertaken Wadajir district in Banadir region Mogadishu-Somalia. The sample size was 60 participating in the data collection phase from 1-30 Jun 2020. This study used primary data. This was collected from respondents in the area of study. Data was collected using a pre-cod structured questionnaire for the survey. Data showed that: 39 (65%) of the respondents answered yes that lack of education caused most unplanned pregnancy, 40 (66%) said that low-income countries are the risk factor of unplanned pregnancy, 47 (78%) of the respondents answered family planning is most common preventive for unplanned pregnancy, and 0 (67%) said that school dropout is the most compilation of unplanned pregnancy. Based on the findings of this research, the knowledge of the majority of respondents about unplanned pregnancy among women college replied yes, and they also replied that the most cause of unplanned pregnancy among women college is lack of education.

Clinical characteristics and fetal outcomes in women with epilepsy with planned and unplanned pregnancy: A retrospective study

PurposeTo compare the antiepileptic drug (AED) treatment patterns, seizure control, and folic acid supplementation between planned and unplanned pregnancy in women with epilepsy (WWE) and to investigate the effects of planned pregnancy on fetal outcomes. MethodsA prospectively collected database including WWE with pregnancy from Feb 2010 to Dec 2018 was retrospectively analyzed. Planned pregnancy was defined as WWE being regularly supervised by epileptologists from the time of intended pregnancy until delivery. Clinical characteristics and fetal outcomes were compared between the planned and unplanned pregnancy groups. Logistic regression was used to identify modifiable factors associated with adverse fetal outcomes. ResultsA total of 188 planned pregnancies and 289 unplanned pregnancies were enrolled in our study. Among planned pregnancies, 66.0 % took AED monotherapy, and 32.4 % received polytherapy. Among unplanned pregnancies, 58.1 % didn’t take AEDs, 28.0 % took monotherapy, and 12.8 % received polytherapy. The planned pregnancies had less generalized tonic-clonic seizures (P = 0.002) and higher proportion of being seizure-free (41.0 % vs. 22.8 %; P <0.001). All planned pregnancies took folic acid while 39.8 % of unplanned pregnancies never took it (P <0.001). The planned pregnancies had less rates of induced abortions (2.7 % vs. 13.5 %; P <0.001), preterm births (3.3 % vs. 20.4 %; P <0.001), and major congenital malformations (1.6 % vs. 7.5 %; P = 0.016). Pregnancy planning was independently associated with adverse fetal outcomes (adjusted OR, 0.14; 95 % CI, 0.08−0.27; P <0.001). ConclusionPlanned pregnancy in WWE contributes to more optimized AED pattern, better seizure control, more appropriate folic acid supplementation, and less adverse fetal outcomes.

A Clinical Approach to Catamenial Epilepsy: A Review.

Catamenial epilepsy (CE) is exacerbated by hormonal fluctuations during the menstrual cycle. Approximately 1.7 million women have epilepsy in the United States. CE affects more than 40% of women with epilepsy. There is a paucity of literature addressing this condition from a clinical standpoint, and the literature that does exist is limited to the neurological community. This article reviews the diagnosis and management of CE for the non-neurologist. Women with CE have early touch points in their care with numerous health care providers before ever consulting with a specialist, including OB/GYNs, pediatricians, emergency department physicians, and family medicine providers. In addition, women affected by CE have seizures that are more recalcitrant to traditional epilepsy treatment regimens. To optimize management in patients affected by CE, menstrual physiology must be understood, individualized hormonal contraception treatment considered, and adjustments and interactions with antiepileptic drugs addressed. CE is a unique subset of seizure disorders affected by menstrual fluctuations of progesterone and estrogen. The diagnosis of CE has been refined and clarified. There is an ever-increasing understanding of the importance and variety of options of hormonal contraception available to help manage CE. Furthermore, antiepileptic drugs and contraception can interact, so attention must be directed to optimizing both regimens to prevent uncontrolled seizures and pregnancy. CE can be diagnosed with charting of menstrual cycles and seizure activity. Hormonal treatments that induce amenorrhea have been shown to reduce CE. Optimizing antiepileptic drug dosing and contraceptive methods also can minimize unplanned pregnancies in women affected by CE.

Cutting the Losses of Pregnant Women With Epilepsy.

If unintended pregnancy is common among women with epilepsy and is associated with increased risk of spontaneous fetal loss (SFL), it is important to develop guidelines for safe and effective contraception for this community. To assess whether planned pregnancy is a determinant of SFL in women with epilepsy. The Epilepsy Birth Control Registry conducted this web-based, retrospective survey between 2010 and 2014. It gathered demographic, epilepsy, antiepileptic drug (AED), contraceptive, and reproductive data from 1144 women with epilepsy in the community between ages 18 and 47 years. Data were analyzed between March 2018 and May 2018. Main outcomes and measures The primary outcome was the risk ratio (RR) with 95% confidence intervals (CIs) for SFL in unplanned versus planned pregnancies. The secondary outcome was the identification of some potentially modifiable variables (maternal age, pregnancy spacing, and AED category) of SFL versus live birth using binary logistic regression. The participants were proportionally younger (mean [standard deviation] age, 28.5 [6.8] years), and 39.8% had household incomes of $25 000 or less. Minority women represented only 8.7% of the participants. There were 530 (66.8%) of 794 unplanned pregnancies and 264 (33.2%) of 794 planned pregnancies. The risk of SFL in 653 unaborted pregnancies in women with epilepsy was greater for unplanned (n = 137 of 391; 35.0%) than planned (n = 43 of 262; 16.4%) pregnancies (RR: 2.14; 95% CI: 1.59-2.90; P < .001). Regression analysis found that the risk of SFL was greater when planning was entered alone (odds ratio [OR], 2.75; 95% CI: 1.87-4.05; P < .001) and more so when adjusted for maternal age, interpregnancy interval, and AED category (OR: 3.57; 95% CI: 1.54-8.78; P = .003). Interpregnancy interval (OR: 2.878; 95% CI: 1.8094-4.5801; P = .008) and maternal age (OR: 0.957; 95% CI: 0.928-0.986 for each year from 18 to 47 years; P = .02), but not AED category, were also associated. The risk was greater when interpregnancy interval was less than 1 year (n = 56 of 122; 45.9%) versus greater than 1 year (n = 56 of 246; 22.8%; RR: 2.02; 95% CI: 1.49-2.72; P < .001). Relative to the younger than 18 years cohort (n = 15 of 29; 51.7%), the risks were lower for the intermediate older cohort aged 18 to 27 years (n = 118 of 400; 29.5%; RR: 0.57; 95% CI: 0.39-0.84; P < .004) and the cohort aged 28 to 37 years (n = 44 of 212; 20.8%; RR: 0.40; 95% CI: 0.26-0.62; P < .001) but not significantly different for the small number of participants in the aged 38 to 47 years cohort (n = 3 of 12; 25.0%). No individual AED category's SFL frequency differed significantly from the no AED category. The Epilepsy Birth Control Registry retrospective survey finding that unplanned pregnancy in women with epilepsy may double the risk of SFL warrants prospective investigation with outcome verification.

Association of Unintended Pregnancy With Spontaneous Fetal Loss in Women With Epilepsy

If unintended pregnancy is common among women with epilepsy and is associated with increased risk of spontaneous fetal loss (SFL), it is important to develop guidelines for safe and effective contraception for this community. To assess whether planned pregnancy is a determinant of SFL in women with epilepsy. The Epilepsy Birth Control Registry conducted this web-based, retrospective survey between 2010 and 2014. It gathered demographic, epilepsy, antiepileptic drug (AED), contraceptive, and reproductive data from 1144 women with epilepsy in the community between ages 18 and 47 years. Data were analyzed between March 2018 and May 2018. The primary outcome was the risk ratio (RR) with 95% confidence intervals for SFL in unplanned vs planned pregnancies. The secondary outcome was the identification of some potentially modifiable variables (maternal age, pregnancy spacing, and AED category) of SFL vs live birth using binary logistic regression. The participants were proportionally younger (mean [SD] age, 28.5 [6.8] years), and 39.8% had household incomes of $25 000 or less. Minority women represented only 8.7% of the participants. There were 530 of 794 unplanned pregnancies (66.8%) and 264 of 794 planned pregnancies (33.2%). The risk for SFL in 653 unaborted pregnancies in women with epilepsy was greater for unplanned (n = 137 of 391; 35.0%) than planned (n = 43 of 262; 16.4%) pregnancies (RR, 2.14; 95% CI, 1.59-2.90; P < .001). Regression analysis found that the risk for SFL was greater when planning was entered alone (odds ratio [OR], 2.75; 95% CI, 1.87-4.05; P < .001) and more so when adjusted for maternal age, interpregnancy interval, and AED category (OR, 3.57; 95% CI, 1.54-8.78; P = .003). Interpregnancy interval (OR, 2.878; 95% CI, 1.8094-4.5801; P = .008) and maternal age (OR, 0.957; 95% CI, 0.928-0.986 for each year from 18 to 47 years; P = .02), but not AED category, were also associated. The risk was greater when interpregnancy interval was less than 1 year (n = 56 of 122; 45.9%) vs greater than 1 year (n = 56 of 246; 22.8%) (RR, 2.02; 95% CI, 1.49-2.72; P < .001). Relative to the younger than 18 years cohort (n = 15 of 29; 51.7%), the risks were lower for the intermediate older cohort aged 18 to 27 years (n = 118 of 400; 29.5%; RR, 0.57; 95% CI, 0.39-0.84; P < .004) and the cohort aged 28 to 37 years (n = 44 of 212; 20.8%; RR, 0.40; 95% CI, 0.26-0.62; P < .001) but not significantly different for the small number of participants in the aged 38 to 47 years cohort (n = 3 of 12; 25.0%). No individual AED category's SFL frequency differed significantly from the no AED category. The Epilepsy Birth Control Registry retrospective survey finding that unplanned pregnancy in women with epilepsy may double the risk for SFL warrants prospective investigation with outcome verification.

Habit Strength and Adherence to Oral Contraceptives: the Role of Time- and Place-Based Cues.

Non-adherence to the oral contraceptive pill (OCP) has been reported by almost half of OCP users. As the efficacy of the OCP requires daily adherence, poor adherence often leads to unplanned pregnancies in women who depend on this method of contraception. This study aims to investigate the association between habit strength and time- and place-based cues in the context of adherence to the OCP. A cross-sectional questionnaire of 245 current OCP users with a mean age of 22.41years (SD = 4.78) and a range of 18-52years was conducted. The Self-Report Behavioural Automaticity Index was employed to measure habit strength. The Medication Adherence Report Scale was used and modified to refer to OCP non-adherence specifically. Additional measures were employed to assess the use of time- and place-based cues. Data were analysed using correlational analyses. Stronger habit strength was associated with better adherence to the OCP (r = - 0.25, p < .001). Having a fixed time of day to take the OCP was associated with habit strength and OCP adherence. Having a fixed place to store the OCP was associated with habit strength but not with OCP adherence. Time- and place-based cues are likely to be an important part of any intervention design to support adherence and strengthen the habit of taking the OCP. It is recommended that future replications include longitudinal study designs and analyses.

Psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth.

ObjectiveTo evaluate the psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth.MethodsA two-phase psychometric evaluation design was set-up. Phase I comprised the translation from English into Dutch and pretesting with 6 women using cognitive interviews. In phase II, the reliability and validity of the Dutch version of the LMUP was assessed in 517 women giving birth recently. Reliability (internal consistency) was assessed using Cronbach’s alpha, inter-item correlations, and corrected item-total correlations. Construct validity was assessed using principal components analysis and hypothesis testing. Exploratory Mokken scale analysis was carried out.Results517 women aged 15–45 completed the Dutch version of the LMUP. Reliability testing showed acceptable internal consistency (alpha = 0.74, positive inter-item correlations between all items, all corrected item-total correlations >0.20). Validity testing confirmed the unidimensional structure of the scale and all hypotheses were confirmed. The overall Loevinger’s H coefficient was 0.57, representing a ‘strong’ scale.ConclusionThe Dutch version of the LMUP is a reliable and valid measure that can be used in the Dutch-speaking population in Belgium to assess pregnancy planning. Future research is necessary to assess the stability of the Dutch version of the LMUP, and to evaluate its psychometric properties in women with abortions.

Risks associated with psychotropic drugs during pregnancy

Unplanned pregnancies in women with psychiatric illness are common and result in exposure of the fetus to multiple psychotropics during the first trimester. Literature reveals that olanzapine may rarely cause major malformations and selective serotonin reuptake inhibitors may be associated with primary pulmonary neonatal hypertension. We present a rare case of 39-year-old (middle-aged) female Gravida 4 para 2 abortion 1 live 2, with bipolar affective disorder with gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) presenting in the third trimester of her pregnancy. The patient continued 5 mg olanzapine and 150 mg sertraline throughout pregnancy unsupervised. Ultrasonographic findings revealed multiple congenital anomalies in the fetus, and emergency cesarean was conducted in the 32nd week of pregnancy, which was followed by neonatal complications including bradycardia, gasping, absent birth cry and reflexes, and weak gross motor activity and early neonatal death. The anomalies observed in the fetus are similar to the anomalies that have been observed and discussed with psychotropics in the past. Thus, we report this case to understand in naturalistic setting – the complications and risks associated with psychotropic medications in pregnancy along with other physical morbidities including GDM and PIH in the female suffering from bipolar disorder.

Risk factors for unplanned pregnancy in women with mental illness living in a developing country.

Pregnant women in general are at an increased risk of experiencing symptoms of mental illness, and those living in a developing country are even more vulnerable. Research points towards a causal relationship between unplanned pregnancy and perinatal mental illness and suggests that pregnancy planning can aid in reducing the negative impact of mental illness on a woman, her unborn baby, and the rest of the family. In this quantitative, descriptive study, we investigated both socio-demographic factors and variables relating to mental illness itself that may place women at an increased risk of experiencing unplanned pregnancy. Data was gathered at two maternal mental health clinics in Cape Town by means of semi-structured interviews. Univariate analyses of the data revealed five independent key risk factors for unplanned pregnancy: lower levels of education, unmarried status, belonging to the Colored ethnic population, substance use, and having a history of two or more suicide attempts. Some of these factors overlap with findings of similar studies, but others are unique to the specific population (women with mental illness within a developing country). Screening of women based on these risk predictors may pave the way for early interventions and reduce the incidence of unplanned pregnancy and the negative consequences thereof in the South African population.

Hormonal contraception and breast cancer, what more do we need to know?

Most women use hormonal contraception for more than 30 years and for many, this may involve exposure in their older reproductive years when baseline breast cancer risk rises steeply. Overall, the risk of breast cancer diagnosis with exposure to hormonal contraception is very small and outweighed by its contraceptive benefits but despite this, there are still outstanding questions for all methods used in clinical practice due to paucity of available evidence, lack of which should not be taken to imply safety. This is exemplified by the following assumptions: the progestogen-only pill and long-acting reversible contraceptives are 'breast-safe' options in peri-menopausal women, use of the levonorgestrel intrauterine system for the management of endometrial pathology in breast cancer survivors is less likely to promote disease recurrence and the benefit all hormonal contraceptive methods confer in reducing unplanned pregnancy in women at high familial risk outweigh the risk of breast cancer diagnosis. There is no data on risk with the concurrent prescription of hormone replacement therapy in women exhibiting climacteric symptoms who are still menstruating. Advice of GPs and Community Sexual & Reproductive Health specialists will inevitably be sought about some or all these issues and in the absence of conclusive evidence from clinical studies, caution should be applied and women counselled appropriately.

Development of a mother and baby unit contraception assessment tool.

Unplanned pregnancies are a unique, yet significant risk factor in perinatal mental health. Our aim was to create an assessment tool to assess mother's views on contraception as part of the discharge planning process. We used a quantitative-qualitative approach. A clinician-guided questionnaire was completed by patients prior to their discharge from hospital and analysed using Microsoft Excel. Semi-structured interviews were used to explore views regarding family planning in greater depth. Interviews were recorded and transcribed verbatim onto Microsoft Word. Emerging themes were identified using a grounded theory thematic analysis approach. Eighteen inpatients were assessed at the Bethlem Mother and Baby Unit over a 4-month period (May-August 2015). Half of the women stated that the pregnancy was unplanned. The most common contraception methods used were condoms, followed by no method/natural cycle technique. Forty-four percent felt unsure of contraception options available and were keen for further advice and referral to family planning services. Interestingly, almost all the women interviewed stated that their experience of perinatal mental illness had changed their views on having more children. The contraception assessment tool is a short, simple questionnaire that can be adopted across inpatient and community settings. In cooperating family, planning into the discharge care plan could be protective in preventing future unplanned pregnancies in women at high risk of perinatal mental illness relapse. Performing the assessment also provided an added opportunity for psycho-education regarding reproductive health and medication use during the perinatal period. The tool also encouraged liaison with GPs and local family planning services.

Contraceptive in Women with Sickle Cell Disease: A Survey Study

Objectives: Despite recognized maternal and neonatal morbidity associated with unplanned pregnancy in women with sickle cell disease (SCD), unmet need for contraception in this population remains high. While low uptake of contraception in women with chronic disease is not unique to SCD, the impact of provider counseling and patient knowledge and attitudes on contraceptive use is unknown. Guidance on contraception for women with SCD is complicated by concerns about the safety of estrogen-containing methods due to increased risk of venous thromboembolism (VTE),[1-3] the potential non-contraceptive benefits of depot medroxyprogesterone acetate (DMPA) on pain[4-6] and the complex relationship between menses and sickle cell crises.[7] The objective of this study was to evaluate contraceptive knowledge, attitudes, and experiences in a sample of women with SCD.Study Design: A convenience sample of women from the adult and pediatric sickle cell clinics at an urban, academic institution in Baltimore completed a self-administered electronic survey. The survey instrument collected comprehensive medical and reproductive health history, explored participant experience with contraception and tested knowledge and attitudes about efficacy and safety of contraceptive methods.Results: 54 women completed surveys. The median age of respondents was 35 years. Over 40% reported they were disabled or unemployed. Seventy percent of women reported a hospital admission for SCD in the past year and 74% reported at least monthly utilization of urgent services for pain crises. Fifty-five percent reported a history of unintended pregnancy, 77% had a history of at least one pregnancy and 74% reported a desire for no further pregnancies. One third of women at risk for pregnancy did not use a birth control method at last intercourse. The most common contraceptive methods were surgical sterilization (30%) and condoms (30%) followed by DMPA (9%). Women were more likely to use estrogen-containing methods (6%) than highly effective long-acting methods like intrauterine devices or contraceptive implants (3%). While the majority of women (83%) were told they had a high-risk pregnancy in the past and 50% were told by a physician they should not be pregnant for their own health in the future, only 23% reported knowledge of safety concerns with some contraceptive methods for women with SCD. Women primarily received contraceptive counseling from gynecologic providers and only 30% reported a provider other than a gynecologist had ever discussed birth control with them.Conclusions: Women with SCD have unmet contraceptive needs. Women with SCD have some knowledge about their obstetric risks, and this knowledge appears to come from their lived experience and provider counseling. Women with SCD were less knowledgeable about the benefits and risks associated with contraceptive use.Implications: Efforts to increase provision of contraception through coordination of care between hematologists, primary care and gynecologic providers has the potential to improve family planning services for women with SCD resulting in improvements in quality of life and a decrease in unintended pregnancy.[1] Haddad L, Curtis K, Legardy-Williams J, Cwiak C, Jamieson D. Contraception for individuals with sickle cell disease: a systematic review of the literature. Contraception 2012;85:527-537.[2] Manchikanti A, Grimes DA, Lopez LM, Schulz KF. Steroid hormones for contraception in women with sickle cell disease. Cochrane Database Systemic Review. 2007 Apr 18;(2):CD006261. Review.[3] Naik R, Streiff M, Haywood C, Nelson J, Lanzkron S. Venous thromboembolism in adults with sickle cell disease: a serious and under-recognized complication. The American Journal of Medicine 2013;126:443-9.[4] Abood M, de Castillo Z, Guerrero F, Espino M, Austin KL. Effect of Depo-Provera or Microgynon on the painful crises of sickle cell anemia patients. Contraception 1997;56:313-6.[5] De Ceulaer K, Gruber C, Hayes R, Serjeant G. Medroxyprogesterone Acetate and homozygous sickle-cell disease. The Lancet 1982;2:229-31.[6] ACOG practice bulletin No. 73: Use of hormonal contraception in women with coexisting medical conditions. Obstetrics and Gynecology 2006;107:1453-72.[7] Yoong WC, Tuck M. Menstrual pattern in women with sickle cell anemia and its association with sickling crises. Journal of Obstetrics and Gynaecology 2002;22(4):399-401. DisclosuresNo relevant conflicts of interest to declare.

Asociación entre conocimientos de anticoncepción y embarazo no planeado. Estudio de corte transversal

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; medir la asociación entre el nivel de conocimientos sobre la resolución de problemas en la utilización de los métodos anticonceptivos y la presencia de embarazo no planeado en mujeres que usan métodos anticonceptivos de corta acción. Establecer la prevalencia del embarazo no planeado y describir actitudes, percepciones y características de la atención en las actividades de planificación familiar.&lt;/p&gt;&lt;p&gt;&lt;br /&gt;&lt;strong&gt;Materiales y métodos:&lt;/strong&gt; estudio analítico de corte transversal. Se incluyeron mujeres entre 14 y 49 años de edad, que acudieron a realizarse una prueba de embarazo a una institución de salud del sector público, de bajo nivel de complejidad, que atiende población del régimen de aseguramiento subsidiado por el Estado en la ciudad Medellín (Colombia). Antes de obtener el resultado de la prueba de embarazo se les realizó una encuesta estructurada y un test coacerca de su conocimiento para resolver situaciones que pueden afectar la efectividad de los métodos de anticoncepción dependientes de la mujer.&lt;br /&gt;Resultados: se realizaron 471 encuestas, el 75,2 % de las mujeres no planeaban embarazarse y el 57 % tuvieron un embarazo no planeado. La mediana del nivel de conocimientos fue del 50 % (p25: 37,5 %, p75: 62,5 %). La razón de prevalencias de embarazo no planeado con nivel medio y alto de conocimientos fue 0,56 (IC 95 %: 0,34-0,92).&lt;/p&gt;&lt;p&gt;&lt;br /&gt;&lt;strong&gt;Conclusión:&lt;/strong&gt; el conocimiento sobre la resolución de los problemas que afectan la efectividad de los métodos anticonceptivos que dependen del buen uso de la mujer para garantizar esa efectividad se asocia a menor frecuencia de embarazo no planeado.&lt;/p&gt;