Women Of Childbearing Years Research Articles

Ayurvedic approach in the functional improvement of Systemic Lupus Erythematosus (SLE) - A Case Report

Systemic lupus erythematosus (SLE) is an auto immune disease in which organs and cells undergo damage mediated by tissue-binding autoantibodies and immune complex.[1]. 90% of patients are women of child-bearing years are affected with this disease. According to Ayurveda, the signs and symptoms can be included under the purview of Vataraktha. Case summary: A 43-year-old female patient approached with chief complaints of pain over bilateral elbow joints, shoulder joints and low back pain, burning sensation over toes for 8 years associated with febrile attacks, coated tongue, mouth ulcer, dryness of mouth aggravated since 2 months. The Ayurvedic diagnosis was made as Vataraktha on the basis of signs and symptoms. The patient was given Sadyovirechana (Purgation therapy), Basti therapy (enema) along with other external procedures and internal medications. Significant improvement was observed after the treatment in terms of VAS Score and other subjective parameters. This case study shows that Ayurvedic treatment is helpful in the functional improvement of SLE and helps in improving the quality of life.

A Food Industry Perspective on Folic Fortification

The U.S. Public Health Service (PHS) has recommended that all women of childbearing years, capable of becoming pregnant, consume 400 fig folic acid/d to reduce their risk of having a neural tube defect (NTD)-affected pregnancy. The U.S. Food and Drug Administration subsequently proposed a fo late fortification scheme for cereal grains, which also allowed the continued fortification of breakfast cereals at 0.1 mg per serving. To determine the contribution of ready-to-eat breakfast cereals (RTEC) to folate in takes in women of childbearing years, data were ana lyzed from the U.S. Department of Agriculture’s 1989-1991 Continuing Survey of Food Intakes by In dividuals and 1987-1988 Nationwide Food Consumption Survey. Women consuming RTEC have higher intakes of folate than women reporting no RTEC consumption. Recent reports indicate that most women are unaware of the PHS recommendation to consume more folate, and many health professionals are not advising women of the need to consume adequate folate during the childbearing years. The food industry has been an effective communicator of health and nutrition messages and should be encouraged to raise awareness about the role of folate in NTDs. Better analysis also needs to be conducted to identify women at risk of low folate intakes, so that targeted educational efforts can be made and appropriate vehicles identified for delivering folate to these women.

Alien Trace Metal Elements in the Body: Changes May Explain Recent Epidemics and Diseases

It is now well-known that many elements of the periodic table find a way into our bodies and have the potential for disturbing the delicate homeostasis (balance) of body chemistry. Nevertheless, in spite of the volume of research published in this area, only vague suppositions result concerning any involvements and little progress has been made concerning human health or addressing the preponderance of the innumerable epidemics that now are evident. This results from the inability for statistical analyses to be sufficiently precise to pinpoint specific causes. As a result, a simpler analysis is presented herein based on the premise that environmental chemical epidemics can only arise from an increased change. As a result, global diets and lifestyles have been examined in detail to establish items of change. Such a needed criteria in the recent decades poses strict requirements eliminating most candidates. Two areas of rapid growth in life-style changes clearly are evident and involve the diet of fish (sushi) (high methyl mercury) and the increase in medical vaccines (aluminum hydroxide). It is apparent that people now live never knowing whether they are at risk from these due to genetic susceptibilities. This is especially important for women of child-bearing years, where a fetus is always at high toxic risk levels. As a result, the availability of general population testing now is desperately needed especially for the neurotoxins, Hg, Al, As, and Pb, all alien species to the body together with Se that appears to be the body’s natural healthy chelator.

Idiopathic Intracranial Hypertension from Benign to Fulminant: Diagnostic and Management Issues.

Idiopathic intracranial hypertension (IIH) primarrily affects obese women of childbearing years and is commonly associated with headaches, pulsatile tinnitus, and vision changes. Though most patients have a "benign" course, it can lead to significant morbidity, including blindness. The treatment approach is based on severity of visual impact and includes weight loss, intracranial pressure lowering medications, and sometimes surgery, such as spinal fluid diversion, optic nerve sheath fenestration, or venous sinus stenting. More studies are needed to determine when surgery is most appropriate and which surgical procedure provides maximal benefit with the least risk.

Peripartum depression and its predictors: A longitudinal observational hospital-based study

BACKGROUNDDepression is a common problem in women in childbearing years due to burdens of motherhood and building a family. Few studies estimate the prevalence of antepartum depression compared to those in the postpartum period. AIMTo estimate the prevalence and the severities of peripartum depression and major depressive disorder and their predictors.METHODSThis is a longitudinal observation study. It included 200 women scoring ≥ 13 with the Edinburgh Postpartum Depression Scale, indicating presence of symptoms of depression. They had a gestational age of ≥ 6 wk and did follow-ups until the 10th week to 12th weeks postpartum. Information of women's reactions to life circumstances and stressors during the current pregnancy were gathered from answers to questions of the designed unstructured clinical questionnaire. Severities of depression, anxiety, and parenting stress were determined by the Beck Depre-ssion Inventory, State-Trait Anxiety Inventory for Adults, and Parenting Stress Index-Short Form, respectively. Psychiatric interviewing was done to confirm the diagnosis of major depression. Measuring the levels of triiodothronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) was done in both antepartum and postpartum periods.RESULTSOut of 968 (mean age = 27.35 ± 6.42 years), 20.66% (n = 200) of the patients had clinically significant symptoms of depression and 7.44% had major depression. Previous premenstrual dysphoria, post-abortive depression, and depression unrelated to pregnancy and were reported in 43%, 8%, and 4.5% of the patients, respectively. Psychosocial stressors were reported in 15.5% of the patients. Antepartum anxiety and parenting stress were reported in 90.5% and 65% of the patients, respectively. Postpartum T3, T4, and TSH levels did not significantly differ from reference values. Regression analysis showed that anxiety trait was a predictor for antepartum (standardized regression coefficients = 0.514, t = 8.507, P = 0.001) and postpartum (standardized regression coefficients = 0.573, t = 0.040, P = 0.041) depression. Antepartum depression (standardized regression coefficients = -0.086, t = -2.750, P = 0.007), and parenting stress (standardized regression coefficients = 0.080, t = 14.34, P = 0.0001) were also predictors for postpartum depression.CONCLUSIONResults showed that 20.66% of the patients had clinically significant symptoms of depression and 7.44% had major depression. Anxiety was a predictor for antepartum and postpartum depression. Antepartum depression and parenting stress were also predictors for postpartum depression.

Treatment of Women With Hepatitis C Diagnosed in Pregnancy: a Co-Located Treatment Approach

The development of direct-acting antiviral (DAA) treatments for hepatitis C virus (HCV) has revolutionized the management of HCV among virtually all patients. However, perhaps the last frontier of HCV treatment is in individuals with HCV during pregnancy for whom there are no specific guidelines for treatment. 1 Kushner T. et al. Ther Adv Infect Dis. 2019; 6: 1-4 Google Scholar Over the past decade, in relation to the increased rates of opioid use among young individuals, a significant increase has been seen in HCV seen among women of childbearing years and in women during pregnancy. 2 Rossi R.M. et al. Obstet Gynecol. 2020; 135: 387-395 Crossref PubMed Scopus (17) Google Scholar Over the past 2 years, the American Association for the Study of Liver Diseases, Centers for Disease Control and Prevention, US Preventative Services Task Force, and, most recently, the American College of Obstetricians and Gynecologists have each recommended screening of all women for HCV during pregnancy. For individuals who screen positive for HCV in pregnancy, per American Association for the Study of Liver Diseases guidelines, “treatment can be considered during pregnancy on an individual basis after a patient-physician discussion about the potential risks and benefits.” 3 American Association for the Study of Liver Diseases. https://www.hcvguidelines.org/unique-populations/pregnancy Google Scholar However, despite these recommendations and a published clinical trial of the use of sofosbuvir/ledipasvir in pregnancy 4 Chappell C.A. et al. Lancet Microbe. 2020; 1: e200-e208 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar (and others currently underway), presently there are no published real-world data regarding HCV treatment during pregnancy in the United States. We describe a case series of women who screened positive for HCV during pregnancy and were referred to our practice for HCV treatment.

Endothelins and liver cirrhosis

AbstractEndothelins are a family of 21‐amino acid oligopeptides, called endothelin‐1 (ET‐1), endothelin‐2 (ET‐2), and endothelin 3 (ET‐3). Endothelins act on hepatocytes, liver endothelial cells, and Kupffer cells in a paracrine or autocrine manner through two G protein‐coated receptors, called endothelin A and B receptors, which are mainly located in interlobular veins, interlobular artery endothelial cells and hepatic stellate cells (HSCs). ET B receptor (ETBR)‐1 is responsible for the induction of endothelial nitric oxide synthase, resulting in nitric oxide release and vasodilatation, whereas ETBR‐2 is located on HSCs and is responsible for vasoconstriction. Endothelins are not stored in the organs. Approximately 20% of endothelins are secreted into the circulation system, and are rapidly cleared by the lungs, liver, heart, and kidneys. As a potent vasoconstrictor, endothelins may have a key role for the treatment of hypertensive vascular diseases, inflammation, fibrosis, and metabolic diseases. By clearing ET‐1 from the circulation, endothelin A receptor (ETAR) antagonists can reduce intraportal vascular resistance by dilatating the portal vein, reducing the contraction of HSCs, increasing the diameter of sinusoids, facilitating the regression of liver fibrosis, and restoring liver parenchyma. ET‐1 induces nitric oxide synthase and upregulates cyclooxygenase 2 mRNA levels, making it a key factor during the onset of fibrosis and in the prognosis of patient outcomes. Endothelins can be used to treat porto‐pulmonary hypertension, portal hypertension, angiogenesis, and liver fibrosis and have been approved for the treatment of porto‐pulmonary hypertension. Endothelins are produced on mesangial cells, podocytes, tubular epithelium, and renal collecting tubes in high amounts. Activation of ETAR supports the progression of kidney diseases, whereas activation of ETBR has protective effects on the kidneys. ET‐1 plays an important role in normal cardiovascular homeostasis. Endothelins are closely associated with severe systemic hypertension, congestive heart failure, atherosclerosis, and pulmonary hypertension. Dual ET receptor antagonists reduce blood pressure, but have several side effects, including liver toxicity, acute liver failure, accumulation of salt and water, testicular toxicity, headache, and teratogenicity. Liver enzymes should be checked in all patients who have received ET receptor antagonists, and women of childbearing years should use contraception.

A175 DISEASE ACTIVITY IN FIRST TRIMESTER IS ASSOCIATED WITH REDUCED GROWTH IN INFANTS BORN TO WOMEN WITH INFLAMMATORY BOWEL DISEASE

BackgroundUlcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory bowel diseases (IBD) that affect a significant portion of women in childbearing years. It is known that disease activity in early pregnancy negatively impacts obstetrical and perinatal outcomes, but the impact on infant growth is largely unknown.AimsThe objective of this study was to compare the growth of infants born to women with active IBD during pregnancy versus those born to women with IBD in remission during pregnancy.MethodsWe conducted a prospective cohort study in a Canadian tertiary centre comprised of 98 pregnant women with IBD (63 with UC and 35 with CD) and 13 healthy pregnant women. We collected maternal demographic at trimester 1 and assessed disease activity at each trimester using clinical disease scores and fecal calprotectin. We then collected perinatal outcomes at delivery and followed the infants’ growth and feeding habits up to 12 months of age.ResultsA total of 103 mother-infant pairs were included in the study, of which 88 infants were born to women with IBD, and 15 born to women with active disease at trimester 1. Active disease at trimester 1 was associated with more adverse obstetrical outcomes, reduced 1-minute and 5-minute APGAR scores and more frequent NICU admissions. Infants born to women with active trimester 1 disease had reduced weight-for-age and length-for-age Z scores up to 6 months of age, in the absence of difference in feeding patterns. In addition, women with active disease at trimester 1 had increased expression of IL-8 and IFN-γ compared to those with trimester 1 remission.ConclusionsActive IBD during first trimester is correlated with decreased infant weight and height up to 6 months of age, suggesting that strict disease control during first trimester, or even preconception, is essential for optimizing infant growth and perinatal outcomes. Funding AgenciesNone

Protection by inclusion: Increasing enrollment of women in cardiovascular trials

Despite differences in biology that influence disease incidence, drug metabolism, and response to therapies, women remain under-enrolled in cardiovascular clinical trials. Estimates regarding treatment efficacy and safety are derived from male-predominant trial populations, with inadequate balance between sex subgroups for meaningful analysis on sex-specific treatment effects. Treatment strategies for women, particularly women of childbearing years, are derived from trials with predominantly men participants, from lower quality, observational studies, or anecdotal evidence. Guideline recommendations for women who are pregnant or lactating are typically based on opinion as there is little evidence to guide them. In this review, we discuss trial design factors independently associated with the under-enrollment of women, identify possible strategies to increase the enrollment of women in trials, and suggest multi-level actions that could close sex-based research disparities. Recruiting and retaining women trialists, independently associated with increased enrollment of women and Black, Indigenous, and Persons of Color (BIPOC) participants, and diversifying research teams may be effective approaches. Modifying trial design by eliminating default sex-specific exclusion criteria, developing patient-centered consent and participation processes, incorporating pragmatic follow-up schemes, and incorporating sex/gender analysis into trial planning may also increase the enrollment of women participants. Journals and funding bodies should require trials to report participant to prevalence ratios, sex-disaggregated trial flow, and sex-treatment interactions. Healthcare systems can help create research-ready cultures that both enhance patient engagement in trials and expedite end-of-trial knowledge translation.

Composition and Stability of the Vaginal Microbiota of Pregnant Women With Inflammatory Bowel Disease.

BackgroundInflammatory bowel disease (IBD) is common in women of childbearing years, and active IBD during pregnancy is associated with increased rates of preterm delivery and low-birth-weight newborns. Changes in the vaginal microbiome have been associated with preterm delivery. We aimed to determine the taxonomic composition of the vaginal microbiota at 3 time points during pregnancy in a population of women with IBD.MethodsParticipants were recruited from the patient registry of the Preconception and Pregnancy IBD Clinic at Royal University Hospital in Saskatoon, Canada. Self-collected vaginal swabs were obtained from patients at each trimester. Microbiota profiles were created by cpn60 amplicon sequencing.ResultsWe characterized the vaginal microbiota of 32 pregnant participants with IBD (33 pregnancies) during each trimester. A total of 32 of 33 pregnancies resulted in a live birth with 43.8% (n = 14 of 32, 2 missing) by caesarean section; 2 of 32 were preterm. Microbiota compositions corresponded to previously described community state types, with most participants having microbiota dominated by Lactobacillus crispatus. In 25 of 29 participants in which samples were available for more than 1 time point, there was no change in the community state type over time. Prevalence of Mollicutes (Mycoplasma and/or Ureaplasma) was significantly higher in pregnant participants with IBD than in a previously profiled cohort of 172 pregnant women without IBD who delivered at term.ConclusionsThe vaginal microbiome of participants with IBD was stable throughout pregnancy. Prevalence of Mollicutes, which has been associated with preterm delivery, warrants further study in this patient group.

Does Age Affect Desmopressin Responsiveness in Patients with Von Willebrand Disease?

Background: Patients with von Willebrand Disease (VWD) typically undergo a desmopressin acetate (DDAVP) responsiveness challenge at diagnosis to assess whether their coagulation deficits are sufficiently reversed following DDAVP administration. If responsive, patients can be treated with DDAVP in future when at increased risk of bleeding. Current practice assumes that DDAVP responsiveness remains constant over the adult lifetime, and therefore many adult patients are not re-tested. In the normal population, VWF plasma levels (VWF:Ag),VWF ristocetin activity (VWF:RCO) and coagulation factor VIII (FVIII:C) increase with age. This relationship has also been observed in patients with type 1 VWD. We hypothesized that DDAVP responsiveness also increased with age, and set out to investigate this relationship in patients with type 1 VWD.Methods: We conducted a retrospective chart review of 106 patients enrolled at our center since 1990 who met diagnostic criteria for VWD and had undergone at least 1 DDAVP challenge. We recorded baseline, 1 hour, 2 hour and 4 hour post-DDAVP VWF related parameters for every patient when available. Baseline values were taken prior to DDAVP challenge, but may not reflect nadir levels required to diagnose VWD. We excluded patients on medications known to impact VWF and FVIII levels, and patients with types 2B, 2M and 3 VWD due to contraindication or lack of benefit with DDAVP. We stratified analyses by gender to control for the impact of estrogen on VWF and FVIII:C levels. Our primary outcome was DDAVP responsiveness in type 1 VWD, measured as changes in VWF:Ag, VWF:RCo, and FVIII:C levels one hour after DDAVP. As a secondary outcome, we determined these changes in type 2A VWD patients. Analyses were conducted using descriptive statistics, and Pearson and Spearman correlations were used to evaluate for the presence of linear and monotonic relationships, respectively.Results: We had 90 patients (66 female) at our center with type 1 and 16 with type 2A (10 female) VWD who had undergone at least 1 DDAVP challenge. Blood type was available for 66 patients with type 1 VWD; 47 were type O (33 female) and 19 were non-type O (18 female). Mean age at DDAVP challenge for women with type 1 VWD was 23.2 years (SD 15.6) and 27.4 years (SD 19.8) for men. Mean DDAVP dose was approximately 0.3 mcg/kg, with no dose cap. Mean baseline VWF:RCo for type 1 VWD women was 0.39 IU/ml (SD 0.16) and 0.25 IU/ml (SD 0.14) for men, with concordant VWF:Ag mean levels. Mean baseline FVIII:C was 0.74 IU/ml (SD 0.33) and 0.49 IU/ml (SD 0.32) for the women and men, respectively. Blood type was available for 11 patients with type 2A VWD; 6 were type O (5 female) and 5 were non-type O (4 female). In the type 2A group, mean age at DDAVP challenge was 23.7 years (SD 19.0) in women and 50.7 years (SD 18.9) in men. Mean baseline VWF related parameters in type 2A VWD patients were, for women and men, respectively: VWF:Ag 0.48 IU/ml (SD 0.33), VWF:RCo 0.20 IU/ml (SD 0.09), FVIII:C 0.56 IU/ml (SD 0.14) and VWF:Ag 0.50 IU/ml (SD 0.30), VWF:RCo 0.18 IU/ml (SD 0.09), FVIII:C 0.57 IU/ml (SD 0.33).We excluded eleven type 1 VWD patients and one type 2A VWD patient due to medication use. The correlation between age and VWF-related responsiveness to DDAVP at 1 hour in women with type 1 VWD did not reveal a meaningful linear (VWF:Ag, Pearson -0.08, p = 0.62; FVIII:C Pearson 0.04, p=0.77) or monotonic (VWF:Ag, Spearman -0.03, p = 0.86; FVIII:C Spearman 0.12, p=0.40) relationship. However, when we explored the relationship graphically there was an indication of an age-related effect in women of child-bearing years for VWF:Ag, VWF:RCo and FVIII:C (see Figure 1). This finding was not observed in men with type 1 VWD, or in type 2A patients. Regression models including non-linear age terms may assist in explaining this trend.Conclusion: In women with type 1 VWD, we found that responsiveness to DDAVP appears to be amplified around child-bearing years. This trend is reminiscent of the well-established relationship between serum estrogen levels and coaguability. To our knowledge, we have shown for the first time that post-pubertal women with type 1 VWD may have an enhanced ability to respond dynamically to DDAVP but only around this time period. We will confirm our findings with advanced statistical modeling. Future studies should assess whether these age-related changes of coagulation studies translate into meaningful lifecycle-related changes in the bleeding phenotype of type 1 VWD. [Display omitted] DisclosuresJames:Bayer: Research Funding; Shire: Research Funding; CSL Behring: Research Funding. Sholzberg:Shire: Honoraria, Research Funding; CSL Behring: Honoraria, Research Funding; NovoNordisk: Honoraria; Octapharma: Honoraria, Research Funding.

Incidence and prevalence of systemic lupus erythematosus among Korean women in childbearing years: A nationwide population-based study

Most women with systemic lupus erythematosus (SLE) are diagnosed with the disease in their reproductive years, but the incidence and prevalence of SLE among women of childbearing age have not been studied. The objective of this study was to estimate the incidence and prevalence of SLE among the Korean women of childbearing age. Women aged 20 to 44 years with SLE were identified from National Health Insurance Service - National Health Information Database (2009-2016), which contain health information of approximately 97% of the Korean population. SLE was defined by International Classification of Diseases, 10th revision code, M32. Incidence and prevalence were calculated per 100,000 person-years and stratified by year and age. A total of 12,756 women with SLE were identified. The incidence of SLE from 2011 to 2016 among women in childbearing years was 8.18/100,000 person-years (95% CI 7.94-8.43), with the highest incidence in 2016 (8.56/100,000 person-years, 95% CI 7.95-9.17) and the lowest incidence in 2012 (7.85/100,000 person-years, 95% CI 7.28-8.42). The prevalence of SLE from 2009 to 2016 among women in childbearing years was 77.07/100,000 person-years (95% CI 75.76-78.39), with the highest prevalence in 2014 (79.47/100,000 person-years, 95% CI 77.64-81.30) and the lowest in 2010 (74.19/100,000 person-years, 95% CI 72.45-75.93). The peak age for SLE incidence was between 25-39 years, and lower incidence was seen in the early (20-24 years) and late (40-44 years) childbearing age periods. There was an increasing trend in prevalence according to age in women of childbearing age, with the highest prevalence occurring in the 40-44 age group. The risk and burden of SLE are high among women during their childbearing years. This calls for special attention to this particular population group when allocating health resources.

1006. Contraception, Pregnancy and ART in Women of Child-Bearing Years

BackgroundSimpler anti-retroviral (ART) regimens with less pill burden and fewer side effects can improve adherence and clinical outcomes. Warnings about dolutegravir possibly causing neural tube defects (NTD) are alarming and have the potential to limit ART options for women of child-bearing years. A recent preliminary analysis from an observational study group in Botswana prompted a warning from the US Department of Health and Human Services (DHHS), released in May 2018, about the use of dolutegravir during conception.MethodsAt a large urban HIV clinic in New Orleans, a retrospective chart review was performed on adult women up to age 40 who were seen in clinic in 2018 to assess for dolutegravir use, as well as discussion of NTD and pregnancy.Results132 woman in the age range were seen in 2018, the mean age was 33 years (range 19 to 40). Average age of HIV diagnosis was 26. Most were African-American (83%) and 81% had Medicaid or no insurance. Eleven percent were diagnosed with HIV due to testing during pregnancy and 17% during routine screening. Sexual exposure was the main reported risk factor for HIV (69%) and 48% had another STD. Only 61% had a documented discussion of contraception and pregnancy plans. Over their treatment at the clinic, 47 pregnancies occurred. Most of the women were on integrase regimens (65%), although 14% were on protease inhibitor regimens and 20% were on other regimens or combination regimens. Forty two percent of the women were ever on dolutegravir and 12 had NTD discussed, resulting in 3 regimen changes. The main reason it was not discussed was permanent sterilization, change to a different ART regimen prior to the warning, long-term contraception, or no sexual activity. Seven pregnancies occurred while on dolutegravir, three were prior to the warning, one after the first trimester, and one ended in abortion. None had an NTD reported.ConclusionDolutegravir is very commonly used due to its tolerability and simplicity. While recent reports show the risk of NTD to be lower than previously thought, it is still elevated compared to other ART and a more open discussion of pregnancy plans, contraception, and NTD if applicable, needs to occur in women living with HIV.Disclosures All Authors: No reported disclosures

IMPACT survey: IMpaired fecundity in Physicians and Association with Clinical Time.

ObjectiveStudies suggest female physicians experience higher rates of infertility than the general population. The overall objective of this study was to determine the rate of impaired fecundity in a sample of female emergency physicians and compare it to the Centers for Disease Control and Prevention (CDC) National Survey of Family Growth (NSFG) data. Impaired fecundity is defined as physical difficulty in getting pregnant or carrying a pregnancy to live birth.MethodsWe performed a cross‐sectional survey of female emergency physicians to determine the rate of impaired fecundity. Survey questions were adapted from the NSFG to allow comparison to the general population. Statistical comparisons were made using contingency tables (with chi‐square and tau‐c assessments), 1‐sample t tests, and independent samples t tests, as appropriate.ResultsA total of 2072 women completed the survey with a mean (SD) current age of 38.9 (7.2) years. Data were analyzed for women of childbearing years (15–44 years old as defined by the CDC; n = 1705 [82% total responses]). The rate of impaired fecundity in emergency physicians was 24.9% as compared to the NSFG cohort (12.1%; P < 0.001). Female emergency physicians with impaired fecundity reported working 9.8 overall more clinical hours (95% CI 2.5–17) and 4.5 more night hours (95% CI 0.8–8.2) than those with normal fecundity.ConclusionFemale emergency physicians have increased rates of impaired fecundity when compared with a general population cohort. Clinical workload and night shifts are greater in female emergency physicians with impaired fecundity. Research is needed to elucidate work‐related impaired fecundity risk factors.

THU0140 COMORBIDITIES AMONG KOREAN WOMEN WITH RHEUMATOID ARTHRITIS IN CHILDBEARING YEARS: A NATIONWIDE POPULATION-BASED STUDY

Background:Rheumatoid arthritis is a chronic systemic inflammatory disease known to be associated with many comorbidities. Many women with rheumatoid arthritis (RA) are diagnosed with the disease before completing childbearing, but the risk of comorbidities associated with RA among women in childbearing years is not known.Objectives:We aimed to investigate the risk of comorbidities among Korean women with RA in childbearing years.Methods:From National Health Insurance Service data of 2009-2016, containing inpatient and outpatient claim information for approximately 97% of the Korean population, we identified 20-44 year aged-women with RA and controls without rheumatic diseases such as RA, systemic lupus erythematosus, and ankylosing spondylitis. Prevalence of comorbidities including cancer (Ca), hypertension (HTN), hyperlipidemia (HLD), and diabetes mellitus (DM) were analyzed. The rheumatic diseases and comorbidities were defined by International Classification of Disease (ICD)-10 codes for disease classifications. The comorbidities associated with RA were defined by the ICD-10 codes presented after the RA diagnosis.Results:Total 23,756 women with RA and 208,941 controls were identified. Women with RA had significantly higher prevalence of all comorbidities analyzed compared with the controls (49.92% vs 25.58%, p&lt;0.001). In women with RA, Ca (OR 1.14), DM (OR 1.22), HTN (OR 1.56), and HLD (OR 2.44) occurred significantly more often compared with the controls (p&lt;0.001).Conclusion:During childbearing years, women with RA are more susceptible to comorbidities leading to a significant burden in this specific population of Korean women in childbearing years.

Vitamin K Status in Women of Childbearing Years Before or After Bariatric Surgery

ABSTRACTBackgroundVitamin K adequacy has not been widely studied before or after bariatric surgery. Reports of babies born with intracranial bleeds to women after bariatric surgery make this an important vitamin to study in women of childbearing years.ObjectivesThe aim of this study was to assess the functional vitamin K status in 2 groups of women of childbearing age, 1 group seeking bariatric surgery and 1 group post Roux-en-Y gastric bypass (RYGB).MethodsIn a cross-sectional design, 40 women [19 presurgical and 21 post-RYGB (6–18 mo following surgery)], aged 18–40 y, completed the study. Participants provided a 3-d food intake record and a list of dietary supplements routinely taken. Participants then underwent a commercially available test to measure des-γ-carboxyprothrombin (DCP) concentration as a measure of functional vitamin K status.ResultsIndependent-samples t tests (P < 0.05) indicated that there was no significant difference [Sig (2-tailed) 0.821] between the DCP concentrations of the presurgical group and those of the post-RYGB group (mean ± SD DCP: 0.3 ± 0.1 and 0.4 ± 0.2 ng/mL, respectively). Vitamin K intake from food (248 ± 227 and 210 ± 239 μg) and supplements (13 ± 31 and 750 ± 271 μg) showed no linear correlation to DCP (presurgical group: 0.25 and –0.15, respectively; post-RYGB group: 0.13 and 0.05, respectively). Vitamin K intakes for both groups were above the current Institute of Medicine's recommended 90 μg/d for women. Bivariate correlation was conducted on other independent variables with only current BMI for the post-RYGB group having a moderate negative correlation to DCP (–0.54, P < 0.05). No correlation with statistical significance was found between other variables and DCP.ConclusionsAlthough the American Society for Metabolic and Bariatric Surgery recommends DCP as a test to determine vitamin K adequacy, no published studies in pre- or post-RYGB patients have been performed with the current commercially available test, which is not FDA approved as a vitamin K biomarker. Previous studies reporting vitamin K inadequacies based on DCP utilized a different assay than the one currently available. Due to the importance of ensuring adequate maternal concentrations of vitamin K after bariatric surgery in order to prevent intracranial bleeding in babies, more research is needed to determine suitable vitamin K measures.

Evaluation of a Presurgical Pregnancy Testing Protocol at an Ambulatory Surgery Center

A presurgical pregnancy testing protocol is recommended to prevent the administration of surgery and anesthesia to women of childbearing years who present for surgery with an undetected pregnancy. It is important to determine the compliance, cost analysis, time required, and barriers to complete a presurgical pregnancy testing protocol. Postimplementation qualitative and quantitative evaluation of a presurgical pregnancy protocol. A review of the patient's electronic medical record, survey of the nursing staff, and an administrative interview was conducted 1 year after implementation of the presurgical pregnancy protocol. Overall presurgical pregnancy protocol compliance was 0.7%. The total labor and equipment costs were $19,033 to $30,202 per year. Nurses reported significant time- and patient-related barriers to execute the protocol. A pregnancy testing protocol is a valuable safety measure that faces barriers, which can impede compliance. Through the use of simplified protocols, educational interventions for patients and providers, protocol compliance can be increased.

Red blood cell folate levels in Canadian Inuit women of childbearing years: influence of food security, body mass index, smoking, education, and vitamin use

BackgroundThe benefits of folic acid for prevention of congenital anomalies are well known. For the Inuit of Canada, where vitamin use is low and access to folate-rich foods limited, fortification is likely a major source of intake. We sought to determine whether red blood cell folate (RBCF) levels of Inuit women reached accepted target levels.MethodsThe Inuit Health Survey, 2007–2008, included evaluation of RBCF levels among 249 randomly selected non-pregnant women of reproductive age. Using descriptive statistics and linear regression analyses, RBCF levels were assessed and compared across several socio-demographic variables to evaluate the characteristics associated with RBCF status.ResultsMean (SD) RBCF levels of 935.5 nmol/L (± 192) reached proposed target levels (> 906 nmol/L); however, 47% of women had lower than target levels. In bivariate analysis, non-smoking, higher education, higher income, food security, increased body mass index, and vitamin use were each significantly associated with higher RBCF. Increased levels of smoking had a negative association with RBCF levels (− 5.8 nmol/L per cigarette smoked per day (p = 0.001)). A total of 6.8% of women reported taking vitamin supplements, resulting in a 226 nmol/L higher RBCF level on average compared to non-users (p < 0.001).ConclusionWhile mean levels of folate reached target levels, this was largely driven by the small number of women taking vitamin supplements. Our results suggest that folate status is often too low in Inuit women of childbearing years. Initiatives to improve food security, culturally relevant education on folate-rich traditional foods, vitamin supplements, and smoking cessation/reduction programs may benefit Inuit women and improve birth outcomes.

Utility of Commercial Ethyl Glucuronide (EtG) and Ethyl Sulfate (EtS) Testing for Detection of Lighter Drinking Among Women of Childbearing Years.

Even moderate alcohol consumption during pregnancy can pose risks to the fetus, making reliable and consistent detection of drinking in pregnancy critical. Ethyl glucuronide (EtG) and ethyl sulfate (EtS) have shown some ability to detect lower levels of drinking, but the sensitivity of commercial EtG/EtS testing to lower levels of drinking among women of childbearing age is unknown. This study sought to determine the ability of an EtG/EtS algorithm, as well as EtG alone, to detect alcohol consumption in women of childbearing age using commercial testing and cutoffs. Ten women (ages 21-39 years of age) were administered one, two, or three standard drinks in separate sessions. Urinary EtG/EtS was measured at baseline and again at five timed intervals for 72 hours following each session. Samples from the first five participants used a commercial algorithm in which a positive test was EtG > 100 ng/ml and EtS > 25 ng/ml; samples from the next five participants were considered positive if only EtG was >100 ng/ml. All samples were positive at the 12-hour follow-up. By 24 hours, sensitivity for one standard drink was poor for the combined EtG/EtS assay as well as for EtG alone (20% detection) and modest for two standard drinks (40% detection). There were no positive EtG results after 36 hours. The EtG/EtS cutoffs used in the present study, which are representative of those used by commercial laboratories, were not sensitive enough to reliably detect light to moderate drinking beyond a 12-hour window among women of childbearing age.

Comorbidities in MS are associated with treatment intolerance and disability

Since the 1990s, an increasing number of disease-modifying therapies (DMTs) have been approved to treat multiple sclerosis (MS), bringing increasing choice and efficacy. With this has come greater complexity for patients in what should be a shared decision-making process, involving oral treatment or injections, with varying frequency of administration and need for laboratory monitoring. Risks are variable, and efficacy may be also. The complexity increases for women in childbearing years.