Disparities in menopausal care in the United States: A systematic review
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Cited by 2 publications
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Systematic Reviews to Inform Practice, November/December 2024
From 2016 to 2021, the rates of gestational diabetes mellitus (GDM) have increased from 6% to nearly 9%. 1 Nearly 16% of pregnancies of individuals aged 40 and older are affected by GDM. Once diagnosed with GDM, there is a 50% chance of developing type 2 diabetes mellitus (DM) within 5 years after the affected pregnancy. 2,3 Long-term health impacts of type 2 DM include cardiovascular, kidney, and retinal damage. Losing weight gained during pregnancy with a goal of returning to a baseline weight is often a challenge in the postpartum period. 4 Anxiety about being at an increased risk for a chronic condition is an additional stressor that can increase this psychosocial burden in the postpartum period.Wang et al 3 conducted a systematic review and metaanalysis to examine the efficacy of lifestyle interventions implemented in the postpartum period on the prevention of type 2 DM, glycemic outcomes, and anthropometric measures. The researchers selected 17 randomized controlled trials (RCTs) representing 5654 participants with GDM; 2825 were in experimental groups and 2829 were in control groups. Lifestyle interventions focused on various diet and physical activity types and lasted from 3 to 81 months. GDM was defined in the selected studies using criteria from World Health Organization (WHO), International Association of the Diabetes and Pregnancy Study Groups, and local diagnostic guidelines. Seven studies used the WHO criteria for gestational diabetes, and 4 articles did not describe their diagnostic criteria. The remaining 4 articles reported using other criteria that included Australasian Diabetes in Pregnancy Society, Carpenter-Coustan criteria, and the UK National Institute of Health Excellence 2015 criteria. Diagnostic methods for type 2 DM included a 75-g glucose tolerance test, fasting glucose, and the presence of oral medication or insulin use. Of the 9 studies that reported type 2 DM, 4 used the WHO criteria, one used the American Diabetes Association criteria, and 4 did not report the criteria that were used. Changes in baseline for glycemic and anthropometric measures were also assessed.Diet types included low glycemic, low calorie, and Mediterranean diets; types of physical activity included walking, resistance, moderate-intensity aerobic, and habitual physical activity. Most studies (n = 14) used both diet and exercise interventions. Intervention delivery methods included face-
Systematic Reviews to Inform Practice, November/December 2024
From 2016 to 2021, the rates of gestational diabetes mellitus (GDM) have increased from 6% to nearly 9%. 1 Nearly 16% of pregnancies of individuals aged 40 and older are affected by GDM. Once diagnosed with GDM, there is a 50% chance of developing type 2 diabetes mellitus (DM) within 5 years after the affected pregnancy. 2,3 Long-term health impacts of type 2 DM include cardiovascular, kidney, and retinal damage. Losing weight gained during pregnancy with a goal of returning to a baseline weight is often a challenge in the postpartum period. 4 Anxiety about being at an increased risk for a chronic condition is an additional stressor that can increase this psychosocial burden in the postpartum period.Wang et al 3 conducted a systematic review and metaanalysis to examine the efficacy of lifestyle interventions implemented in the postpartum period on the prevention of type 2 DM, glycemic outcomes, and anthropometric measures. The researchers selected 17 randomized controlled trials (RCTs) representing 5654 participants with GDM; 2825 were in experimental groups and 2829 were in control groups. Lifestyle interventions focused on various diet and physical activity types and lasted from 3 to 81 months. GDM was defined in the selected studies using criteria from World Health Organization (WHO), International Association of the Diabetes and Pregnancy Study Groups, and local diagnostic guidelines. Seven studies used the WHO criteria for gestational diabetes, and 4 articles did not describe their diagnostic criteria. The remaining 4 articles reported using other criteria that included Australasian Diabetes in Pregnancy Society, Carpenter-Coustan criteria, and the UK National Institute of Health Excellence 2015 criteria. Diagnostic methods for type 2 DM included a 75-g glucose tolerance test, fasting glucose, and the presence of oral medication or insulin use. Of the 9 studies that reported type 2 DM, 4 used the WHO criteria, one used the American Diabetes Association criteria, and 4 did not report the criteria that were used. Changes in baseline for glycemic and anthropometric measures were also assessed.Diet types included low glycemic, low calorie, and Mediterranean diets; types of physical activity included walking, resistance, moderate-intensity aerobic, and habitual physical activity. Most studies (n = 14) used both diet and exercise interventions. Intervention delivery methods included face-
Bone Loss and Fractures in Post-Menopausal Women Living with HIV: A Narrative Review
Introduction: Post-menopausal women living with Human Immunodeficiency Virus (WLHIV) face an increased risk of bone fractures due to the relationship between HIV-related factors and menopause. This narrative review aims to summarise the current knowledge about fracture risk among post-menopausal WLHIV in particular looking at hormonal changes, combined antiretroviral therapy (cART), lifestyle factors, and psychosocial implications. We also profiled a summary of the significant, recent studies of post-menopausal WLHIV residing in low-income countries (LIC). Methods: A thorough search of the literature was performed across PubMed, Medline, Scopus, and Google Scholar, focussing on studies published between 2000 and 2024. Inclusion criteria entailed original research, reviews, and meta-analyses addressing bone mineral density (BMD), fracture incidence, and related risk factors in post-menopausal WLHIV. Results: The review identified 223 relevant studies. Post-menopausal WLHIV exhibit significantly lower BMD and higher fracture rates compared to both HIV-negative post-menopausal women and pre-menopausal WLHIV. cART, particularly tenofovir disoproxil fumarate (TDF), contributes to reduced BMD. Menopausal status exacerbates this risk through decreased oestrogen levels, leading to increased bone resorption. Moreover, lifestyle choices such as smoking, alcohol consumption, and low physical activity are more prevalent in PWHIV, which further elevates fracture risk. Different psychosocial factors may make WLWHIV more vulnerable at this stage of their life, such as depression, isolation, stigma, and housing and nutritional issues. Women living in LICs face a variety of challenges in accessing HIV care. There are gaps in research related to the prevalence of osteoporosis and bone loss in post-menopausal WLHIV in LICs. Conclusion: Post-menopausal women living with HIV face a significantly higher risk of bone loss and fractures due to the combined effects of HIV and menopause. Antiretroviral therapy (particularly TDF), lifestyle factors, and psychosocial challenges exacerbate this risk. There is a need for careful selection of cART, hormone replacement therapy (HRT), and emerging treatments such as Abaloparatide. A holistic approach including lifestyle changes and psychosocial support is crucial to reduce fracture risk in WLHIV, especially in low-income countries.
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