History of unintended pregnancy and patterns of contraceptive use among racial and ethnic minority women veterans

Quinn, Deirdre A.; Sileanu, Florentina E.; Zhao, Xinhua; Mor, Maria K.; Judge-Golden, Colleen; Callegari, Lisa S.; Borrero, Sonya

doi:10.1016/j.ajog.2020.02.042

Cited by 11 publications

(9 citation statements)

References 25 publications

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“…However, limited animal studies have investigated the effects of lower, moderate, and high ethanol doses administered acutely during specific developmental stages [ 47 , 84 , 85 , 86 ] and established the time, pattern, and dose of ethanol exposure to model heavy human drinking (i.e., 3–5 drinks in one sitting on 2 successive days). This issue is especially important when women continue with a regular consumption of alcohol before recognizing that they are pregnant [ 23 , 24 ]. Drinking during this early unrecognized pregnancy period could expose a developing embryo at critical developmental stages, such as the gastrulation or neurulation periods of gestation [ 47 , 84 , 85 , 86 ].…”

Section: Discussionmentioning

confidence: 99%

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Binge-like Prenatal Ethanol Exposure Causes Impaired Cellular Differentiation in the Embryonic Forebrain and Synaptic and Behavioral Defects in Adult Mice

Subbanna

Basavarajappa

2022

Brain Sciences

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An embryo’s in-utero exposure to ethanol due to a mother’s alcohol drinking results in a range of deficits in the child that are collectively termed fetal alcohol spectrum disorders (FASDs). Prenatal ethanol exposure is one of the leading causes of preventable intellectual disability. Its neurobehavioral underpinnings warrant systematic research. We investigated the immediate effects on embryos of acute prenatal ethanol exposure during gestational days (GDs) and the influence of such exposure on persistent neurobehavioral deficits in adult offspring. We administered pregnant C57BL/6J mice with ethanol (1.75 g/kg) (GDE) or saline (GDS) intraperitoneally (i.p.) at 0 h and again at 2 h intervals on GD 8 and GD 12. Subsequently, we assessed apoptosis, differentiation, and signaling events in embryo forebrains (E13.5; GD13.5). Long-lasting effects of GDE were evaluated via a behavioral test battery. We also determined the long-term potentiation and synaptic plasticity-related protein expression in adult hippocampal tissue. GDE caused apoptosis, inhibited differentiation, and reduced pERK and pCREB signaling and the expression of transcription factors Pax6 and Lhx2. GDE caused persistent spatial and social investigation memory deficits compared with saline controls, regardless of sex. Interestingly, GDE adult mice exhibited enhanced repetitive and anxiety-like behavior, irrespective of sex. GDE reduced synaptic plasticity-related protein expression and caused hippocampal synaptic plasticity (LTP and LTD) deficits in adult offspring. These findings demonstrate that binge-like ethanol exposure at the GD8 and GD12 developmental stages causes defects in pERK–pCREB signaling and reduces the expression of Pax6 and Lhx2, leading to impaired cellular differentiation during the embryonic stage. In the adult stage, binge-like ethanol exposure caused persistent synaptic and behavioral abnormalities in adult mice. Furthermore, the findings suggest that combining ethanol exposure at two sensitive stages (GD8 and GD12) causes deficits in synaptic plasticity-associated proteins (Arc, Egr1, Fgf1, GluR1, and GluN1), leading to persistent FASD-like neurobehavioral deficits in mice.

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Section: Discussionmentioning

confidence: 99%

“…Many women continue with the regular consumption of alcohol before recognizing that they are pregnant [ 23 , 24 ]. However, by that time, a developing embryo will have already passed through two critical developmental stages: gastrulation in the third week of gestation and neurulation in the fourth week of gestation.…”

Section: Introductionmentioning

confidence: 99%

Binge-like Prenatal Ethanol Exposure Causes Impaired Cellular Differentiation in the Embryonic Forebrain and Synaptic and Behavioral Defects in Adult Mice

Subbanna

Basavarajappa

2022

Brain Sciences

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“…Pregnancy prevention when conception is not intended and fertility optimization when pregnancy is desired are essential determinants of reproductive health. In studies focusing on female US veterans, significantly lesser overall contraceptive knowledge and understanding of the relative irreversibility of tubal sterilization as well as higher rates of unintended pregnancy were reported among Black and Hispanic veterans compared to White peers, despite similar levels of educational attainment and equal access to healthcare [13,14 ▪▪ ]. Given that non-Hispanic Black women are more likely to choose surgical sterilization compared to White women [14 ▪▪ ,15], the observed racial differences in utilization and understanding of relative permanency of surgical sterilization merit deeper scrutiny.…”

Section: Comprehensive Reproductive Health and Implications For Ferti...mentioning

confidence: 99%

Racial disparities in access to reproductive health and fertility care in the United States

Beroukhim

Mahabamunuge

Pal

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTo examine the status of racial and ethnic inequalities in fertility care in the United States (U.S.) at inception of 2022. This review highlights addressable underpinnings for the prevalent differentials in access to and utilization of infertility treatments and underscores gaps in preventive care as key contributors to racial and ethnic disparities in risk burden for subfertility and infertility.Recent findingsSignificant gaps in access to and utilization of fertility care are consistently reported among racial and ethnic minorities, particularly Black and Hispanic women. Access to and utilization of contraceptives, human papilloma virus vaccination rates, preexposure prophylaxis use, and differentials in treatment of common gynecologic disorders are relevant to the prevalent racial and ethnic disparities in reproductive health. The spectrum of differential in reproductive wellness and the magnitude of reproductive health burden afflicting racial minorities in the U.S. raise concerns regarding systemic and structural racism as plausible contributors to the prevalent state of affairs.SummaryDespite efforts to reform unequal reproductive health practices and policies, racial and ethnic disparities in fertility care are pervasive and persistent. In addition to measures aimed at reducing barriers to care, societal efforts must prioritize health disparity research to systematically examine underpinnings, and addressing structural racism and interpersonal biases, to correct the prevalent racial inequities and mitigate disparities.

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“…9 Previous VHA studies describe disparities in contraceptive use among Veterans related to race and ethnicity, racebased discrimination, and mental health or substance use disorders. [10][11][12] While these previous studies describe hormonal contraceptive methods with ongoing use, such as pills, patches, or rings, data on the episodic, single-dose, oral EC provision in the VHA are lacking. As barriers to oral EC provision in the VHA may be different from civilian health systems and disparities in vulnerable VHA populations may exist, further study is warranted to ensure female Veterans can access oral EC in a timely fashion when needed.…”

Section: Introductionmentioning

confidence: 99%

Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study

Gawron

Lewis

et al. 2022

J GEN INTERN MED

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Background In the USA, oral emergency contraception (EC) use to prevent unintended pregnancy is increasing. Oral EC methods include levonorgestrel (LNG) and ulipristal acetate (UPA), with increased UPA efficacy over LNG in high BMI users and those beyond 3 days post intercourse. The Veterans Health Administration (VHA) provides oral EC at low or no cost, yet prescription-level Veteran data are lacking. Objective To describe oral EC provision in VHA, including method type and Veteran user and prescriber characteristics. Design A retrospective cohort study using VHA administrative data. Participants All VHA oral EC prescriptions from January 1, 2016, to December 31, 2020. Main Measures We linked Veteran-level sociodemographic and military characteristics and provider-level data with each prescription to identify variables associated with oral EC method. Key Results A total of 4280 EC prescriptions (85% LNG) occurred for 3120 unique Veterans over 5 years. While prescriptions remained low annually, the proportion of UPA prescriptions increased from 12 to 19%. Compared to LNG users, UPA users were older (34% vs 25% over age 35 years, p <0.001); more likely to identify as white (57% vs 46%) and non-Hispanic (84% vs 79%) (p <0.001); and more likely to have a BMI ≥ 25 (76% vs 67%, p <0.001). UPA prescriptions originated most frequently from VA Medical Centers (87%) and women’s health clinics (76%) compared to community-based or other clinic types. In multivariable regression models, race, ethnicity, BMI ≥30, and prescriber facility type of a VA Medical Center or a women’s clinic location were predictive of UPA prescription. Conclusions Oral EC provision in VHA remains low, but UPA use is increasing. LNG prescription occurs frequently in high BMI Veterans who would benefit from increased efficacy of UPA. Interventions to expand oral EC access in VHA are essential to ensure Veterans’ ability to avert unwanted pregnancies.

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History of unintended pregnancy and patterns of contraceptive use among racial and ethnic minority women veterans

Cited by 11 publications

References 25 publications

Binge-like Prenatal Ethanol Exposure Causes Impaired Cellular Differentiation in the Embryonic Forebrain and Synaptic and Behavioral Defects in Adult Mice

Binge-like Prenatal Ethanol Exposure Causes Impaired Cellular Differentiation in the Embryonic Forebrain and Synaptic and Behavioral Defects in Adult Mice

Racial disparities in access to reproductive health and fertility care in the United States

Oral Emergency Contraception Provision in the Veterans Health Administration: a Retrospective Cohort Study

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