Conference Highlights: ACOG 2017

PTSD in Women With HIV

Studies indicate that PTSD is common in women living with HIV and associated with poor antiretroviral therapy adherence, alcohol dependence, and poor health outcomes. However, few studies have quantified the prevalence of PTSD in a high-risk population of women with HIV. For a study, women with HIV were categorized as having experienced trauma, experienced no trauma, or PTSD. More than 82% of women had experienced at least one trauma, approximately 43% met criteria for lifetime PTSD, and 20% met criteria for current PTSD. The most common types of trauma were rape (40%), physical assault (29%), and seeing violence (17%). More than one-third of all rapes occurred before age 17, and more than 10% of participants reported inappropriate sexual conduct before age 15. Major depressive disorder was the most frequent co-morbid psychiatric diagnosis.

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Postpartum Reversible Contraception Use

Rates of long-acting reversible contraception insertion immediately after childbirth have increased in recent years according to previous studies. However, little is known about the relatively new service. Women who underwent tubal ligation, intrauterine device (IUD) insertion, or contraceptive implant insertion from 2008 to 2013 were assessed for a study. While rates of postpartum sterilization did not change during the study period, postpartum use of long-acting reversible conception increased from 1.86 to 13.5 per 10,000 deliveries. Women who received an IUD or implant were 92% more likely to have a medical comorbidity when compared with those who received neither. Participants on Medicaid or paying out of pocket were more than 5 times more likely to receive an IUD or implant that those with private insurance. Women who delivered at teaching hospitals were nearly 15 times more likely to receive an IUD or implant than those who delivered elsewhere.

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Transgender Men & Gynecologic Care

Less than one-third of obstetricians and gynecologists report being comfortable with caring for transgender men, and transgender men have reported several barriers to care. Researchers conducted a study to assess transgender men’s experiences with, ability to access, and understanding of gynecologic care. Although 78% were insured and 81% reported having seen a gynecologist at least once, only 38% attended annual visits. Also, despite nearly 50% recognizing sexually transmitted infection testing as “extremely important,” only 38%, 27%, and 19% considered annual gynecologic care, routine cancer screening, and pelvic examination to be also be extremely important, respectively. Respondents reported mistreatment by a gynecologist (23%) and gender identify concerns (59%) as reasons for avoiding or delaying gynecologic care.

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Lifestyle Counseling During Pregnancy

Maternal and fetal health benefits have been linked to mild-to-moderate exercise, proper diet, and appropriate weight gain during pregnancy. Yet, few studies have explored discrepancies in patient counseling offered by outpatient clinicians. For a study, women completed surveys focused on demographic and lifestyle counseling information prior to obstetric office visits. Less than half (48.5%) of patients received exercise counseling, 64.2% received diet counseling, and 58.2% received weight-gain counseling. Caucasian and African-American women were counseled about diet at a higher rate than Asian-American or Hispanic women. Obese and underweight women received more exercise and diet counseling than normal-weight women. No differences were observed in rates of weight-gain counseling by BMI class or race.

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Identifying CVD in Women With Preeclampsia

The American Heart Association recognizes that women with prior preeclampsia are at similar risk factor for cardiovascular disease (CVD) as diabetics and smokers, and ACOG recommends early CVD screening for these patients. However, no guidelines in the internal medicine literature address CVD screening in women with prior preeclampsia. Women with at least one prior delivery who presented for a wellwoman visit after 2013 were included in a study that assessed documentation of preeclampsia versus traditional CVD risk factors and if CVD screening was performed according to ACOG guidelines. Less than one-fourth of women were asked about preeclampsia, whereas nearly all were asked about diabetes or smoking. All participants were asked about hypertension. The study authors see their findings as an opportunity to improve provider education and ensure the continuum of obstetrical care to primary care.

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Sleep & Adolescent Female Health

Sleep debt has been associated with reproductive and metabolic disorders in numerous studies. However, the current status of the effects of sleep deprivation on metabolic and endocrine functions in adolescents has not been well described. A meta-analysis of the effects of intentional sleep curtailment on adolescent females found that, through various channels, sleep debt in adolescents adversely affects glucose metabolism, aid in the development of obesity, create a state of glucocorticoid excess that is associated with memory deficit, increase stress that can cause amenorrhea or alterations in the menstrual cycle, decrease sex steroid output, and modify reproductive functions in such a way that can potentially cause infertility.