Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-2 (of 2 Records) |
Query Trace: Miele Kathryn [original query] |
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Congenital syphilis-related stillbirths in the United States from 2015 to 2019
Machefsky Aliza , Miele Kathryn , Kimball Anne , Thorpe Phoebe , Bachmann Laura , Bowen Virginia . Am J Obstet Gynecol 2022 226 (2) 303-304 Objectives | Given recent increases in congenital syphilis (CS) in the United States, we describe national trends in the number of CS-related stillbirths, describe CS-related stillbirths by gestational age, and compare characteristics of women delivering CS-related stillbirths to those delivering full term and preterm liveborn CS infants to provide important clinical insight. | | Methods | CS is nationally notifiable with case reports submitted to Centers for Disease Control and Prevention (CDC). We analyzed reported cases of CS born during 20152019, categorizing birth outcomes as stillbirth, preterm <37 weeks, or full term 37 weeks; cases with unknown vital status or gestational age were excluded. We calculated frequencies of maternal clinical characteristics by birth outcome, including receipt of prenatal care, stage of syphilis, and highest reported titer during pregnancy. | | Results | Of the 5,269 CS cases reported to CDC for 20152019, 5,127 (97.3%) had known vital status and gestational age. Among these, 307 (6.0%) were stillbirths. While the number of CS-related stillbirths increased each year during 20152019 (from 2994), the proportion of CS cases reported as stillbirths did not vary considerably across the period (range: 5.1%7.3%). Median gestational age at delivery for CS-related stillbirths was 30 weeks (interquartile range: 2733 weeks). Most CS cases were born to mothers with early latent (31.4%) or late/unknown duration (59.7%) syphilis, though mothers of stillborn infants were 2.3 times as likely as mothers of full term liveborn infants to have secondary syphilis (10.8% vs. 4.6%). Adverse pregnancy outcomes were more likely to have a high maternal syphilis titer; 80.8% of stillbirth, 58.1% of preterm, and 40.2% of full-term deliveries occurred among women with a titer 1:32 during pregnancy. Among women delivering a CS-related stillbirth, 33 (10.7%) had evidence of syphilis seroconversion during pregnancy. Most mothers delivering a CS-related stillbirth (53.4%) did not receive prenatal care, compared to mothers delivering full term liveborn CS infants (18.4%). | | Conclusions | Increases in CS-related stillbirths in the United States reflect increases in CS cases; without prevention efforts, CS could become a larger contributor to overall U.S. stillbirth levels. Understanding when CS-related stillbirths occur, as well as the differences between women delivering CS-related stillbirths and women delivering liveborn CS infants (higher titer, syphilis stage, and prenatal care) may aid with stillbirth prevention. Overcoming barriers to prenatal care is essential for preventing CS stillbirths. Low rates of prenatal care also highlight the importance of syphilis testing outside traditional settings and at the time of stillbirth delivery. Delivery may provide a rare interaction with the healthcare system enabling syphilis testing and treatment, and prevention of future CS-related adverse outcomes. |
COVID-19 and family planning service delivery: Findings from a survey of U.S. physicians.
Zapata LB , Curtis KM , Steiner RJ , Reeves JA , Nguyen AT , Miele K , Whiteman MK . Prev Med 2021 150 106664 Equitable access to contraception is critical for reproductive autonomy. Using cross-sectional data from the DocStyles survey administered September-October 2020 (68% response rate), we compared changes in family planning-related clinical services and healthcare delivery strategies before and during the COVID-19 pandemic and assessed service provision issues among 1063 U.S. physicians whose practice provided family planning services just before the pandemic. About one-fifth of those whose practices provided the following services or strategies just before the pandemic discontinued these services during the pandemic: long-acting reversible contraception (LARC) placement (16%); LARC removal (17%); providing or prescribing emergency contraceptive pills (ECPs) in advance (18%); and reminding patients about contraception injections or LARC removal or replacement (20%). Many practices not providing the following services or strategies just before the pandemic initiated these services during the pandemic: telehealth for contraception initiation (43%); telehealth for contraception continuation (48%); and renewing contraception prescriptions without requiring an office visit (36%). While a smaller proportion of physicians reported service provision issues in the month before survey completion than at any point during the pandemic, about one-third still reported fewer adult females seeking care (37%) and technical challenges with telehealth (32%). Discontinuation of key family planning services during the COVID-19 pandemic may limit contraception access and impede reproductive autonomy. Implementing healthcare service delivery strategies that reduce the need for in-person visits (e.g., telehealth for contraception, providing or prescribing ECPs in advance) may decrease disruptions in care. Resources exist for public health and clinical efforts to ensure contraception access during the pandemic. |
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