Erika E. Levi

Crisis pregnancy center websites: Information, misinformation and disinformation

OBJECTIVE Most states with 24-h waiting periods prior to abortion provide state resource directories to women seeking abortion. Our objective was to evaluate the information on abortion provided on the websites of crisis pregnancy centers listed in these resource directories. STUDY DESIGN We performed a survey of the websites of crisis pregnancy centers referenced in state resource directories for pregnant women. We searched for these state-provided resource directories online. We contacted state Departments of Health and Human Services for a print copy when a directory could not be found online. The crisis pregnancy center websites were evaluated for the information provided on abortion. Standardized data collection tools were used. Descriptive statistics were generated. RESULTS Resource directories of 12 states were procured. A total of 254 websites referring to 348 crisis pregnancy centers were identified. Overall, a total of 203/254 [80%, 95% confidence interval (CI) 75%-84%] of websites provided at least one false or misleading piece of information. The most common misleading or false information included on the websites were a declared link between abortion and mental health risks (122/254 sites; 48%, 95% CI 42%-54%), preterm birth (54/254; 21%, 95% CI 17%-27%), breast cancer (51/254; 20%, 95% CI 16%-25%) and future infertility (32/254; 13%, 95% CI 9%-17%). CONCLUSION Most crisis pregnancy centers listed in state resource directories for pregnant women provide misleading or false information regarding the risks of abortion. States should not list agencies that provide inaccurate information as resources in their directories.

Intrauterine Device Placement During Cesarean Delivery and Continued Use 6 Months Postpartum: A Randomized Controlled Trial.

OBJECTIVE: To compare intrauterine device (IUD) use at 6 months postpartum among women who underwent intracesarean delivery (during cesarean delivery) IUD placement compared with women who planned for interval IUD placement 6 or more weeks postpartum. METHODS: In this nonblinded randomized trial, women who were undergoing a cesarean delivery and desired an IUD were randomized to intracesarean delivery or interval IUD placement. The primary outcome was IUD use at 6 months postpartum. A sample size of 112 (56 in each group) was planned to detect a 15% difference in IUD use at 6 months postpartum between groups. RESULTS: From March 2012 to June 2014, 172 women were screened and 112 women were randomized into the trial. Baseline characteristics were similar between groups. Data regarding IUD use at 6 months postpartum were available for 98 women, 48 and 50 women in the intracesarean delivery and interval groups, respectively. A larger proportion of the women in the intracesarean delivery group were using an IUD at 6 months postpartum (40/48 [83%]) compared with those in the interval group (32/50 [64%], relative risk 1.3, 95% confidence interval 1.02–1.66). Among the 56 women randomized to interval IUD insertion, 22 (39%) of them never received an IUD; 14 (25%) never returned for IUD placement, five (9%) women declined an IUD, and three (5%) had a failed IUD placement. CONCLUSION: Intrauterine device placement at the time of cesarean delivery leads to a higher proportion of IUD use at 6 months postpartum when compared with interval IUD placement. LEVEL OF EVIDENCE: I

Screening women for oral contraception: can family history identify inherited thrombophilias?

OBJECTIVE: Screening for inherited thrombophilias with laboratory tests is impractical before starting women on combined oral contraceptives. As an alternative, some recommend eliciting a family history of venous thromboembolism. The validity of this approach, however, remains unclear. DATA SOURCES: We sought all published reports that correlated a family history of venous thromboembolism with any thrombophilia confirmed by laboratory test. We used sequential, overlapping computer searches including MeSH terms used for articles in PubMed, a narrative search phrase in Google Scholar, and then all “related” articles in PubMed for each article included without time or language limitations. This was supplemented by a search of www.clinicaltrials.gov. METHODS OF STUDY SELECTION: The search yielded 10 reports. Information was sought without success from corresponding authors of four other reports that may have had relevant data. Most reports studied atypical, high-prevalence referral populations. TABULATION, INTEGRATION, AND RESULTS: Results were presented according to the MOOSE (Meta-analysis of observational studies in epidemiology) guidelines for systematic reviews of observational studies. The patient populations varied widely, definitions of family history included first- or first- and second-degree relatives, and the thrombophilias studied differed among these reports. Hence, aggregation of results was not possible. Despite these differences, all reports consistently documented poor validity of family history for detecting thrombophilias. Sensitivity ranged from 16% to 63% and positive predictive value from 6% to 50% for the various thrombophilias studied. In no study did family history meet the benchmark for a good test (sensitivity plus specificity greater than 150%). CONCLUSION: Obtaining a family history of venous thromboembolism before starting combined oral contraceptives is not a valid means to detect a womans risk of thrombophilia. Even in high-prevalence populations, in which the positive predictive value is increased, a positive family history of venous thromboembolism was no better than flipping a coin in predicting thrombophilia.

Rapid Repeat Pregnancy and Contraceptive Uptake: A Retrospective Cohort Study [7N]

INTRODUCTION: Rapid repeat pregnancy, a pregnancy occurring within 18 months of a prior delivery, accounts for one third of all pregnancies in the United States. Short inter-pregnancy intervals are associated with poor health outcomes. This study seeks to identify factors associated with rapid repeat pregnancy. METHODS: This retrospective cohort study identified all women who delivered a live birth at a Montefiore Medical Center in 2012. Patient demographics, and contraceptive use and initiation in the postpartum period were abstracted from medical records and multivariate logistic regression was used to analyze association with rapid repeat pregnancy. RESULTS: Among the women who had a birth in 2012 (N=6210), 5.7% had a rapid repeat delivery within 24 months. Attending an outpatient visit for contraceptive initiation (OR 0.59, 95% CI 0.43–0.80), age 31–40 (OR 0.72, 95% CI 0.55–0.95), and Cesarean delivery (OR 0.67, 95% CI 0.53–0.87) were associated with a significantly decreased risk of a rapid repeat pregnancy. Notably, receiving Depo-Provera (OR 0.92, 95% CI 0.61–1.38) or a prescription for Progestin contraceptive pills (OR 1.23, 95% CI 0.94–1.63) prior to discharge from the hospital were not significantly associated with a decreased risk of rapid repeat pregnancy. CONCLUSION: Women who attended an outpatient visit for contraceptive initiation were significantly less likely to have a rapid repeat delivery. Patients who received Depo-Provera or Progestin contraceptive pills had no reduction in the incidence of rapid repeat delivery. These data suggest that increased emphasis should be placed on outpatient encounters for contraceptive management in the postpartum period.