Jessica R. Gorman

To preserve or not to preserve: how difficult is the decision about fertility preservation?

The decision to pursue fertility preservation (FP) after a cancer diagnosis is complex. We examined the prevalence of high decisional conflict and specific factors that influence this decision using the Decisional Conflict Scale (DCS).

Experiencing reproductive concerns as a female cancer survivor is associated with depression

Young adult female cancer survivors have unmet reproductive concerns and informational needs that are associated with poorer quality of life. The purpose of this study was to examine the association between current reproductive concerns and moderate to severe depression among young survivors.

Theory-based predictors of influenza vaccination among pregnant women

BACKGROUND Guidelines recommend influenza vaccination for pregnant women, but vaccine uptake in this population is far below the goal set by Healthy People 2020. The purpose of this study was to examine predictors of seasonal influenza vaccination among pregnant women. METHODS Between 2009 and 2012, the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) conducted a prospective cohort study of influenza vaccine safety among pregnant women in the US and Canada that oversampled vaccinated women. Data for the present paper are from an additional cross-sectional telephone survey completed during the 2010-2011 influenza season. We examined predictors of influenza vaccination, focusing on Health Belief Model (HBM) constructs. RESULTS We surveyed 199 pregnant women, 81% of whom had received a seasonal influenza vaccine. Vaccination was more common among women who felt more susceptible to influenza (OR=1.82, 95% CI 1.10-3.01), who perceived greater vaccine effectiveness (OR=3.92, 95% CI 1.48-10.43), and whose doctors recommended they have flu shots (OR=3.06, 95% CI 1.27-7.38). Those who perceived greater barriers of influenza vaccination had lower odds of vaccination (OR=0.19, 95% CI 0.05-0.75). Perceived social norms, anticipated inaction regret, and worry also predicted uptake, though demographic characteristics of respondents did not. CONCLUSION The HBM provides a valuable framework for exploring influenza vaccination among pregnant women. Our results suggest several potential areas of intervention to improve vaccination rates.

Breastfeeding among Women Exposed to Antidepressants during Pregnancy

This prospective cohort study compares the breastfeeding outcomes of women exposed to selective serotonin reuptake inhibitor (SSRI) antidepressants at the time of delivery, those who discontinued use prior to delivery, and those not exposed. Participants include 466 pregnant women who enrolled in the California Teratogen Information Service Clinical Research Program (CTIS) over 10 years. In bivariate analyses, breastfeeding rates were significantly different across SSRI exposure groups, with unexposed women having the highest rates. We used logistic regression to examine the relationship between SSRI exposure and breastfeeding outcomes. After adjustment for potential confounders, those exposed to an SSRI both prior to delivery (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.20-0.94) and at the time of delivery (OR, 0.34; 95% CI, 0.16-0.72) were significantly less likely to initiate breastfeeding as compared to unexposed women. Women exposed to an SSRI during pregnancy appear to be at risk for poorer breastfeeding outcomes and may benefit from additional education and support.

A Review of Evidence-Based Approaches for Reduction of Alcohol Consumption in Native Women Who Are Pregnant or of Reproductive Age

Background: Fetal alcohol spectrum disorders (FASDs) are the leading preventable cause of developmental disabilities in the United States and likely throughout the world. FASDs can be prevented by avoiding alcohol use during pregnancy; however, efforts to prevent risky alcohol consumption in women of childbearing potential have not been universally successful. Objectives: Data suggest that successful interventions may require tailoring methods to meet the needs of specific populations and cultures. Key findings of interventions previously tested among American Indian and Alaskan Native (AI/AN) women who are or may become pregnant, data gaps, and promising ongoing interventions are reviewed. Methods: A systematic review of the current literature on empirically based interventions among AI/AN women was conducted. Selected alternative approaches currently being tested in AI/AN settings are also described. Results: Similar to findings among other populations of women in the United States, a number of interventions have been implemented; however, only a small number have measured results. Approaches have included standard interventions involving hospitalization, inpatient, or outpatient care; wellness education; traditional approaches; and case management for high-risk women. An ongoing Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol comparing the effectiveness of a web-based culturally adapted tool, or a peer health educator model to standard clinical practice is described. Conclusion: Translation of successful interventions from other settings to AI/AN populations holds promise. Scientific Significance: FASDs represent a significant health issue with high personal and societal costs. Improvement of interventions to prevent prenatal alcohol consumption in specific populations, including AI/AN women, is a critical public health need.

Creating a Culturally Appropriate Web-Based Behavioral Intervention for American Indian/Alaska Native Women in Southern California: The Healthy Women Healthy Native Nation Study.

Health disparities in fetal alcohol spectrum disorders (FASD) are of high importance to American Indian/Alaska Native (AI/AN) communities. We conducted focus groups and interviews with 21 AI/AN women and key informants in Southern California to modify a brief, Web-based program for screening and prevention of prenatal alcohol use. This process resulted in several important program modifications and was essential for fostering partnerships between researchers and the community, engaging community members in research, and identifying community priorities.

Effect of Depression on Risky Drinking and Response to a Screening, Brief Intervention, and Referral to Treatment Intervention

We assessed alcohol consumption and depression in 234 American Indian/Alaska Native women (aged 18-45 years) in Southern California. Women were randomized to intervention or assessment alone and followed for 6 months (2011-2013). Depression was associated with risk factors for alcohol-exposed pregnancy (AEP). Both treatment groups reduced drinking (P < .001). Depressed, but not nondepressed, women reduced drinking in response to SBIRT above the reduction in response to assessment alone. Screening for depression may assist in allocating women to specific AEP prevention interventions.

Self-collected dried blood spots as a tool for measuring ovarian reserve in young female cancer survivors

STUDY QUESTION Are female young cancer survivors (YCS) able to self-collect high-quality dried blood spots (DBSs) at home to provide biospecimens for studying ovarian reserve? SUMMARY ANSWER YCS can self-collect high-quality DBS specimens in non-clinical settings, and anti-Mullerian hormone (AMH) levels can be assayed in such specimens. WHAT IS KNOWN ALREADY Large-scale biosample collection is a barrier to studying ovarian reserve in YCS. DBS collected by research personnel has high acceptability. AMH levels measured in DBS are highly correlated with those measured by serum-based methods. STUDY DESIGN, SIZE, DURATION In a prospective cohort study, YCS were recruited to self-collect DBS samples. AMH levels were assayed in 112 samples. PARTICIPANTS/MATERIALS, SETTING, METHODS YCS participants, ages 18-44, were recruited from a nationwide longitudinal cohort and DBS collection materials were posted to them. AMH levels were assayed by the Ansh DBS AMH ELISA and compared according to participant characteristics. MAIN RESULTS AND THE ROLE OF CHANCE Among 163 potential participants, 123 (75%) were enrolled. Of those enrolled, 112 (91%) were able to complete DBS self-collection and submit mailed samples adequate for measuring AMH. Participants (mean age 31.6 [SD 5.5]) were 85% white, 87% college graduates and 46% reported higher income. Common cancer types were lymphoma and leukemia (34%), breast cancer (30%) and thyroid or skin cancer (8%). The geometric mean (95% confidence interval) AMH level in DBS samples was 0.24 ng/ml (0.16-0.36). In adjusted analysis, AMH levels for survivors of breast cancer (0.02 ng/ml [0.01-0.07]) or leukemia/lymphoma (0.03 ng/ml [0.01-0.08]) were lower than the levels in thyroid or skin cancer survivors (0.12 ng/ml [0.03-0.44]). Pelvic radiation remained associated with lower AMH levels (0.20 ng/ml [0.10-0.40] in unexposed versus 0.02 ng/ml [0.01-0.06] in exposed). Amenorrheic survivors had AMH levels (0.02 ng/ml [0.01-0.06]) that were lower than those of YCS with 7-9 (0.09 ng/ml [0.03-0.32]) or ≥10 (0.17 ng/ml [0.08-0.37]) menstrual periods in the past year. LIMITATIONS, REASONS FOR CAUTION The results are generalizable to a population of highly educated, higher income YCS. It is unclear how generalizable the results are to other populations. WIDER IMPLICATIONS OF THE FINDINGS Self-collected DBS is a patient-friendly and minimally invasive tool for studying ovarian reserve in geographically diverse populations. STUDY FUNDING/COMPETING INTERESTS Research related to the development of this paper was supported by the National Institutes of Health, grants UL1 RR024926 pilot and HD080952-02, and by the American Cancer Society MRSG-08-110-01-CCE. The authors report no competing interests.

Contraception concerns, utilization and counseling needs of women with a history of breast cancer: a qualitative study

Introduction Reproductive-aged women who have had breast cancer face unique challenges when it comes to making decisions about contraception. Clinical guidelines indicate that patients should avoid pregnancy during cancer treatment, however the extent of contraception counseling and utilization after diagnosis has not been well studied. Methods We conducted three focus groups and one semi-structured interview with women between the ages of 18 and 50 years old diagnosed with breast cancer within the last 5 years. We used clinic- and population-based recruitment methods to identify participants. Participants were asked a series of open-ended questions regarding their contraception decision-making and concerns at the time of their diagnosis, during treatment and afterward. We analyzed data to identify themes among participant responses. Results A total of 10 women participated. We identified the following themes: 1) doctors treating cancer do not focus on reproductive health issues; 2) there is misinformation and lack of information on contraceptive options and risks; 3) women fear unintended pregnancy but have limited guidance on prevention; 4) peers are a trusted source of contraception information; and 5) information about contraception should be provided soon after diagnosis. Conclusion Reproductive-aged breast cancer survivors have unique contraceptive concerns and may not be adequately informed about their contraceptive options. The results of this study may help guide and improve contraceptive counseling services for breast cancer survivors.

Pregnant women's attitudes toward influenza vaccination while breastfeeding.

Objective The goal of this study was to assess the concerns pregnant women have about influenza vaccination while breastfeeding and to determine if having these concerns represents a barrier to vaccination uptake. Methods The Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) conducted a prospective cohort study in the US and Canada of influenza vaccine safety among pregnant women, oversampling vaccinated women. Data for the present paper are from an additional cross-sectional telephone survey completed during the 2010–2011 and 2012–2013 influenza seasons. Results We surveyed 431 pregnant women about their attitudes regarding influenza vaccination while breastfeeding. Almost half of the participants identified one or two concerns and 4% reported three or more concerns. About one quarter reported that they would be unlikely to have an influenza vaccination while breastfeeding. In the multivariate model, those reporting 1–2 concerns (OR = 0.16, 95% CI 0.09–0.28) and those reported 3 or more concerns (OR = 0.07, 95% CI 0.02–0.22) had lower odds of being likely to vaccinate. Conclusions Pregnant women and postpartum women who are breastfeeding could benefit from receiving information and recommendations specific to vaccination from their healthcare providers, with a focus on discussing known risks and benefits to the babys health.