Mary D. Nettleman

Reasons for unprotected intercourse in adult women: a qualitative study.

Despite the focus on adolescents, most unintended pregnancies occur in adults. The objective of this study was to identify reasons why adult women have unprotected intercourse when they do not desire pregnancy. We held 4 focus groups to explore reasons for unprotected intercourse. Participants were adult women aged 18 to 39 who were unmarried, fertile, not currently pregnant, not desiring pregnancy, and who had recently had intercourse without using effective contraception. Sessions were audiotaped and transcripts were analyzed thematically. Women gave 146 reasons for unprotected intercourse. Four major categories emerged: method-related, user-related, partner-related, and cost/access-related reasons. The reasons for unprotected intercourse were numerous, but could be organized into a logical framework. The results suggest that multidimensional interventions may be needed to effectively reduce the rate of unintended pregnancy.

Late recognition of pregnancy as a predictor of adverse birth outcomes.

OBJECTIVE We examined the relationship between the time of recognition of pregnancy and birth outcomes, such as premature births, low birthweight (LBW), admission to the neonatal intensive care unit (NICU), and infant mortality. STUDY DESIGN A secondary analysis was performed using the Pregnancy Risk Assessment and Monitoring System (PRAMS) multistate data from 2000-2004. The sample consisted of 136,373 women who had a live childbirth. Analysis involved multiple logistic regression models, appropriately weighted for point and variance estimation to reflect the complex survey design of the PRAMS using STATA 9.2 (Stata Corp, College Station, TX). RESULTS Approximately 27.6% recognized their pregnancy late (after 6 weeks of gestation). Late recognition was significantly associated with an increased odds of having premature births (odds ratio [OR], 1.09; 99% confidence interval [CI], 1.01-1.19), LBW (OR, 1.08; 99% CI, 1.01-1.15), and NICU admissions (OR, 1.12; 99% CI, 1.03-1.21). CONCLUSION These results provide a rationale and an impetus for developing interventions that promote early recognition of pregnancy.

Cost-effectiveness of prenatal testing for Chlamydia trachomatis

We investigated the cost-effectiveness of strategies for screening pregnant women for Chlamydia trachomatis. Screening was not cost-effective unless certain conditions were met. Direct antigen testing of all pregnant women would be cost-effective if the test cost less than

Time from pregnancy recognition to prenatal care and associated newborn outcomes

6.30 or the prevalence of infection exceeded 6%. However, the positive predictive value of the test was only 51%. Culturing was not cost-effective until the prevalence of infection exceeded 14.8%. If a direct antigen test cost less than

Self-Testing for Pregnancy Among Women at Risk A Randomized Controlled Trial

3.90 or prevalence exceeded 8.7%, direct antigen testing of all women and using culture to confirm positive direct antigen tests would be cost-effective. If a direct antigen test cost

Characteristics of adult women who abstain from sexual intercourse

8.00 and culture cost

Scheduling the first prenatal visit: office-based delays

25.00, the excess cost of performing a direct antigen test in all women and confirming positive results with culture would be

Utilization of Home Pregnancy Testing Among Women at Risk for Unintended Pregnancy

2.09 per pregnant woman. Screening all pregnant women for chlamydia is not cost-effective, but the excess cost is modest when direct antigen tests are used.

Funding primary care in the United States

OBJECTIVE To examine the relationship between newborn outcomes and late prenatal care initiation after recognition of pregnancy. DESIGN Secondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. SETTING Twenty-nine states. PARTICIPANTS Women of childbearing age (135,623) who resided in 29 states in the PRAMS study who received prenatal care and had live births. METHODS Population-based survey from 2000 through 2004 that examined four newborn outcomes: prematurity, low birth weight (LBW), admission into Neonatal Intensive Care Unit (NICU), and infant mortality. RESULTS The average time lag (difference between the time of pregnancy recognition and initiation of prenatal care) for the study was 3.2 weeks (99% CI [3.12, 3.21]). Women who recognized their pregnancies before 6 weeks had a longer lag time (3.5 weeks, 99% CI [3.43, 3.53]) than women who recognized their pregnancies later (2.1 weeks, 99% CI [1.96, 2.15]). After adjusting for confounders including the timing of pregnancy recognition, longer time lag was associated with reduced risks of prematurity (odds ratio [OR]=0.99, 99% Confidence Interval [CI] [0.97, 1.00], p<.01), LBW (OR=0.98, 99% CI [0.97, 0.99], p<.01) and NICU admission (OR=0.99, 99% CI [0.98, 1.00], p<.01) but not with infant mortality (OR=1.00, 99% CI [0.95, 1.05], p>.01). CONCLUSION Average time lag from pregnancy recognition to prenatal care was not associated with poor newborn outcomes once results were adjusted for time of pregnancy recognition and other confounders.

Global warming and infectious disease

BACKGROUND The timing of pregnancy recognition affects early pregnancy and the timing of prenatal care. Little research has been done on how to make women at risk more alert to the possibility of pregnancy. DESIGN The study was an RCT performed and analyzed between 2006 and 2007. SETTING/PARTICIPANTS Participants were low-income, adult women who were having unprotected intercourse and were not actively trying to conceive. INTERVENTION Women in the intervention group received a free home-pregnancy test kit and were able to order more kits as needed. Six-month follow-up information was obtained. MAIN OUTCOME MEASURES The main outcome measures were suspicion and testing for pregnancy. RESULTS Ninety-one percent of the 198 participants completed the study. Women in the intervention group suspected pregnancy 2.3 times during the 6-month period compared to 1.2 times for women in the control group (p<0.0001). Women in the intervention group tested for pregnancy 93% of the time when they suspected pregnancy. Women in the control group tested for pregnancy only 64% of the time when they suspected pregnancy (p<0.0001). CONCLUSIONS Women who were having unprotected intercourse were more likely to suspect and test for pregnancy if they were supplied with a free home-pregnancy test kit.