Sherry L. Farr

Infant Morbidity and Mortality Attributable to Prenatal Smoking in the U.S.

BACKGROUND Although prenatal smoking continues to decline, it remains one of the most prevalent preventable causes of infant morbidity and mortality in the U.S. PURPOSE The aim of this study was to estimate the proportion of preterm deliveries, term low birth weight deliveries, and infant deaths attributable to prenatal smoking. METHODS Associations were estimated for prenatal smoking and preterm deliveries, term low birth weight (<2500 g) deliveries, sudden infant death syndrome (SIDS), and preterm-related deaths among 3,352,756 singleton, live births using the U.S. Linked Birth/Infant Death Data Set, 2002 birth cohort. The 2002 data set is the most recent, in which 49 states used the same standardized smoking-related question on the birth certificate. Logistic regression models estimated ORs of prenatal smoking for each outcome, and the prenatal smoking population attributable fraction was calculated for each outcome. RESULTS Prenatal smoking (11.5% of all births) was significantly associated with very (AOR=1.5, 95% CI=1.4, 1.6); moderate (AOR=1.4, 95% CI=1.4, 1.4); and late (AOR=1.2, 95% CI=1.2, 1.3) preterm deliveries; term low birth weight deliveries (AOR=2.3, 95% CI=2.3, 2.5); SIDS (AOR=2.7, 95% CI=2.4, 3.0); and preterm-related deaths (AOR=1.5, 95% CI=1.4, 1.6). It was estimated that 5.3%-7.7% of preterm deliveries, 13.1%-19.0% of term low birth weight deliveries, 23.2%-33.6% of SIDS, and 5.0%-7.3% of preterm-related deaths were attributable to prenatal smoking. Assuming prenatal smoking rates continued to decline after 2002, these PAFs would be slightly lower for 2009 (4.4%-6.3% for preterm-related deaths, 20.2%-29.3% for SIDS deaths). CONCLUSIONS Despite recent declines in the prenatal smoking prevalence, prenatal smoking continues to cause a substantial number of infant deaths in the U.S.

Depression and Treatment Among U.S. Pregnant and Nonpregnant Women of Reproductive Age, 2005–2009

BACKGROUND Depression is often undiagnosed and untreated. It is not clear if differences exist in the diagnosis and treatment of depression among pregnant and nonpregnant women. We sought to estimate the prevalence of undiagnosed depression, treatment by modality, and treatment barriers by pregnancy status among U.S. reproductive-aged women. METHODS We identified 375 pregnant and 8,657 nonpregnant women 18-44 years of age who met criteria for past-year major depressive episode (MDE) from 2005-2009 nationally representative data. Chi-square statistics and adjusted prevalence ratios (aPR) were calculated. RESULTS MDE in pregnant women (65.9%) went undiagnosed more often than in nonpregnant women (58.6%) (aPR 1.1, 95% confidence interval [CI] 1.0-1.3). Half of depressed pregnant (49.6%) and nonpregnant (53.7%) women received treatment (aPR 1.0, 95% CI 0.90-1.1), with prescription medication the most common form for both pregnant (39.6%) and nonpregnant (47.4%) women. Treatment barriers did not differ by pregnancy status and were cost (54.8%), opposition to treatment (41.7%), and stigma (26.3%). CONCLUSIONS Pregnant women with MDE were no more likely than nonpregnant women to be diagnosed with or treated for their depression.

Health Concerns of Women and Infants in Times of Natural Disasters: Lessons Learned from Hurricane Katrina

Pregnant women and infants have unique health concerns in the aftermath of a natural disaster such as Hurricane Katrina. Although exact numbers are lacking, we estimate that approximately 56,000 pregnant women and 75,000 infants were directly affected by the hurricane. Disruptions in the supply of clean water for drinking and bathing, inadequate access to safe food, exposure to environmental toxins, interruption of health care, crowded conditions in shelters, and disruption of public health and clinical care infrastructure posed threats to these vulnerable populations. This report cites the example of Hurricane Katrina to focus on the needs of pregnant women and infants during times of natural disasters and provides considerations for those who plan for the response to these events.

Maternal Mortality and Morbidity in the United States: Where Are We Now?

This article provides a brief overview of the work conducted by the Division of Reproductive Health at the Centers for Disease Control and Prevention on severe maternal morbidity and mortality in the United States. The article presents the latest data and trends in maternal mortality and severe maternal morbidity, as well as on maternal substance abuse and mental health disorders during pregnancy, two relatively recent topics of interest in the Division, and includes future directions of work in all these areas.

Zika Virus Disease in Colombia — Preliminary Report

Background Colombia began official surveillance for Zika virus disease (ZVD) in August 2015. In October 2015, an outbreak of ZVD was declared after laboratory-confirmed disease was identified in nine patients. Methods Using the national population-based surveillance system, we assessed patients with clinical symptoms of ZVD from August 9, 2015, to April 2, 2016. Laboratory test results and pregnancy outcomes were evaluated for a subgroup of pregnant women. Concurrently, we investigated reports of microcephaly for evidence of congenital ZVD. Results By April 2, 2016, there were 65,726 cases of ZVD reported in Colombia, of which 2485 (4%) were confirmed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay. The overall reported incidence of ZVD among female patients was twice that in male patients. A total of 11,944 pregnant women with ZVD were reported in Colombia, with 1484 (12%) of these cases confirmed on RT-PCR assay. In a subgroup of 1850 pregnant women, more than 90% of women who were reportedly infected during the third trimester had given birth, and no infants with apparent abnormalities, including microcephaly, have been identified. A majority of the women who contracted ZVD in the first or second trimester were still pregnant at the time of this report. Among the cases of microcephaly investigated from January 2016 through April 2016, four patients had laboratory evidence of congenital ZVD; all were born to asymptomatic mothers who were not included in the ZVD surveillance system. Conclusions Preliminary surveillance data in Colombia suggest that maternal infection with the Zika virus during the third trimester of pregnancy is not linked to structural abnormalities in the fetus. However, the monitoring of the effect of ZVD on pregnant women in Colombia is ongoing. (Funded by Colombian Instituto Nacional de Salud and the Centers for Disease Control and Prevention.).

A public health focus on infertility prevention, detection, and management

In 2002, 2 million American women of reproductive age were infertile. Infertility is also common among men. The Centers for Disease Control and Prevention (CDC) conducts surveillance and research on the causes of infertility, monitors the safety and efficacy of infertility treatment, and sponsors national prevention programs. A CDC-wide working group found that, despite this effort, considerable gaps and opportunities exist in surveillance, research, communication, and program and policy development. We intend to consult with other federal agencies, professional and consumer organizations, the scientific community, the health care community, industry, and other stakeholders, and participate in the development of a national public health plan for the prevention, detection, and management of infertility.

Infertility services reported by men in the United States: national survey data.

OBJECTIVE To describe the extent to which men report they or their partners had made use of infertility services, what services and conditions were reported, and what factors were associated with their use of services. DESIGN Analysis of the male sample of the 2002 National Survey of Family Growth, a nationally-representative household survey of men 15-44. Analysis involved estimation of percentages, chi-squared tests of difference, and multivariate logistic regression analysis. SETTING The 2002 National Survey of Family Growth, Cycle 6. PATIENT(S) A total of 4109 sexually experienced men aged 15-44 years in the 2002 National Survey of Family Growth who had received infertility services. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Percentage of men reporting that they had sought help with having a baby. RESULT(S) A total of 7.5% of all sexually experienced men reported a visit for help with having a child; 2.2% reported a visit in the past year, equivalent to 3.3-4.7 million men reporting a lifetime visit and 787,000-1.5 million a past-year visit. Visits were reported more frequently by older men, those currently or previously married, and the more highly educated. Male-related infertility conditions were reported by 18.1% of those who sought help, the most frequent being sperm or semen problems and varicocele. CONCLUSION(S) Previous estimates of infertility help-seeking were based on data from women. Men report a percentage seeking help that appears to be somewhat lower than reported by women. About 1 in 5 of those seeking help reported male-related infertility conditions.

High-risk human papillomavirus reactivation in human immunodeficiency virus-infected women: Risk factors for cervical viral shedding

OBJECTIVE: To evaluate the presence of and estimate risk factors for reactivation of latent high-risk human papillomavirus (HPV) cervical infection in human immunodeficiency virus (HIV)-infected and HIV-uninfected women. METHODS: Data from 898 women in the HIV Epidemiology Research Study (HERS) were used to evaluate cervical HPV latency and reactivation. Prior exposure to HPV types (16, 18, 31, 35, and 45) was determined by serologic testing at enrollment, and cervical shedding of HPV was detected by polymerase chain reaction at 6-month intervals. Human papillomavirus cervical shedding and sexual history were used to estimate rates of reactivation and recurrence. Repeated measures survival analysis was used to estimate hazard ratios and 95% confidence intervals for reactivation and recurrence. Rates of total HPV shedding (recurrence and reactivation) during follow-up were assessed by HIV status and rate ratios were calculated. RESULTS: Reactivation of latent HPV infections was observed in HIV-infected women, but few reactivation events were identified in HIV-uninfected women. Factors consistently associated with reactivation in HIV-infected women included CD4 count less than 200/mm3 and age younger than 35 years. Women infected with HIV had 1.8 to 8.2 times higher rates of viral shedding (reactivation plus recurrence) compared with HIV-uninfected women. CONCLUSION: Women with a history of cervical HPV infection may be at risk of reactivation of latent viral infection even in the absence of sexual activity, and this risk is higher in women with HIV infection. LEVEL OF EVIDENCE: II

Mental health and access to services among US women of reproductive age

OBJECTIVE The objective of the study was to estimate prevalence of depression and serious psychological distress (SPD) and mental health service receipt among reproductive-age women. STUDY DESIGN We used 2006-2007 nationally representative data to estimate the prevalence of depression and SPD among nonpregnant women aged 18 to 44 years. Using logistic regression, we individually examined predictors of depression and SPD and characteristics associated with clinical diagnosis and current treatment. RESULTS More than 14% of women had current depression and 2.7% had current SPD. Risk factors for major depression and SPD included older age, less education, being unmarried, inability to work/unemployed, and low income. Among depressed women, 18-24 year-olds, nonwhite women, those with children, the employed, and urban women had lower odds of clinical diagnosis. Among women with SPD, Hispanic, employed, and those without health insurance had lower odds of receiving treatment. CONCLUSION Mental health conditions are prevalent among women of reproductive age and a substantial proportion goes untreated.

Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age.

OBJECTIVE The objective of the study was to provide national prevalence, patterns, and correlates of marijuana use in the past month and past 2-12 months among women of reproductive age by pregnancy status. STUDY DESIGN Data from 2007-2012 National Surveys on Drug Use and Health, a cross-sectional nationally representative survey, identified pregnant (n = 4971) and nonpregnant (n = 88,402) women 18-44 years of age. Women self-reported marijuana use in the past month and past 2-12 months (use in the past year but not in the past month). χ(2) statistics and adjusted prevalence ratios were estimated using a weighting variable to account for the complex survey design and probability of sampling. RESULTS Among pregnant women and nonpregnant women, respectively, 3.9% (95% confidence interval [CI], 3.2-4.7) and 7.6% (95% CI, 7.3-7.9) used marijuana in the past month and 7.0% (95% CI, 6.0-8.2) and 6.4% (95% CI, 6.2-6.6) used in the past 2-12 months. Among past-year marijuana users (n = 17,934), use almost daily was reported by 16.2% of pregnant and 12.8% of nonpregnant women; and 18.1% of pregnant and 11.4% of nonpregnant women met criteria for abuse and/or dependence. Approximately 70% of both pregnant and nonpregnant women believe there is slight or no risk of harm from using marijuana once or twice a week. Smokers of tobacco, alcohol users, and other illicit drug users were 2-3 times more likely to use marijuana in the past year than respective nonusers, adjusting for sociodemographic characteristics. CONCLUSION More than 1 in 10 pregnant and nonpregnant women reported using marijuana in the past 12 months. A considerable percentage of women who used marijuana in the past year were daily users, met abuse and/or dependence criteria, and were polysubstance users. Comprehensive screening, treatment for use of multiple substances, and additional research and patient education on the possible harms of marijuana use are needed for all women of reproductive age.