Type Of Treatment For Miscarriage Does Not Have An Effect On Long Term Fertility

A study published on bmj today reports that the type of treatment a woman receives after an early miscarriage does not affect subsequent fertility. Around 80 percent of women have a live birth within five years of their miscarriage.


It is established that fifteen per cent of pregnancies end in early miscarriage. For decades the typical management of early miscarriage was surgical evacuation of retained products of conception. However, this was increasingly questioned. Now women are usually offered expectant (watch and wait) and medical management as well.


Earlier studies, including the largest published trial (the MIST trial), have indicated that all three methods are probably similar in terms of gynecological infection. However, the long term effects on fertility are unknown.


Researchers based in the South West of England decided to compare fertility rates for the three management methods (expectant, medical or surgical).


A total of 762 women who had taken part in the original MIST study were surveyed. They had randomly received surgical, medical or expectant management for an early miscarriage (less than 13 weeks gestation).


These women answered a questionnaire about the succeeding pregnancies and live births after this miscarriage. The age factor, previous miscarriage and previous birth history were considered.



Among the survey respondents, 83.6 percent reported a subsequent pregnancy, with 82 percent having a live birth.


The time to subsequently give birth was very similar in the three management groups: 79 percent of those randomized to expectant management, 78.7 percent of the medical group and 81.7 percent of the surgical group, all had a live birth five years after their miscarriage.


On the other hand, older women and those suffering three or more miscarriages had considerably less probabilities to subsequently give birth.


In closing, the authors confirm that the method of miscarriage management does not affect subsequent pregnancy rates. In addition, around four in five women have a live birth within five years of a miscarriage.


They write: "Women can be reassured that long term fertility concerns need not affect their choice of miscarriage, management method."


"Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial"

Lindsay F P Smith, research lead, Paul D Ewings, director of Peninsula RDSU, Catherine Quinlan, research administrator

BMJ 2009; 339:b3827

doi:10.1136/bmj.b3827

bmj


Stephanie Brunner (B.A.)

Many Women Delay, Skip Care Because of Cost, Survey Says, USA

Twenty-seven percent of women under age 65 and 67% of uninsured women delayed or went without needed medical care in the last year because they did not think they could afford it, according to a new survey from the... Kaiser Family Foundation, the Minneapolis Star Tribune reports (O'Rourke, Scripps Howard/Minneapolis Star Tribune, 7/7). For the survey, researchers questioned 2,766 women ages 18 and older by telephone from July though September 2004 (Reuters/New York Post, 7/8). According to the survey, 17% of women with private insurance delayed or went without care because of cost concerns (CQ HealthBeat, 7/7). One in three Latinas -- who are the least likely among all U.S. women to have a regular physician -- said they delayed or forwent health care because of cost, the survey finds (Scripps Howard/Minneapolis Star Tribune, 7/7). Eight in 10 mothers or legal guardians said they had the responsibility for health care decisions in a family, and 12% of women said they are caregivers for sick or aging relatives, according to the survey (Powell, Akron Beacon Journal, 7/8).

Prescription Drugs
Among uninsured women, 41% reported that they did not fill a prescription because of costs, compared with 17% of women with private insurance and 19% of women enrolled in Medicaid. Fourteen percent of women also reported that they skipped or took smaller doses of their medicines in the past year to make them last longer, the survey shows (Kaiser Family Foundation release, 7/7). Women are more likely than men to use a prescription drug on a regular basis, and they also are more likely to report difficulties affording such medications, the survey finds (Scripps Howard/Minneapolis Star Tribune, 7/7). Moreover, 38% of women have chronic conditions such as diabetes, asthma or hypertension, compared with 30% of men (Akron Beacon Journal, 7/8). Thirty-four percent of women in poor health did not fill a prescription because they could not afford it, the study shows (Kaiser Family Foundation release, 7/7).

Physician Communication
According to the survey, about one-third of women reported that they spoke to a physician in the past three years about smoking, 20% spoke to a doctor about alcohol use and 43% discussed calcium intake (CQ HealthBeat, 7/8). Fifty-five percent of women discussed diet, exercise and nutrition with their physicians. Thirty-one percent of women of reproductive age said they discussed sexual history, sexually transmitted diseases and HIV/AIDS with their physician (Portillo, Knight Ridder/Detroit Free Press, 7/8).

Preventive Care
The survey also found that the rate of women receiving a mammogram decreased from 73% in 2001 to 69% in 2004 among women ages 40 to 64 (CQ HealthBeat, 7/8). Three-quarters of women with private insurance coverage in 2004, 73% of Medicare beneficiaries and 40% of uninsured women received a mammogram in the last year (Kaiser Family Foundation release, 7/7). In addition, the rate of women ages 18 to 64 who received a Pap test decreased from 81% in 2001 to 76% in 2004 (Scripps Howard/Minneapolis Star Tribune, 7/7). Thirty-eight percent of women age 50 and older reported having had a colon cancer screening test in the past two years and 37% of women age 45 and older said they received an osteoporosis test in the past two years, the survey shows (CQ HealthBeat. 7/8).

Comments
Alina Salgagnicoff, director of women's health policy at the Kaiser Family Foundation and a foundation vice president, said, "We're finding that cost is increasingly becoming a barrier for women. The cost is more of an issue for women than men" (Akron Beacon Journal, 7/8). She added, "A sizeable share of women are falling though the cracks, either because they don't have insurance or even with insurance can't afford to pay for medical care or prescription drugs" (Scripps Howard/Minneapolis Star Tribune, 7/7). Carolyn Clancy, director of the Agency for Healthcare Research and Quality, said during a panel discussion on the survey that women should be more proactive about speaking with their physicians and should prepare a checklist of things to ask before appointments (CQ HealthBeat, 7/7).

The survey is available online.

A HealthCast of the panel discussion on the survey also is available online at kaisernetwork.


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Pope Benedict XVI Says Catholic Politicians 'Especially' Obliged To Defend Church Beliefs On Issues Such As Abortion

Pope Benedict XVI in a 130-page "apostolic exhortation" released on Tuesday wrote that "values" such as opposition to abortion, euthanasia and gay marriage are "non-negotiable," and that Roman Catholic politicians are "especially" obligated to defend the church's beliefs on the issues, the New York Times reports. The exhortation, which is a synopsis of opinion from a 2005 global meeting of bishops at the Vatican, said, "Catholic politicians and legislators, conscious of their grave responsibility before society, must feel particularly bound on the basis of a properly formed conscience to introduce laws inspired by values grounded in human nature" (Fisher, New York Times, 3/14). The pope also wrote that there is an "objective connection" between the stance a Catholic politician takes on abortion or gay marriage and receiving Communion, the Irish Times reports. "Bishops are bound to reaffirm constantly these values as part of their responsibility to the flock entrusted to them," the pope wrote. Cardinal Angelo Scola, when asked if the pope's statement meant that Catholic politicians could be refused Communion, said the document "doesn't say what it doesn't say" (McGreevy, Irish Times, 3/14). The United States Conference of Catholic Bishops in June 2004 at a closed meeting in Colorado voted to approve a statement saying that the decision to deny Communion to Roman Catholic politicians who support abortion rights is up to the local bishop. The statement also says that Catholic politicians should work against legalized abortion "lest they be guilty of cooperating in evil and in sinning against the common good" (Kaiser Daily Women's Health Policy Report, 11/15/06).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Study Shows Women's Race And Class Impact Contraception Recommendations

A woman's race/ethnicity and socioeconomic status impact whether health care providers recommend one of the most highly effective forms of contraception, a UCSF study confirms. The results also indicate that the interaction of both factors plays a role in clinicians' decisions.



Recommendations by health care providers previously have been found to vary by patients' race and socioeconomic status, contributing to health disparities, according to the researchers. The team investigated the effect of these factors on recommendations for contraception.



Study results appear in the October print edition of the American Journal of Obstetrics and Gynecology and are available online here. An editorial commenting on the study also is included in the Journal.



In the study, clinicians' recommendations for intrauterine devices (IUDs), considered among the most effective forms of contraception, were affected by both the patient's class and her race/ethnicity.
Clinicians were less likely to recommend IUDs to white women of low socioeconomic status than to white women of high socioeconomic status.
Socioeconomic status had no significant effect on recommendations for IUDs for Latinas and black women.
But when the researchers evaluated the groups by race/ethnicity, clinicians were more likely to recommend IUDs to Latinas and black women of low socioeconomic status than to white women of low socioeconomic status.

"Understandably, people want simple answers but the complexity of the results is not surprising. We live in a complex world where race and class are intertwined, " said Christine Dehlendorf, MD, MAS, assistant professor in the UCSF Department of Family and Community Medicine and the UCSF Department of Obstetrics, Gynecology & Reproductive Sciences. "Clinicians need to be cognizant of how their patients' characteristics may influence the care they provide."



In the study, one of 18 videos depicting patients with varying socioeconomic and racial characteristics was shown to 524 healthcare providers, who then were asked whether they would recommend an IUD to the patient. The study group was drawn from medical physicians, osteopathic physicians, nurse practitioners and physician assistants who attended meetings of professional societies of family medicine and gynecology.



Previous research on the effect of patient race/ethnicity and class on clinicians' behaviors has focused on patient-provider interactions involving medical decisions about diseases, such as coronary artery disease, for which there is general consensus about appropriate treatments. Decisions about family planning, in contrast, involve multiple clinically appropriate options. The most effective choice may depend on a patient's personal preference, the team states.
















"Providing contraceptive services is a particularly sensitive area of health care, both because of the intimate nature of the discussion of sexual behavior and because of the historical relationship of efforts to promote contraception with attempts to limit the fertility of minority and poor women in the United States," Dehlendorf said. "Family planning providers should work to ensure that they provide quality, patient-centered care to all women."



The inconsistency in health care provider recommendations for such an effective contraception method suggests a need for further research into the influence of clinicians' recommendations on family planning and ways to prevent the differences in care, she said.



The IUD, a small, plastic device that is inserted and left inside the uterus to prevent pregnancy, is more effective than most other forms of birth control, according to the American Congress of Obstetricians and Gynecologists.



"This is an especially important area of research given the high rate of unintended pregnancy in the US. It is critical that we provide comprehensive contraceptive counseling and equitable access to highly effective long-acting reversible contraceptives such as the IUD to all women," said Jody Steinauer, MD, MAS, senior study author and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences.



Notes:



Co-authors are Rachel Ruskin, MD, of the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences; Kevin Grumbach, MD, of the UCSF Department of Family and Community Medicine; Eric Vittinghoff, PhD, of the UCSF Department of Epidemiology and Biostatistics; Kirsten Bibbins-Domingo, MD, PhD, of the UCSF Department of Epidemiology and Biostatistics and UCSF Department of Medicine; and Dean Schillinger, MD, of the UCSF Department of Medicine.



The study was funded by the Fellowship in Family Planning and by the National Institutes of Health.



UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.



Source:

Karin Rush-Monroe

University of California -- San Francisco

Health Insurers Pledge Commitment To Greater Equality In Women's Coverage Under Health Reform

In testimony before the Senate Health, Education, Labor and Pensions Committee on Thursday, America's Health Insurance Plans President and CEO Karen Ignagni said the insurance industry supports health reform proposals that would prohibit charging women higher premiums or denying coverage based on gender, age or pre-existing conditions, including pregnancy or previous caesarean sections, CQ HealthBeat reports.

Ignagni also defended AHIP's recent study projecting that the Senate Finance Committee's reform bill would increase premiums. The study's methodology was widely criticized, but Ignagni said the message is that "costs are going to go up for individuals and working families if we don't have everyone participate." She repeatedly called for Congress to include a provision in health reform legislation requiring all U.S. residents to obtain health insurance.

The hearing's focus was "equal health care for equal premiums" regarding women's health coverage, and it included testimony from both liberal and conservative groups. National Women's Law Center Co-President and founder Marcia Greenberger said that women face many challenges in the individual insurance market, including finding affordable maternity coverage. A 2008 NWLC report found that 12% of individual policies offered comprehensive maternity coverage, while others offered riders costing as much as $1,000 per month in addition to regular premiums. Sen. Al Franken (D-Minn.) said it is "a top priority" that health reform includes "access to affordable family planning services," which he called "a crucial women's health services." Franken added, "Access to contraception is a fundamental right of adult Americans."

Sen. Barbara Mikulski (D-Md.) said a 25-year-old woman can be charged up to 45% more than a man of the same age for the same individual health insurance plan. She added that the disparity increases to 140% or more when women reach age 40. Women can also be denied coverage because they are pregnant, have had a c-section or have experienced domestic violence, Mikulski said. A witness at the hearing testified that she was denied coverage because she had undergone a c-section and was then told by the insurance company that she could receive coverage if she underwent a sterilization procedure. Mikulski said the testimony was "bone chilling," adding, "No one, no one, in the United States of America, in order to get health insurance, should ever be coerced into getting a sterilization" (Norman, CQ HealthBeat, 10/15).

ABC 'World News' Covers HELP Committee Hearing

ABC's "World News with Charles Gibson" on Thursday included a segment on the hearing (Gibson, "World News with Charles Gibson," ABC, 10/15).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


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