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At least 271 records · Page 15Linked to original sources
PubMed1998

Why don't women with diabetes plan their pregnancies?

OBJECTIVE: To determine why women with diabetes generally do not plan their pregnancies, consequently entering their pregnancies with poor blood glucose control and greatly increasing the risk of birth defects in their infants. RESEARCH DESIGN AND METHODS: A population-based sample of 85 women with diabetes diagnosed before the index pregnancy were recruited within 6 months postpartum from 15 hospitals in the state of Washington. Women with planned and unplanned pregnancies were compared using qualitative and quantitative analysis of personal interviews, self-administered questionnaires, and medical record review. RESULTS: Although most women (79%) knew they should optimize their blood glucose levels before conception, fewer than half (41%) of their pregnancies were planned. Women with planned pregnancies had significantly higher income and more education; were more likely to have private health insurance, to see an endocrinologist before pregnancy, to be happily married, and to be Caucasian; and were less likely to use tobacco. Most unplanned pregnancies were not contraceptive failures, but may have been consciously or subconsciously intended. Women with planned pregnancies generally described an ongoing and positive relationship with their health care providers. Women who felt that their doctors discouraged pregnancy were more likely to have an unplanned pregnancy than were women who had been reassured they could have a healthy baby. CONCLUSIONS: Many women with diabetes still perceive negative messages about pregnancies and become pregnant without optimal planning. We believe there are many opportunities for increasing the proportion of women with diabetes who plan their pregnancies, particularly in the areas of prepregnancy information, support that women are given, and the quality of the relationships they experience within the health care system. It is crucial that couples be reassured that with pre-conception glucose control, almost all women with diabetes can have healthy babies.

Adult↗
PubMed2002

Pregnancies diagnosed during Depo-Provera use.

We conducted a review of contraceptive failures among women using Depo-Provera (depot medroxyprogesterone acetate), using reports to the Insurance Division of Planned Parenthood Federation of America, Inc. Cases were included if the Depo-Provera had been given at a Planned Parenthood center and pregnancy had either been diagnosed by, or reported to, a Planned Parenthood center. There were 402 reports of pregnancy from 1994 through 1998. The crude rate of reported pregnancies was 0.42 pregnancies per 1000 women using Depo-Provera each year. Pregnancy was diagnosed after the first trimester in 46% of women. Seventy-seven women (19.1%) received additional Depo-Provera injections while pregnant. Of the women whose date of conception could be estimated, 113 of 258 (45%) became pregnant after the injection. There was no observed increase in ectopic pregnancy rate, and no fetal anomalies were reported. Although pregnancy during Depo-Provera use is rare, it does occur. These pregnancies are frequently unrecognized until beyond first trimester.

Adolescent↗
PubMed2003

Effect of topiramate or carbamazepine on the pharmacokinetics of an oral contraceptive containing norethindrone and ethinyl estradiol in healthy obese and nonobese female subjects.

PURPOSE: To study the pharmacokinetics of a combination oral contraceptive (OC) containing norethindrone and ethinyl estradiol during OC monotherapy, concomitant OC and topiramate (TPM) therapy, and concomitant OC and carbamazepine (CBZ) therapy in order to comparatively evaluate the pharmacokinetic interaction, which may cause contraceptive failure. METHODS: This randomized, open-label, five-group study included two 28-day cycles. Five groups of female subjects received oral doses of ORTHO-NOVUM 1/35 alone (cycle 1) and then concomitant with TPM or CBZ (cycle 2). The treatment groups were group 1, TPM, 50 mg/day; group 2, TPM, 100 mg/day; group 3, TPM, 200 mg/day; group 4, TPM, 200 mg/day (obese women); and group 5, CBZ, 600 mg/day. Group 4 comprised obese women whose body mass index (BMI) was between 30 and 35 kg/m(2). The BMI of the remaining four groups was < or =27 kg/m2. RESULTS: Coadministration of TPM at daily doses of 50, 100, and 200 mg (nonobese) and 200 mg (obese) nonsignificantly (p > 0.05) changed the mean area under the curve (AUC) of ethinyl estradiol by -12%, +5%, -11%, and -9%, respectively, compared with OC monotherapy. A similar nonsignificant difference was observed with the plasma levels and AUC values of norethindrone (p > 0.05). CBZ (600 mg/day) significantly (p < 0.05) decreased the AUC values of norethindrone and ethinyl estradiol by 58% and 42%, respectively, and increased their respective oral clearance by 69% and 127% (p < 0.05). Because CBZ induces CYP 3A-mediated and glucuronide conjugation metabolic pathways, the significant increase in the oral clearance of ethinyl estradiol and norethindrone was anticipated. CONCLUSIONS: TPM, at daily doses of 50-200 mg, does not interact with an OC containing norethindrone and ethinyl estradiol. The lack of the TPM-OC interaction is notable when it is compared with the CBZ-OC interaction.

Administration, Oral↗
PubMed1979

Behavioral response to vasectomy.

This article reviews the literature concerning the behavioral and psychological response of men and their wives to the vasectomy operation when used as a contraceptive technique. The data suggest that two primary changes may frequently be observed postoperatively. Individuals who have experienced anxiety in conjunction with intercourse because of a fear of contraceptive failure or pregnancy tend to report a decline in anxiety and a disinhibition of sexual arousal postoperatively. Also, test results suggest that behavoir patterns within the marital dyad are altered in some cases when the men adopt stereotyped masculine behavior, presumably to deny any suggestion that they are less masculine because of the operation. Ramifications of these findings as well as numerous other speculations, are considered, along with the suggestion that prescreening and postvasectomy counseling may help reduce negative response to the operation.

Adult↗
PubMed1984

Delayed spontaneous recanalization of the vas deferens.

Eight patients were identified who had undergone successful vasectomy a mean of 4.6 years previously and in whom all were microscopically shown to have recurrent motile spermatozoa in their ejaculate. All had been referred following a pregnancy in their wives, and all agreed to undergo repeat vasectomy. Histological examination of the excised portions revealed the presence of spermatozoa in the distal end of one side; but also the presence of a well formed sperm granuloma in continuity with both divided ends of the vas. There does not appear to be any correlation with the suture previously used, nor incidence of infections or injury. Although recanalization is a recognized complication of vasectomy, the majority have occurred within months of the operation. The association of the delayed recanalization with sperm granuloma formation in these cases suggests an aetiological link, it being previously reported that such granuloma can develop up to six years postoperatively.

Adult↗
PubMedDate not supplied

Comparison of laparoscopic sterilization via spring-loaded clip and tubal ring.

The spring-loaded clip and tubal ring techniques of laparoscopic female sterilization were compared for ease of performance, safety and effectiveness at the Asociación Demográfica Salvadoreña in San Salvador, where they were randomly assigned to a total of 299 patients. Rates of technical/equipment difficulties and procedural difficulties during laparoscopy were similar for both techniques. Procedure-related surgical complications occurred in three ring patients as a result of tubal transection. Pain during the procedure was more severe for tubal ring patients. Results suggest that both techniques can be safely and effectively used for laparoscopic sterilization.

Adult↗
PubMed1983

Origin of chromosomal abnormalities: evidence for delayed fertilization in meiotic nondisjunction.

This study ascertained 35 aneuploid patients, of which 34 had trisomy 21 and one had trisomy 18. Their parents were matched by age at the conception with parents of 35 euploid patients with congenital defects. Interviews with the couples focused on exposures and activities at the time of the conception. No parents had infectious hepatitis preceding the conception, and one study mother and four comparison parents reported drug ingestion. Eight parents in the study group and two in the comparison reported radiation exposure. One family in each group had a history of thyroid disorder. The groups differed mainly in their sexual histories; circumstances favoring the possibility of delayed fertilization (contraceptive failure, infrequency of intercourse, or premarital conception) existed in 22 of the study group but in only seven of the comparison group.

Adolescent↗
PubMed1988

Outcomes of pregnancy with an IUD in situ--a population based case-control study.

Use of IUDs was examined among 962 women whose pregnancy was terminated at the University Hospital of Trondheim, Norway during 1983. Ectopic pregnancy was significantly more often diagnosed among women with an IUD in place at conception compared to non-users (7.8% vs 1.3%, p less than 0.01). Despite removal of the IUD during the first trimester, women who became pregnant with an IUD in situ had spontaneous abortion more often than non-users (15.6% vs 7.0%, p less than 0.05). The causal significance of these findings will require further investigation. The small number of ectopic pregnancies subsequent to an IUD contraceptive failure in relation to the number of all pregnancies within the same time frame may explain the lack of a demonstrable link between increasing IUD use and increasing rates of ectopic pregnancy.

Clinical Trials as Topic↗