BACKGROUND:
Pregnancy
rates in veterans are
an understudied phenomenon.
OBJECTIVE:
The
objective of this study was to identify predictors of pregnancy within 1 year
of starting hormonal contraception among female veterans.
METHODS:
This was
a retrospective, cohort study of female veterans from Veterans Affairs facilities within Southern California
and Nevada, who newly started hormonal contraception (pill, patch, or ring
only) between October 2008 and September 2012. Pregnancy was defined as any
event corresponding to a pregnant state using ICD-9 codes. Patients were
followed for 1 year post-initiation. Multivariate logistic regression analysis
was performed.
RESULTS:
The final
analysis included a total of 2166 patients. Approximately 5.9% (n = 127) of
patients became pregnant during follow-up. Increased odds of pregnancy were
associated with the following: mental health disease (odds ratio [OR] 1.69, 95%
confidence interval [CI] 1.15-2.58), lowest socioeconomic quintile (OR 1.50,
95% CI 1.05-2.09), and Christian faith (OR 1.69, 95% CI 1.31-2.41). Age groups
25 to 34 years (OR 0.55, 95% CI 0.38-0.92] and 35 to 44 years (OR 0.32, 95% CI
0.06-0.64) were both associated with decreased odds of pregnancy versus age
group 18 to 24 years.
CONCLUSION:
This
study successfully identified several predictors of pregnancy in female veterans starting a pill, patch, or ring form of
hormonal contraception. Female veterans in
the lowest socioeconomic quintile, aged 18 to 24 years, diagnosed with a mental
health disorder, and of Christian faith were found to be at significantly
higher odds of a pregnancy. Identification of these at-risk populations may
help clinicians and policy makers choose strategies to identify which patients
could benefit the most from more effective long-acting reversible contraception
therapy.
- 1Veterans Affairs San Diego Healthcare System, San Diego, CA, USA UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA rashid.kazerooni@va.gov.
- 2Veterans Affairs San Diego Healthcare System, San Diego, CA, USA UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA.
Below: (a) Southern Nevada Health District, (b) University Medical Center of Southern Nevada Wellness Center, (c) Area Health Education Center, (e) Aid for AIDS of Nevada, (f) University of Nevada School of Medicine
Twenty-six infants were born to HIV-infected mothers from July 2005 to June 2006 with 6 documented infections. One hundred and five infants were born to HIV infected mothers from January 2007 to December 2012. Postimplementation, adequacy of prenatal care increased from 58% (15/26) to 85% (89/105); appropriate use of ARV therapy before delivery increased from 73% (19/26) to 86% (90/105); cesarean section as the method for delivery increased from 62% (16/26) to 74% (78/105); adequacy of zidovudine prophylaxis to newborn increased from 54% (14/26) to 87% (91/105). HIV transmission rate dropped from 23% (6/26) to 0%.
Integrating public health and clinical services in the care of HIV-infected pregnant women and exposed infants leads to better coordination of care and improved quality of care.
Read more at: http://ht.ly/QSkzt HT @NevadaMedicine
