Women’s Health

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21747

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Determinants of Urinary Bisphenol-A Concentrations During Pregnancy
(2015-03) Board, Amy; Robledo, Candace; Peck, Jennifer
Purpose: Given the short half-life (5-6 hours) of bisphenol-A (BPA), a suspected endocrine disruptor, we examined whether urinary concentrations of bisphenol-A (BPA) among pregnant women were correlated with 24 hour self-reported consumption of canned beverages and/or canned/prepackaged foods. Methods: Pregnant women (n=306) were recruited from the University of Oklahoma Medical Center Women’s and High Risk Pregnancy clinics in Oklahoma City, Oklahoma. Banked urine specimens were analyzed for total (free BPA + conjugates) urinary BPA concentrations (ng/mL). Participants were asked to self-report the number of servings of canned beverages, canned foods and prepackaged foods within the last 24 hours. Spearman rank correlation coefficients were used to identify statistically significant correlations between log-transformed urinary concentrations of BPA and self-reported measures of canned beverage and canned/prepackaged food consumption. Linear regression analysis was also performed, adjusting for specific gravity, BMI, age, smoking, income, race, education, and consumption of coffee within the past 24 hours. Results: The majority of women were non-white, reported an annual household income below $30,000 and were not active smokers ( Conclusions: Total urinary concentrations appear to be correlated to the consumption of canned beverages in the previous 24 hours. However, canned beverages do not appear to contribute greatly to maternal BPA levels measured during pregnancy.
Prevalence of high-risk human papillomavirus types among substance abusing women screened for cervical and anal cancer.
(2015-03) Felini, Martha; Tod, Nicole; Kremer, Timothy; Bangara, Saritha; Igenoza, Oluwatosin; Jegede, Opeyemi; Anderson, Ralph; Qualls-Hampton, Raquel Y.
Purpose Prevalence studies of HPV in the general US population have provided important baseline data for monitoring HPV vaccination efforts. As the field of HPV progresses, funders are calling for HPV studies to be conducted in more meaningful and high risk populations to uncover new leads in HPV infection. Our primary objective in this cross-sectional study was to estimate the seroprevalence of high-risk HPV (hr-HPV) among a high risk population - substance abusing women. Further investigation was conducted to assess concordance of hr-HPV infection between cervical and anal sites. Methods Women were recruited from Nexus Recovery Center – the largest female only substance abuse recovery center in DFW. Cervical and anal pap smears were used to collect samples for hr-HPV co-testing. HPV results were received from 318 cervical samples and 243 anal samples. Chi-square and t-tests were used to determine differences in hr-HPV status by age, race, smoking, high risk sexual activity, cytology, and concordance. Results Seropositivity for cervical hr-HPV was 29%. Anal hr-HPV was observed significantly more often (32%) compared to cervical sites. Seropositivity for hr-HPV among women with abnormal cervical cytology was 63%; for those with normal cervical cytology hr-HPV was 47%. However, only 39% of abnormal anal cytology tested seropositive for hr-HPV. hr-HPV status differed by age and cervical cytology, but not by race, smoking, sexual activity, or anal cytology. Of those testing positive for either cervical or anal hr-HPV, nearly half (46%) had infection concurrently at both sites. Conclusion Our study population demonstrated higher rates of cervical and anal hr-HPV infections compared to US women (23% and 19%, respectively). As expected, hr-HPV status differed by cervical cytology results. Contrary to our hypothesis, hr-HPV status was similar regardless of anal cytology results. This unexpected finding may suggest a different ability of anal hr-HPV clearance, or it could reflect the younger age of our study group given the older age predilection of anal dysplasia. Concordance of hr-HPV between cervical and anal sites is generating a separate study of type-specific hr-HPV at cervical, anal, and oral sites. Our findings lend importance to determining whether anal Pap smears and/or anal hr-HPV testing should be included in well woman exams and also presents baseline HPV prevalence for the first time in this high risk population.
Pregnancy Outcomes Among Women in Substance Abuse Treatment
(2015-03) Felini, Martha; Raines-Milenkov, Amy; Alexander, Brian; Ukpaka, Kelechi; Bangara, Saritha; Igenoza, Oluwatosin; Jegede, Opeyemi; Anderson, Ralph; Qualls-Hampton, Raquel
Purpose Pregnancy outcomes are powerfully influenced by what occurs long before pregnancy begins. Providing preconception care is a critical component to decreasing rates of adverse pregnancy and birth outcomes, as reflected in the Healthy People 2020 objectives. To help promote progress on these objectives, improvements in birth outcomes must be made in our highest risk and most disparate populations. Using self-reported reproductive history data from an ongoing cervical cancer prevention services project delivered to substance abusing women in treatment, we examined the reproductive history and frequency of pregnancy outcomes. Further analysis explored whether previous trauma and risky sexual activity were associated with adverse pregnancy outcomes. Methods Study participants included women aged ≥18 years attending our cancer prevention education seminars at Nexus Recovery Center – the largest female only substance abuse recovery center in DFW. Demographics, past trauma, risky sexual activity, and birth histories (preterm births, miscarriages, abortions, number of children) were collected using self-administered questionnaires. Chi-square tests were used to assess differences between birth outcomes, trauma, and risky sexual activity. Results A total of 286 women with a median age of 32 years were included in this study. The majority of women were white (68%). Two-thirds reported histories of physical abuse, 50% reported sexual abuse, and 42% sold sex for drugs. Nearly nine out of 10 women reported previously being pregnant. A total of 809 pregnancies were observed among 237 pregnant women. Among pregnancies reported, 506 (63%) ended with childbirth (437 full term delivery, 69 preterm delivery), 123 (15%) with miscarriage, 148 (18%) with abortion, while the outcome was unknown for 32 (4%). Pre-term births were higher among women with histories of physical abuse (p=0.02) and more miscarriages were reported among victims of sexual abuse (p=0.02). No differences in poor birth outcomes were observed with high risk sexual activity. Conclusion Our findings suggest adverse pregnancy outcomes are high for substance abusing women in treatment compared to the general population. An exceptional window of opportunity exists to integrate preconception care interventions within treatment recovery centers, but the key challenge will be determining the best delivery mechanism within the context of significant trauma histories.
Evaluation of the UNTHSC Campus as a Mother-Friendly Worksite
(2015-03) Miller, Jennifer M.; Beyer, Molly; Barnes, Shelly; Hanich, Kristen; Sam, Justena; Adeniyi, Quadir; Pramanik, Priyanka; Chinyanta, Nellie; Lee, Parker; Paul, Marcy
Objective Mothers face numerous barriers with breastfeeding specifically returning to work. Lack of privacy and storage to breastfeed or pump, and accepted break times are reasons to cease. Texas created the Mother-Friendly Worksite Initiative in 1995 which offers certification for worksites that meet certain criteria including “Flexible work schedules with breaks and work patterns providing time milk expression, access to a private location(s), not a bathroom and clean and safe water source for washing hands and cleaning equipment, and access to hygienic refrigeration to safely store breastmilk." This pilot research project evaluated breastfeeding-friendliness on the UNTHSC campus and sought to assess steps to become a mother-friendly worksite. Materials and Methods Fifteen MPH students and one DrPH student were assigned UNTHSC buildings and asked to evaluate the assets and barriers to breastfeeding on campus. The assessment, conducted with photographs and journaling ascertained whether there were already designated places to breastfeed, pump, and/or store milk. Results The results found three lactation-designated areas on campus and surrounding buildings. Two lactation rooms were private with locked doors but neither were labeled as such. The third lactation area was located in a restroom with a curtain and chair. None of the three lactation areas had refrigeration to store expressed breastmilk. Conclusions To become a certified mother-friendly worksite, UNTHSC needs to 1) increase lactation spaces on campus; 2) generate policy that facilitates faculty, staff, and students to take breaks to pump or breastfeed, and 3) create designated spaces for patients and guests to breastfeed and pump.
Identifying Primary Factors Responsible for the Decline of Obstetric Care by Rural Texas Family Practice Physicians
(2015-03) Beaver, Ryan; Chiapa-Scifres, Ana; Bowling, John
There is a well-documented decline of family practice physicians (FPs) providing OB, and the known reasons behind the decline are varied and complex. The purpose of this study is to assess which factors are most responsible for the decline in OB provided by FPs, with a specific focus on those in rural Texas communities. Specifically, it seeks to determine: 1.) What rural FPs are currently providing OB services? 2.) What are the primary factors/barriers responsible for the decline of OB services provided by rural FPs? A statewide survey of self-identified rural FPs targeted the degree of OB services currently provided and graded factors/barriers responsible for the decline of obstetric care in their personal practices. Current OB practice characteristics were divided into 3 primary categories: currently performing, previously performed, or never performed. Individual factors/barriers were graded using a scale of 1 through 5 and ranked according to highest arithmetic average. The survey was distributed in both physical and online forms to various professional FP societies in Texas and the data and statistical analysis were recorded in Qualtrics online survey software. 35 FPs volunteered to participate. 2 respondents did not self-identify as rural and were excluded from the analysis. Of the remaining 33, we found that 85% felt as if they had received adequate OB training in residency, yet only 29% were currently performing vaginal deliveries as part of their practice. Another 43% had previously performed vaginal deliveries but were not currently, and 29% had never performed vaginal deliveries as part of their practice. Of those adequately trained in OB, lifestyle (4.36), family (4.00), and sleep issues (3.75) accounted for the top three factors, followed by liability (3.41) and difficulty obtaining back-up coverage (3.14). The lowest ranked factors/barriers were hospital privileges (2.11), concern with skill level (1.96), and credentialing barriers (1.79). This data confirms that qualified FPs are declining to provide OB care. Primary factors responsible include lifestyle/family-related issues, liability, and poor back-up coverage. Factors of least concern were credentialing barriers, concern with skill level, and hospital privileges. This study confirms that non-medical factors are affecting medical care in rural areas, and future solutions must take these factors into account.
Cervical Cancer Screening Among Refugee Populations in Tarrant County
(2015-03) Liang, Lai Y.; Raines-Milenkov, Amy; Qualls-Hampton, Raquel Y.; Baker, Eva
Cervical cancer is the second most common cause of cancer mortality among women, with most cancer deaths among women of developing countries. It is also the most easily preventable cancer in women. This study evaluates cervical cancer screening practices among several refugee populations in Tarrant County: Burmese, Bhutanese, Somalian, and Congolese. Many factors influence participation in cervical cancer screening among refugee women. Such factors include knowledge about cervical cancer, cultural beliefs, financial concerns, access to health care, physician characteristics, and time in the United States. The study aimed to investigate the impact of time in the United States on cervical cancer screening. Data for this study were obtained from a project called the Building Bridges Initiative. As part of this program, trained refugee Lay Health Educators reached out to refugee women in their communities with education and assistance in receiving cervical, breast, and Hepatitis B screenings. The Lay Health Educators consented and interviewed women who met the inclusion criteria during the baseline assessment. For the purposes of this study, the following baseline questions were examined: “Have you had a Pap test?” and “What was the date of your last Pap test?” in addition to demographic information and time of arrival in the United States. The association of arrival in the United States and screening, as well as qualitative data from comments shared during the group education sessions are presented to illustrate barriers to screening. Rates of cervical cancer screening among refugee populations are far below that of the recommended rate in the United States as outlined by Healthy People 2020. Therefore, refugee populations in the Unites States, especially when resettling from countries with a high incidence of cervical cancer, are in need of culturally and linguistically tailored cancer education prevention and intervention programs.
Contributors to Depressive Symptoms among Pregnant Women
(2015-03) Andrews, Alita R.; Fulda, Kimberly; Franks, Susan
The Division of Reproductive Health of the CDC has made mental health conditions of pregnant woman a top priority (CDC, 2013). Depression during pregnancy (AKA Perinatal Depression) often goes undiagnosed; therefore, identifying potential risk factors for screening purposes is important for all health professionals. The current study examined whether race / ethnicity predicts depression symptomatology in pregnant women. Additionally, current identified risk factors for perinatal depression (maternal stress, anxiety level, social support, relationship status, education level, healthcare coverage, and employment status) were analyzed in this study. Participants in this study (n=454) completed a survey and were recruited from the Tarrant County WIC clinics and UNT Health OB/GYN clinic at Harris Methodist Hospital. African American, Caucasian, and Hispanic pregnant women were eligible to complete this questionnaire. Variables examined in this study included demographic information and psychosocial measures (depressive symptoms, anxiety, and stress-level). Simple and multiple logistic regressions were utilized to predict depression symptomatology (no depressive symptoms vs mild, moderate, or major depressive symptoms). Models controlled for perceived stress, anxiety, social support, age, employment status (employed, student, not employed), health insurance (yes, no), marital status (married or in a relationship, not in a relationship), highest education (less than high school, high school or GED, more than high school), and recipient of WIC (yes, no). Odds ratios and 95% confidence intervals are presented. Participants were Caucasian [n=193 (42.5%)], African-American [n= 103 (22.7%)], and Hispanic [n=158 (34.7%)]. Depressive symptomatology was present in 158 participants (34.7%). Unadjusted analyses showed that African American women had 1.7 times greater odds of having depressive symptoms (95% CI [1.008-2.721]) as compared to Caucasian women, but no differences were observed between Hispanic and Caucasian women. Additionally, stress, anxiety, social support, WIC assistance, education-level, and marital status were all individually predictive of depressive symptoms in unadjusted analyses. However, in the adjusted model, only anxiety predicted perinatal depressive symptomatology. No differences were observed by race/ethnicity. This study shows the high percentage of pregnant women with depressive symptoms. Although individual analyses of race/ethnicity were significant, overall it was not predictive of depression symptoms in pregnant women. Follow-up studies are needed to help health professionals identify risk factors of perinatal depressions and direct patients to appropriate treatment.
Gender Differences in the Arterial Pressure Response to Apnea
(2015-03) Jouett, Noah; Moralez, Gilbert; Smith, Michael L.
Background: Gender-based differences in basic physiology receive intense scrutiny within the scientific community. These differences can potentially explain the mechanisms of various health outcome disparities among the genders. It has been widely documented that women and men respond differently to physiological stress—especially in the response to sympathetic stimulation. Women are considered “cardiac responders” (increasing heart rate and contractility) while men are considered “vessel responders” (increasing systemic vascular resistance). Up to this point, no study has tested this hypothesis with apnea. This study tested the hypothesis that women receiving metoprolol will decrease their arterial pressure and heart rate response to hypoxic voluntary apnea compared to men. Methods: For this pilot study, 2 men and 4 women were recruited. Each of the women was in the early follicular phase of her menstrual cycle (day 1-4 post menses). No women were taking hormonally active medications. Each subject was exposed to 12% oxygen via Douglas bag for 5 minutes. The subject then initiated 3 voluntary apneas. Beat-to-beat arterial pressure (Finometer) and O2 saturation (Nellcor pulsoximeter) were measured. Each subject repeated the experimental condition with (a) a full blocking dose of intravenous metoprolol (average=0.1 mg/kg) and (b) the same dose of normal saline. Results: Males and females exhibited similar responses in systolic, diastolic and mean arterial pressure to voluntary hypoxic apnea with and without metoprolol (all P [greater than] 0.05, repeated measures two-way ANOVA). Conclusions: This preliminary study has shown that women in the early follicular phase of menstruation respond similarly to men with hypoxic apnea in terms absolute arterial pressure. This potentially implicates the role of estrogen and progesterone in this phenomenon. Future studies will quantify the role of menstrual cycle phase and comparison to other physiological stressors.
Assessing the Obstetric Patient’s Knowledge of Pregnancy
(2015-03) Hoang, Christine; Vu, Manhan; Patel, Bimal; Morse, Steven
Purpose: Anecdotal evidence suggests a majority of patients in our urban, county hospital setting are lacking in their knowledge and understanding of pregnancy. Tarrant County has an increasing infant mortality rate which is higher than state and national rates. Currently, there is no consensus regarding what minimal basic knowledge obstetrical patients are encouraged to know regarding pregnancy. Centering pregnancy is a new model of antenatal care that integrates health assessment, education, and support through group-based meetings and facilitated discussions. This setting may be more conducive to patient education than traditional prenatal care. A survey was designed in attempt to assess and establish a baseline of our obstetric patient population’s level of knowledge regarding pregnancy. Methods: A questionnaire was developed to collect patient demographic information and assess basic knowledge. The knowledge-based questions were designed based on patient education materials available from ACOG and a consensus of providers from our department. The questions focused on modifiable maternal risks factors found to have the highest correlation to infant mortality in Tarrant County. Questions assessing knowledge utilized a Likert scale response. Patients self-reported whether they received traditional, Centering Pregnancy, or no prenatal care. Univariate statistical analysis was performed on the demographic information. For analysis of the knowledge-based questions, a score was given based on the sum of items correctly responded. Results: From July to August 2014, 150 surveys were completed by patients on their first postpartum day. 6.5% reported they did not receive any prenatal care and the remaining respondents received care from a physician, nurse practitioner, or midwife. 24% of those who received prenatal care attended Centering Pregnancy. 44% reported they learned most of their pregnancy information from family and friends versus 36% from a clinical provider. 45% were high school graduates. For the knowledge based questions, 46.9% of the respondents answered 80% of the questions correctly. The average score for the entire sample was 72.9% correct. Respondents who received traditional care had a score of 73.5% correct versus Centering Pregnancy with 70% correct. Respondents scored higher on questions regarding health and social behavior questions such as diabetes, hypertension, smoking, and drug use, compared to questions pertaining to the postpartum period or self-perception. Conclusions: Information concluded from the study allows providers to better understand our current patient population’s basic knowledge of pregnancy. There appears to be a better recognition of health and social risks factors affecting pregnancy such as smoking, drug use, diabetes, and hypertension. Deficits in knowledge, such as aspects regarding the postpartum period, were better identified, which will allow providers to tailor their antepartum and postpartum patient education. Providers do need to recognize that patients heavily rely on family members for pregnancy information. Though the patients who received Centering Pregnancy received a slightly overall lower knowledge score, as the sample size of patients who received Centering Pregnancy was small, a direct correlation cannot be drawn. The average knowledge score of 72.9% correct offers a baseline standard on to which we can assess for improvements in patient education in future studies. In improving basic patient knowledge and affecting modifiable risk factors, providers can potentially impact the infant mortality rate.
An Evaluation of Prenatal Behaviors in a Rural Texas Community
(2015-03) John, Jennifer; Chiapa-Scifres, Ana
Purpose: Appropriate prenatal care for mothers is an important part of maternal health and should be a public health concern. Mothers need to be adequately educated on appropriate health practices during their pre-conception, prenatal, and post-conception time periods. This study was aimed to assess the behaviors of reproductive age women in a rural community concerning their prenatal care and to see if age and education level played a role in their behaviors. Methods: 46 women completed a survey that was given out at the Perryton Health Center in Perryton, Texas. The study was given to women of reproductive age 18-45 who were pregnant at the time or had been pregnant. The survey asked about their most recent pregnancy and the behaviors associated: how early they sought prenatal care, tobacco use, folic acid supplementation, and flu vaccination. Results: 41% of the respondents were 18-25 years old; in that age group, the average time of their first prenatal visit was 6.94 weeks, 15.8% were smoking while pregnant, 52.6% got their flu shot, and 63.2% took prenatal vitamins every day. 44% were 26-35 year olds; the average time of their first visit was 6.59 weeks, 5% were still smoking, 55% got their flu shot, and 70% took prenatal vitamins every day. 15% were aged 36-45; the average time of their first visit was 6.28 weeks, 14.3% were still smoking, 71.4% got their flu shot, and 42.9% were taking their prenatal vitamins every day. Conclusions: It is important to educate women on safe behavior during the prenatal period. This data shows that younger moms seek prenatal care later and are less likely to get the flu shot. But when it came to smoking and taking prenatal vitamins, both the youngest and oldest age groups had poor behaviors. This information can help healthcare providers know what to focus on in their patient encounters and what the patients should be asked about and educated on.

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