Adverse Maternal Outcomes Among People With Human Immunodeficiency Virus (HIV) Using Antiretroviral Therapy in Botswana.

Objective: This study aimed to evaluate maternal outcomes in a large cohort with high prevalence of human immunodeficiency virus (HIV) infection in Botswana after implementation of a treat-all policy.

Methods: In this retrospective cohort study, data were collected from the medical record at the time of discharge from November 2021 to December 2023. Outcomes were recorded in the Tsepamo Birth Outcomes Surveillance and Safe Birth studies at Princess Marina Hospital in Botswana.

General Versus Local Anesthesia in Loop Electrosurgical Excision Procedures: A Systematic Review and Meta-Analysis.

Objective: Loop electrosurgical excision (LEEP) is the standard of care for high-grade cervical intraepithelial neoplasia. The primary aim of this study was to compare patient-reported outcomes among patients who received local anesthesia (LA) during LEEP with those who received GA.

Materials And Methods: PubMed, Embase, and Cochrane databases were searched for studies comparing GA with LA in LEEP.

Associations of personal care product use during pregnancy and the postpartum period with markers of postpartum glycemic control - Results from the ERGO Study.

Background: Personal care products frequently contain endocrine disrupting chemicals (EDCs) including parabens and phthalates, which can alter glucose metabolism. The postpartum period is a time of rapid metabolic change, but whether EDC-associated product use impacts postpartum glucose metabolism is unknown.

Methods: We included 270 participants from the Boston, MA-based Environmental Reproductive and Glucose Outcomes (ERGO) pregnancy cohort with data on self-reported personal care product use at ≤4 pregnancy visits (median: 11, 19, 26, 36 weeks of gestation) and 1 postpartum visit (median: 9 weeks).

Improved cervical screening using HPV type restriction and cycle threshold limit setting with the AmpFire assay: A prospective screening cohort of women with and without HIV in Botswana.

Objective: The aim of this study was to evaluate the performance of HPV type restriction and cycle threshold (Ct)-limit setting to optimize detection of cervical intraepithelial neoplasia (CIN) with primary HPV testing.

Methods: Baseline cervical screening at time of entry into a prospective longitudinal cohort of women with and without HIV was conducted from February 2021 to July 2022 in Botswana. All women underwent HPV testing of 15 individual types using the AmpFire assay; all HPV-positive and a random subset of HPV negative had histopathology collected.

A Randomized Controlled Trial of Instillation Protocols Prior to Intradetrusor OnabotulinumtoxinA.

Introduction And Hypothesis: Achieving adequate pain relief is crucial for intradetrusor onabotulinumtoxinA treatments for idiopathic overactive bladder in office settings. The objective of this study was to determine whether buffered lidocaine bladder instillation provides better pain control than standard lidocaine prior to intradetrusor onabotulinumtoxinA injections.

Methods: We conducted a prospective, double-blind, randomized controlled trial comparing two protocols.

Out-of-pocket expenses and hospital write-offs are associated with patient reported financial toxicity.

Purpose: Financial toxicity is an adverse outcome of cancer care and is often quantified by patient-reported validated survey tools, such as The Comprehensive Score for Financial Toxicity (COST). We aimed to examine the association of objective financial measures of hospital out-of-pocket (OOP) expenses and write-offs with the patient derived COST scores in patients with gynecologic cancer.

Methods: We identified individuals who completed our cross-sectional survey in discrete periods between 2017 and 2021.

A Spanish-Language Patient-Reported Outcome Measure for Trust in Pregnancy Care Clinician.

Importance: Despite the importance of patient trust in health care, there are no patient-reported outcome measures (PROMs) for trust in their clinician that have been developed empirically in Spanish, which is the second most common language in the US.

Objective: To develop and validate a Spanish-language PROM for trust in pregnancy care clinician.

Design, Setting, And Participants: This cross-sectional study used a national online panel of patients who reported a Spanish language preference and had limited English proficiency and were currently pregnant or had given birth within the 12 months before the survey.

Smoking's Impact on 30-Day Complications in Mesh and Nonmesh Prolapse Surgery.

Importance: Tobacco smoking is linked to poor surgical outcomes, leading many physicians to avoid synthetic implants like mesh in smokers due to concerns about impaired healing. While long-term outcomes for smokers have been studied, the effect of smoking on 30-day postoperative complications, especially related to surgical mesh, is less understood.

Objectives: This study aimed to quantify the association between tobacco smoking and risk of postoperative infection, readmission, and reoperation within 30 days of minimally invasive apical prolapse repair.

Cervical dysplasia in women with HIV in the modern treat-all era: elevated risk remains despite long-term ART and normal CD4 + cell count.

Objective: To evaluate the impact of antiretroviral therapy (ART) duration and CD4 + cell count on risk for high grade cervical dysplasia in women with HIV (WWH) compared to women without HIV in the treat-all era with integrase strand inhibitors (INSTIs).

Design: A prospective longitudinal cohort study in Botswana.

Methods: From February 2021 to July 2022, baseline HPV self-sampling was offered to women with and without HIV.

A novel approach for inferring effects on pregnancy loss.

Identifying the determinants of pregnancy loss is a critical public health concern. However, pregnancy loss is often not noticed, and even when it is, it is inconsistently recorded. Thus, past studies have been limited to medically-identified losses or small, highly selected cohorts, which can lead to biased or non-generalizable results.

Anemia Near Delivery Is Prevalent, Pernicious, and Associated With Lower Neighbourhood Income: An Analysis of Over 50 000 Pregnancies.

Objectives: Anemia in pregnancy has negative impacts on maternal and neonatal morbidity and mortality and has been described as an issue of health equity. The primary aim of our study was to describe the rates of anemia near delivery and assess whether this correlates with neighbourhood-level income status.

Methods: We conducted a retrospective cohort study of pregnant persons delivering from January 2012 through December 2022 at 2 large academic centres.

Determinants of utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate.

Objective: To examine the association between sociodemographic factors and utilization of infertility services by race and ethnicity in a state with a comprehensive infertility mandate.

Design: Retrospective cohort.

Exposure: Initial infertility evaluation and treatment utilization.

Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity.

Importance: Limited access to healthy foods, resulting from residence in neighborhoods with low food access, is a public health concern. The contribution of this exposure in early life to child obesity remains uncertain.

Objective: To examine associations of neighborhood food access during pregnancy or early childhood with child body mass index (BMI) and obesity risk.

Prenatal Care Clinician Preferences Among Patients With Spanish-Preferred Language.

Objective: To measure what patients with Spanish language preference and limited English proficiency value most when selecting a prenatal care clinician.

Methods: A discrete choice experiment was administered at two large academic medical centers in Boston, Massachusetts. Participants were identified by electronic medical record, had preferred Spanish language and self-identified limited English proficiency, and either were pregnant with a completed fetal anatomy scan or had given birth within the past 12 months at the time of the study.

Implementation of a financial navigation program in gynecologic oncology.

Background: "Financial Toxicity" (FT) is the financial burden imposed on patients due to disease and its treatment. Approximately 50% of gynecologic oncology patients experience FT. This study describes the implementation and outcomes of a novel financial navigation program (FNP) in gynecologic oncology.

Using Parametric g-Computation for Time-to-Event Data and Distributed Lag Models to Identify Critical Exposure Windows for Preterm Birth: An Illustrative Example Using in a Retrospective Birth Cohort Based in Eastern Massachusetts (2011-2016).

Background: Parametric g-computation is an attractive analytic framework to study the health effects of air pollution. Yet, the ability to explore biologically relevant exposure windows within this framework is underdeveloped.

Objectives: We outline a novel framework for how to incorporate complex lag-responses using distributed lag models (DLMs) into parametric g-computation analyses for survival data.

A Randomized Controlled Trial of Consent for Patients Undergoing Transobturator Slings.

Importance: Improving patients' recall and understanding of their planned surgery is essential for fully informed consent.

Objective: The objective of this study was to assess if the addition of an information handout to the standard preoperative consent process for the transobturator midurethral sling procedure improved patient understanding, recall, and satisfaction.

Study Design: This is a randomized controlled trial of adult women undergoing a transobturator midurethral sling procedure for the treatment of stress urinary incontinence.

Polybrominated diphenyl ethers and gestational weight gain: a multi-center prospective cohort study.

Objective: To evaluate the associations of plasma polybrominated diphenyl ether (PBDE) concentrations in early pregnancy with gestational weight gain (GWG).

Design: Prospective cohort study.

Setting: US-based, multicentre cohort of pregnant women.

Cohort profile: the Environmental Reproductive and Glucose Outcomes (ERGO) Study (Boston, Massachusetts, USA) - a prospective pregnancy cohort study of the impacts of environmental exposures on parental cardiometabolic health.

Purpose: Pregnancy and the postpartum period are increasingly recognised as sensitive windows for cardiometabolic disease risk. Growing evidence suggests environmental exposures, including endocrine-disrupting chemicals (EDCs), are associated with an increased risk of pregnancy complications that are associated with long-term cardiometabolic risk. However, the impact of perinatal EDC exposure on subsequent cardiometabolic risk post-pregnancy is less understood.

Cerclage Plus Adjuvant Vaginal Progesterone for Preterm Birth Prevention in Patients with a Short or Dilated Cervix without Prior Preterm Birth.

Objective:  The primary objective was to determine if vaginal progesterone following cerclage for cervical length <10 mm or cervical dilation in patients without a history of spontaneous preterm birth (sPTB) decreased the risk of preterm birth at <34 weeks' gestation compared with cerclage alone. Secondary objectives were to determine if vaginal progesterone following cerclage (1) decreased the risk of preterm birth at <24, <28, and <37 weeks' gestation and (2) increased the latency period from cerclage placement to delivery compared with treatment with cerclage alone.

Study Design:  Multicenter retrospective cohort study from 2015 to 2020 of singleton pregnancies, without prior sPTB, who had cerclage placement <24 weeks' gestation for cervical length <10 mm or cervical dilation.