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Open Access Publications from the University of California

Scholarly Works (15 results)

  • Article
  • Peer Reviewed
UC Davis Previously Published Works (2014)
    Cover page: Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization: in reply
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2023)
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2018)
      INTRODUCTION:: Depression is a common perinatal occurrence, yet research regarding how early depression can be identified and whether it differs by pregnancy outcome (delivery/abortion) is limited. METHODS:: English- or Spanish-speaking women, aged 15–44, <24 weeks gestation seeking pregnancy testing or abortion care were enrolled in a prospective cohort study from 2014 to 2015. The Edinburgh Depression Scale (EDS) assessed depression at enrollment and 3 months later. Participants with positive depression screen (EDS ≥13) received mental health referral. Pregnancy outcomes were assessed via phone interviews and medical chart review. Women with miscarriage were excluded from this analysis. RESULTS:: Among 100 participants with complete EDS data, women averaged 26.8 (±6.3) years and 9.3 (±4.6) weeks gestation. Seventy-nine percent presented for walk-in pregnancy testing; 21% for abortion. Participants were culturally diverse: 48.0% Hispanic, 30.6% Black, non-Hispanic, 14.3% White, non-Hispanic and 7.1% multiracial. Most (66%) continued pregnancy, 44% chose abortion. At enrollment, 21% screened positive for depression, and women choosing delivery (17%) were not statistically different from women choosing abortion (29%) (P=.138). At 3-month follow-up, 18% screened positive for depression; no difference was observed between women choosing delivery (14%) compared to abortion (27%) (P=.114). The overall proportion of women with a positive screen for depression remained stable from enrollment to 3-month follow-up (P=.549), and remained stable among women choosing delivery (P=.727) and abortion (P=>.999). CONCLUSION:: Antenatal depression is common amongst women early in pregnancy, whether choosing delivery or abortion. Early screening may provide opportunities for early interventions. Future research should test early interventions.
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2017)

        Objective

        To contribute to decision analysis by estimating utility, defined as an individual's valuation of specific health states, for different pregnancy contexts.

        Study design

        Cross-sectional analysis of data from pregnant women recruited at pregnancy testing clinics during June 2014-June 2015. Utility was measured using the visual analog scale (VAS), PROMIS GSF-derived utility, standard gamble (SG), and time-trade-off (TTO) approaches. Six dimensions of pregnancy context were assessed including: intention, desirability, planning, timing, wantedness, and happiness. Multivariable regression modeling was used to examine the associations between pregnancy context and utility while controlling for women's sociodemographic and health characteristics.

        Results

        Among 123 participants with diverse characteristics, aged 27±6 years, with mean gestation of 7.5±3 weeks, few reported optimal pregnancy contexts. Mean utility of the pregnancy state varied across contexts, whether measured with VAS (0.28-0.91), PROMIS GSF-derived utility (0.66-0.75), SG (0.985-1.00) or TTO (0.9990-0.99999). The VAS-derived mean utility score for unintended pregnancy was 0.68 (95% CI 0.59, 0.77). Multivariable regression analysis demonstrated significant disutility of unintended pregnancy, as well as all other unfavorable pregnancy contexts, when measured by VAS. In contrast, PROMIS GSF-derived utility only detected a significant reduction in utility among ambivalent compared to wanted pregnancy, while SG and TTO did not show meaningful differences in utility across pregnancy contexts.

        Conclusions

        Unintended pregnancy is associated with significant patient-reported disutility, as is pregnancy occurring in other unfavorable contexts. VAS-based measurements provide the most nuanced measures of the utility for pregnancy in varying contexts.

        Implications

        Decision analyses, including assessments of the cost-effectiveness of pregnancy related interventions, should incorporate measures of the utility of pregnancy in various contexts.
          Cover page: Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2017)

          Objective

          The objective was to quantify the association of pregnancy context and health-related quality of life (HRQoL).

          Study design

          English- or Spanish-speaking women, aged 16-44, with pregnancies <24 weeks' gestation were enrolled in this cross-sectional study between June 2014 and June 2015. Participants completed self-assessments of pregnancy "context," including timing, intention, wantedness, desirability, happiness, and planning (measured with the London Measure of Unplanned Pregnancy). HRQoL was measured using the Patient Reported Outcomes Measurement Information System Global Short Form. Associations between measures of pregnancy context and HRQoL scores in the lowest tertile were examined using multivariable logistic regression to adjust for potential confounding variables.

          Results

          We enrolled 161 participants (mean age=27.2±6.6 years). Only 14% self-identified as White, non-Hispanic; 42% Hispanic; 37% Black, non-Hispanic; and 7% multiracial. Most (79%) participants were unmarried, and 75% were parenting. Mean gestational age was 9±4.6 weeks. In unadjusted models, women reporting mixed feelings about wanting to have a baby, an undesired pregnancy or feeling unhappy about learning of their pregnancy more frequently had low mental and physical HRQoL compared to women reporting wanted, desired, happy pregnancies. Women with an unplanned pregnancy or pregnancy occurring at the wrong time also had lower physical HRQoL than women reporting pregnancies that were planned or happened at the right time. However, after multivariate adjustment, including history of depression, pregnancy contexts were not associated with low mental or physical HRQoL.

          Conclusions

          After adjusting for multiple confounders, pregnancy context is not significantly associated with HRQoL.

          Implications

          The focus on pregnancy intention in public health programs may not sufficiently assess multidimensional aspects of pregnancy context and may not align with patient-centered outcomes such as HRQoL.
            Cover page: Pregnancy context and women’s health-related quality of life
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2015)
              Cover page: Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2011)

              To estimate the probability of successful sterilization after an hysteroscopic or laparoscopic sterilization procedure.

              An evidence-based clinical decision analysis using a Markov model was performed to estimate the probability of a successful sterilization procedure using laparoscopic sterilization, hysteroscopic sterilization in the operating room, and hysteroscopic sterilization in the office. Procedure and follow-up testing probabilities for the model were estimated from published sources.

              In the base case analysis, the proportion of women having a successful sterilization procedure on the first attempt is 99% for laparoscopic sterilization, 88% for hysteroscopic sterilization in the operating room, and 87% for hysteroscopic sterilization in the office. The probability of having a successful sterilization procedure within 1 year is 99% with laparoscopic sterilization, 95% for hysteroscopic sterilization in the operating room, and 94% for hysteroscopic sterilization in the office. These estimates for hysteroscopic success include approximately 6% of women who attempt hysteroscopically but are ultimately sterilized laparoscopically. Approximately 5% of women who have a failed hysteroscopic attempt decline further sterilization attempts.

              Women choosing laparoscopic sterilization are more likely than those choosing hysteroscopic sterilization to have a successful sterilization procedure within 1 year. However, the risk of failed sterilization and subsequent pregnancy must be considered when choosing a method of sterilization.

                Cover page: Reliability of laparoscopic compared with hysteroscopic sterilization at 1 year: a decision analysis.
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2018)
                Health-related quality of life (HRQoL) is an important patient-reported outcome, yet research regarding HRQoL during pregnancy is limited. We examined HRQoL during pregnancy using the Patient Reported Outcomes Measurement Information System (PROMIS) Global Short Form (GSF) and validated the GSF compared to legacy HRQoL measures. We evaluated HRQoL among 161 women seeking pregnancy care in urban clinic settings. Participants completed measures of HRQoL, social support, antenatal depression, and utility. Descriptive statistics and correlation coefficients were calculated. Participants averaged 27(±6.6) years and were culturally diverse: 42% self-identified as Hispanic, 37% Black, non-Hispanic, 14% White, non-Hispanic and 7% multiracial or other. Mean estimated gestational age was 9 (±4.6) weeks. PROMIS GSF Physical T-scores were significantly correlated with SF-12 Physical Component Score (PCS) and Mental Component Score (MCS) HRQoL measures (correlation coefficient=0.40 and 0.49, p-value<0.0001, respectively), the Modified Kendler Social Support Index (MKSSI) (correlation coefficient=0.42, p-value<0.0001), and the Visual Analog Scale (VAS) measure of utility (correlation coefficient=0.19, p-value =0.04). GSF Mental T-scores were associated with SF-12 MCS and PCS (correlation coefficient=0.66, p-value<0.0001, and 0.26, p-value<0.01, respectively), MKSSI (correlation coefficient=0.50, p-value<0.0001), and VAS (correlation coefficient=0.29, p-value<0.01). GSF Physical and Mental scores were inversely associated with the Edinburgh Postpartum Depression Scale (EPDS), correlation coefficient= −0.62 and − 0.71, respectively (p-value<0.0001). GSF-derived utility measures demonstrate significant correlation with SF-12 PCS and MCS, MKSSI, EPDS, and VAS. Overall, PROMIS GSF domains demonstrate correlation with legacy HRQoL measures as well as validated measures of social support, depression, and utility among a diverse cohort of pregnant women.
                  • Article
                  • Peer Reviewed
                  UC Davis Previously Published Works (2016)
                    Cover page: Hysteroscopic Essure Inserts for Permanent&nbsp;Contraception: Extended Follow-Up Results of a Phase III Multicenter&nbsp;International Study
                    • Article
                    • Peer Reviewed
                    UC Davis Previously Published Works (2014)

                    To compare the expected probability of pregnancy after hysteroscopic versus laparoscopic sterilization based on available data using decision analysis.

                    We developed an evidence-based Markov model to estimate the probability of pregnancy over 10 years after three different female sterilization procedures: hysteroscopic, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation. Parameter estimates for procedure success, probability of completing follow-up testing and risk of pregnancy after different sterilization procedures were obtained from published sources.

                    In the base case analysis at all points in time after the sterilization procedure, the initial and cumulative risk of pregnancy after sterilization is higher in women opting for hysteroscopic than either laparoscopic band or bipolar sterilization. The expected pregnancy rates per 1000 women at 1 year are 57, 7 and 3 for hysteroscopic sterilization, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation, respectively. At 10 years, the cumulative pregnancy rates per 1000 women are 96, 24 and 30, respectively. Sensitivity analyses suggest that the three procedures would have an equivalent pregnancy risk of approximately 80 per 1000 women at 10 years if the probability of successful laparoscopic (band or bipolar) sterilization drops below 90% and successful coil placement on first hysteroscopic attempt increases to 98% or if the probability of undergoing a hysterosalpingogram increases to 100%.

                    Based on available data, the expected population risk of pregnancy is higher after hysteroscopic than laparoscopic sterilization. Consistent with existing contraceptive classification, future characterization of hysteroscopic sterilization should distinguish "perfect" and "typical" use failure rates.

                    Pregnancy probability at 1 year and over 10 years is expected to be higher in women having hysteroscopic as compared to laparoscopic sterilization.

                      Cover page: Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization.
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