ABSTRACT
OBJECTIVE: NT-proBNP, a marker of ventricular dysfunction, varies by BMI outside of pregnancy. This study aimed to determine whether obesity affects NT-proBNP levels in pregnancy. STUDY DESIGN: This was a prospective observational study of healthy pregnant people in the 3rd trimester and postpartum (PP). Subjects were excluded if they had significant medical comorbidities or if their fetuses had anomalies, growth restriction or aneuploidy. NT-proBNP was measured at 28 weeks (3TM), prior to delivery (PD), 1-2 days PP (IPP), and 4-6 weeks PP (DPP). LogNT-proBNP levels were analyzed using linear mixed effects models, including BMI < or ≥30, time, and time-by-BMI interactions. RESULTS: Fifty-five people (28 [51%] with BMI ≥ 30 and 27 [49%] with BMI < 30) were enrolled. A greater proportion of obese than non-obese subjects developed hypertensive disorders of pregnancy (50% vs 15%, p=0.010) and obese subjects had higher systolic blood pressures at all time points (p<0.05). NT-proBNP levels (median [IQR] in pg/mL) were 18 (6-28) vs 26 (17-48) at 3TM, 16 (3-38) vs 43 (21-60) at PD, 58 (20-102) vs 63 (38-155) at IPP, and 33 (27-56) vs 23 (8-42) at DPP for obese compared to non-obese subjects. In linear mixed effects models, logNT-proBNP was lower in obese subjects at 3TM (ß=-0.89 [95% confidence interval -1.51, -0.26]) and PD (ß=-1.05 [95% CI -1.72, -0.38]). The logNT-proBNP trends over time differed by BMI category, with higher values in obese subjects at both postpartum time points compared to the 3TM (IPP ß=1.24 [95% CI 0.75, 1.73]); DPP ß=1.08 [95% CI 0.52, 1.63]), but only IPP for non-obese subjects (ß=0.87 [95% CI 0.36, 1.38]). CONCLUSIONS: Obese subjects had lower NT-proBNP levels than non-obese subjects during pregnancy, but not postpartum. The prolonged postpartum elevation in NT-proBNP in obese subjects suggests that their postpartum cardiac recovery may be more prolonged.
ABSTRACT
BACKGROUND: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students' access to on-campus health resources, including reproductive health services. OBJECTIVE: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. METHODS: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants' sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. RESULTS: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). CONCLUSIONS: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic.