ABSTRACT
Objective: To evaluate whether receiving a COVID-19 vaccine or infection with COVID-19 had an impact on the length of menstrual cycles in women of reproductive age. Material(s) and Method(s): Cross-sectional, nationwide study of reproductive age females users of the menstrual tracker app Glow. All participants were aged 18-55 and lived in the United States. From 3/3/22 to 4/7/22, participants who had at least 6 months of continuous app use prior to and after April 2021 (defined as logging of menstrual cycle data) were invited to participate in a short questionnaire asking about vaccine status, COVID infection status, and symptoms around the time of vaccination and/or infection. This study was approved by the University of California IRB. Result(s): Out of 218,977 eligible individuals, 11,591 completed the study. 10,922 (representing 269,278 cycles) were included. Some patients were excluded due to not having 6 cycles of data before or after the vaccine or infection and for reporting hormonal birth control use. 75% received two doses of the vaccine (60% Pfizer-BioNTech, 34% Moderna, and 7% J&J), 5% received one dose (63% Pfizer-BioNTech, 37% Moderna, and 1% J&J), and 20% were unvaccinated. There was no change in menstrual cycle length after one or two doses of the vaccine (-0.01 day, 95% CI -0.05 to 0.03 and -0.01 days, 95% CI -0.06 to 0.03, respectively), as was the case in unvaccinated patients (0.05 days, 95% CI -0.02 to 0.12). While participants who reported a COVID infection were noted to have a shorter first cycle after infection (-0.07 days, 95% CI -0.11 to -0.02), this difference was not clinically significant. There were no differences in months 2-6 after infection, or in average cycle length in the 6 months after infection. Of note, whether a patient was symptomatic or asymptomatic with vaccination or infection did not meaningfully impact the menstrual cycle length. Conclusion(s): The COVID-19 vaccine and COVID-19 infection do not result in meaningful menstrual cycle changes compared to unvaccinated or uninfected individuals, respectively. Impact Statement: This is the largest study to date to describe that the COVID-19 vaccine and COVID-19 infection do not appear to result in menstrual cycle changes and adds to the body of literature supporting the safety of the COVID-19 vaccine. Support: No financial support. Copyright © 2022
ABSTRACT
OBJECTIVE: To describe the prevalence of anxiety symptoms in early pregnancy and identify predictors of early pregnancy anxiety during the COVID-19 pandemic. MATERIALS AND METHODS: We assessed baseline moderate-to-severe anxiety symptoms after enrollment into the UCSF ASPIRE (Assessing the Safety of Pregnancy in the Coronavirus Pandemic) Prospective Cohort from May 2020 through February 2021. Pregnant persons <10 weeks' gestation completed questions regarding sociodemographic characteristics, obstetric/ medical history, and pandemic-related experiences. Chi-square and multivariate hierarchical logistic regression analyses determined predictors of moderate or severe anxiety symptoms (GAD-7 R10). All analyses performed with Statistical Analysis Software (SAS®) version 9.4. RESULTS: 4,303 persons completed the GAD-7 questionnaire. The mean age of this nationwide sample was 33 years and 25.7% of participants received care through a fertility clinic. 12.6% of pregnant persons reported moderate-to-severe anxiety symptoms. On univariate analysis, less than a college education (p<0.0001), pre-existing history of anxiety (p<0.0001), and history of prior miscarriage (p=0.0143) were predictors of moderate-to-severe anxiety symptoms;care at a fertility center was protective (26.6% vs 25.7%, p= 0.0009). COVID-19 related stressors were strongly predictive of anxiety in pregnancy (p<0.0001). Race/ ethnicity and a prior history of live birth were not predictors of moderate- to-severe anxiety. In the hierarchical logistic regression model, pre-existing history of anxiety remained associated with anxiety during pregnancy. While education was no longer significant, there was a trend towards this being predictive. Hierarchical Logistic regression predicting moderate to severe anxiety symptoms CONCLUSIONS: Pre-existing history of anxiety and low maternal educational attainment likely exacerbated the contribution of stressors due to the COVID-19 pandemic on early pregnancy anxiety. IMPACT STATEMENT: Socioeconomic disparities may exacerbate the contribution of pandemic-related stressors to early pregnancy anxiety risk. With limitations in prenatal care administration during the pandemic, continued emotional health support should remain an important focus for providers.
ABSTRACT
OBJECTIVE: To evaluate whether a shiftto virtual care during the COVID-19 pandemic negatively impacted patient satisfaction among REI patients. MATERIALS AND METHODS: A modified version of a validated multiple-choice survey assessing satisfaction with care was sent to current patients who agreed to participate in research at a tertiary medical center. The survey evaluated satisfaction with multiple aspects of care. Respondents were categorized by visit type: in-person only (n=23), virtual-only (n=12), and a mix of both settings (n=52). Responses were dichotomized into “Agree” or “Disagree”, with neutral grouped with “agree”. Chi-squared tests of independence to assess differences between groups were conducted in R (Version 3.4.4). P<0.05 was interpreted as statistically significant. The study was approved by the University of California San Francisco Institutional Review Board. RESULTS: Out of 1282 patients who received an invitation to participate, 526 patients (41.0%) completed our survey. Eighty-seven of these were seen by the Division of REI and included in this study. Median participant age was 36.5 (range: 21-76). There were no significant differences in respondents' satisfaction with the type of care received (in-person vs. virtual vs. mixed, p=0.43). There were no statistically significant differences in respondents' ability to develop a relationship with their provider (p=0.25), provider's friendliness (p=0.50), skills or knowledge (p=0.71), and concern (p=0.80) as rated by respondents. The frequency of visits starting on time (p=0.50), convenience of the visit date and time (p=0.78), and the amount of time spent with the provider (p=0.89) were also similar across all three groups. Although 56% of respondents who had mixed care reported that virtual visits may have compromised their health, this was not shown in either the virtual-only or in-person only groups, introducing the possibility of a confounder. Sixty-eight percent of respondents seen virtually were likely to recommend virtual visits to others. When asked about preferences for primary visit type after the COVID-19 pandemic, at least 50% of participants in all groups preferred in-person visits, with a minority choosing virtual visits (22%), alternating between virtual and in-person (16%), or expressing no preference (5%). CONCLUSIONS: A shift to virtual care during the COVID-19 pandemic did not appear to impact patient satisfaction with the care received as patients were highly satisfied regardless of the setting in which they received care. A majority of patients seen virtually were likely to recommend virtual visits to others. Nonetheless, a plurality of patients in all three groups preferred their primary visit type to be in-person. IMPACT STATEMENT: This study shows no significant differences in patient satisfaction regardless of visit type. Further research is needed to understand how to optimize virtual care delivery after the COVID-19 pandemic.